To evaluate the effect of social media, TV shows, plastic surgeons' self-advertisement, and before-and-after cosmetic surgery photos of patients who actually visited the clinic to seek a consultation or intervention. This is a cross-sectional study; institutional review board approval was granted in 2018. This study was conducted among patients attending cosmetic clinics at King Abdulaziz University Hospital in Riyadh, Saudi Arabia. The questionnaire is composed of socio-demographic data and about the reason for the trending of plastic surgeries. Three hundred and ninety-nine patients participated in the study. Of all participants, 60.4% agreed on the impact of the surgeon’s self-advertisement in the trending of plastic surgeries; 53.4% said yes to cosmetic television programs having an effect on the trend of plastic surgeries; 65.7% of the participants answered yes to before-and-after pictures of social media having an effect on the trend of cosmetic procedures; and 54.1% of the participants answered yes to wanting to look better in selfies as a reason for the rise of cosmetic surgery. The results of this study have shown that the majority of patients visiting plastic surgery clinics were positively affected, but not exclusively, by media coverage of cosmetic surgery results.

Augmentation rhinoplasty depends mainly on intact stable bony and cartilaginous parts. Many trials have used different materials as a graft to perform the operation and support the nose. Debate exists whether alloplastic or autogenic grafts are more appropriate. Common available alloplastic grafts include silicone, medpor, and gore-tex. Autogenic grafts are usually derived from costal cartilages. Warping, infection, and hypertrophic scars are the main complications of the procedure. Yet no subgroup analysis has been performed to investigate the effect of different risk factors. To investigate the effect of different types of grafts and the association of the income level of the country on surgery complications. A comprehensive literature search of articles was conducted in PubMed, Cochrane Library, Web of Science, and SCOPUS databases through October 2019. We included articles that used autologous or alloplastic grafts in nasal dorsum reconstruction surgery. We performed subgroup analysis according to the type of graft used, region, and income level of the country. A meta-regression analysis model was carried out from the period of 1999–2018, to study the incidence of these complications over time. The overall complication rate was 7.1%, which was higher in the alloplastic group (7.8%) than the autogenic group (6.9%). The most common complications were secondary surgery for re-correction (4.1%), infection (2.1%), warping (1.6%), and hypertrophic scars (1.6%). All outcomes were homogeneous (I² < 50%). Patients with autogenic grafts are less liable to develop complications than their peers reconstructed with alloplastic grafts. Moreover, Asian patients are less susceptible to overall rhinoplasty complications. Attention should be noted for low-income countries in which surgical complications are more prone to occur.

Background: Primary rhinoplasty outcomes may not meet individual expectations. Consequently, reoperation may be advocated to improve results. This study examines the prevalence of individuals considering revision rhinoplasty, while identifying the main cosmetic and functional complaints and factors associated. Methodology: This is a cross-sectional study conducted in Saudi Arabia using a self-reported online questionnaire distributed through social media channels. The sample included 1370 participants who were all Saudi nationals over the age of 16 who had undergone primary rhinoplasty at least 1 year prior. Results: The prevalence of individuals considering revision rhinoplasty was 44.7%. The primary reason for considering it was the desire for further esthetic improvement in an already acceptable result (50.16%). The most common cosmetic complaints subjectively reported were poorly defined nasal tip (32.35%). The most prevalent nasal function symptom was nasal obstruction (56.9%). Significant factors associated with considering revision rhinoplasty included the physician not understanding the patient’s complaints, short consultation time, low monthly income, inadequate information about the expected results, not using computer imaging to predict outcomes, lack of rapport with the surgeon, and inadequate information about the risks and complications. Conclusions: A thorough understanding of patient concerns and expectations, as well as thoughtful consideration of risk factors, may help surgeons achieve more successful outcomes and potentially reduce the incidence of revision rhinoplasties. Level of evidence: III

The size, shape, and symmetry of the nose contribute significantly to the facial aesthetic, so it is understandable why rhinoplasty is one of the most popular cosmetic procedures undertaken nowadays. Several factors are associated with the rates of both success and postoperative complications of rhinoplasty. To determine the relationship between nasal skin thickness and postoperative periorbital ecchymosis and edema among patients who underwent rhinoplasty at King Abdulaziz University Hospital. A prospective study was conducted among all patients operated on for rhinoplasty at King Abdulaziz University Hospital in the Department of Otolaryngology, Riyadh, Saudi Arabia, between May and December 2018. To determine the relationship between nasal skin thickness and postoperative periorbital edema and ecchymosis, demographic data (gender, age), mean nasal skin thickness, surgical factors (time of surgery, extent of intraoperative bleeding), and scoring for periorbital ecchymosis and edema were obtained. The statistical analysis was done by comparing means and frequency using analysis of variance. A total of 54 patients participated in this study with ages ranging from 19 to 33 years and a mean age of 24.43. According to this study, postoperative edema presentation on the first, third, and seventh days upon examination was higher among patients with thicker nasal skin (6 mm), and results are statistically significant (P = .001). Ecchymosis was also higher among patients with thicker nasal skin (6 mm) on day 1 examinations, but there was no correlation with nasal thickness during the other examinations. Therefore, there is some degree of correlation between ecchymosis and nasal skin thickness overall, but the results are not significant (P = .26). This study concludes that the severity of edema and ecchymosis correlates with nasal skin thickness. The degree of edema and ecchymosis was higher during the initial postoperative examinations, but following that, it was reduced and completely diminished by the 21st day post-surgery.

Objective: The purpose of this study is to evaluate our experience with endoscopic repair of ossicular discontinuity at the incudostapedial joint, with or without an intact stapes suprastructure, and present our hearing results. We classify results based on the causative pathology, the type of ossiculoplasty, and type of lesion. We demonstrate the ability to endoscopically place a total ossicular replacement prosthesis (TORP), measuring 4.25 mm, between the stapes footplate and the incus remnant to reestablish ossicular continuity. Methods: This was a retrospective case series conducted in tertiary referral center (Hopital de la Timone) Marseille, France. 25 patients underwent incudostapedial rebridging ossiculoplasty between 2009 and 2013. Fifteen cases of chronic otitis media and 10 otosclerosis revisions were included in the study. Three different materials were used in ossiculoplasty, hydroxyapatite cement, incus remnant, and partial/total ossicular replacement prostheses. Audiometric results were evaluated before and after ossiculoplasty. Twelve month follow-up data is provided. Results: The mean postoperative air-bone gap was 15 dB (5–25 dB). Hearing results were better inotosclerosis revisions. Hydroxyapatite cement produced an air-bone gap of 5 dB, TORP placed under the incus produced a 12 dB gap, and TORP placed under the malleus resulted in a 12 dB gap and one deaf ear. In cases of chronic otitis media, the residual air-bone gap was 17 dB with PORP, 12 dB with TORP, and 20 dB with incus transposition. Conclusion: The hydroxyapatite cement is effective in the reconstruction of ossicular discontinuity but the high price limits its utilization. TORP placed under the incus is a reliable and stable method of ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.

Rhytidectomy poses a significant risk of bleeding. Several studies have reported the safety profile and efficacy of tranexamic acid (TXA), an antifibrinolytic agent, in minimizing perioperative sequelae, particularly hematoma and bleeding. The aim of this systematic review was to analyze the effect of TXA administration in facelift surgery, its effect with different routes of administration, and to compare different administration routes in reducing intraoperative blood loss, postoperative edema, and ecchymosis in rhytidectomy. A systematic literature search was conducted to identify studies that reported on TXA in facelift surgery. The primary outcomes of interest were intraoperative blood loss, time to achieve hemostasis, operation duration, and postoperative hematoma, edema, ecchymosis, drain output, and major and minor complications. Meta-analyses of hematoma, operation duration, drain output, and major and minor complications were performed, and the risk of bias was assessed with ROBINS-I for nonrandomized studies, and Cochrane's RoB 2.0, a tool for randomized controlled trials. In total, 104 articles were included in the initial screening. Out of 388 participants 170 patients were administered TXA, predominantly female (over 91%), with ages from the late 50s to mid-60s. TXA administration varied, with subcutaneous injection being the most common method. The meta-analysis revealed that the pooled prevalence of minor and major hematoma in TXA recipients was remarkably low, with a significant reduction in the risk of minor hematoma (odds ratio [OR] = 0.18, 95% CI 0.05-0.62, P < .001) and no significant difference in major hematoma risk. Interestingly, TXA significantly reduced postoperative drainage compared to the controls (mean difference = −25.59, 95% CI, −30.4-−20.77, P < .01). Additionally, neither minor nor major complications were significantly different between the TXA recipients and controls. Specifically, the pooled odds for the incidence of major complications were not significantly different (OR = 1.47, 95% CI, 0.23-9.19, P = .68), and similar results were found for minor complications (OR = 0.59, 95% CI, 0.23-1.48, P = .26). TXA significantly reduces postoperative drain output and minor hematomas in facelift surgery without increasing major complications. It also reduces edema, ecchymosis, and intraoperative blood loss. However, further studies are required to explore the efficacy of TXA with different dosages and administration routes.