Chronic rhinosinusitis (CRS) is increasingly recognized as a heterogeneous condition characterized by distinct inflammatory endotypes. In Western populations, CRS is mostly type 2 (T2) eosinophilic. In contrast, Asian cohorts show higher rates of non-T2 endotypes, posing unique challenges and limiting the applicability of Western treatment models. This expert commentary and scoping review explores endotype-driven care in CRS, synthesizes current research on Asian CRS cohorts, and examines existing gaps in our understanding, particularly in non-T2 CRS. Endotype-driven care improves treatment precision and minimizes therapeutic failure. However, most models remain largely Western-centric. Establishing Asia-specific criteria, accessible diagnostics, and therapies for non-T2 disease is essential.

Body dysmorphic disorder (BDD) is a condition to be assessed preoperatively prior to cosmetic rhinoplasty, as it may influence patient outcomes and satisfaction. The prevalence of BDD in Asians is not well-studied, and the literature consists predominantly of smaller case series. This systematic review and meta-analysis estimated BDD prevalence in Asian rhinoplasty candidates and examined the impact of diagnostic methods and regional factors. Following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, five databases were searched up to March 2025. Two reviewers independently screened studies. Meta-analysis using a random-effects model was conducted; study quality and publication bias were assessed. Fifteen studies (n = 1,977) were included. The pooled BDD prevalence was 30.0% (95% CI: 26.8–35.7), with higher rates using the Body Dysmorphic Disorder Questionnaire (36%) versus DSM-V criteria (18%). Substantial heterogeneity was observed and addressed. BDD may affect nearly one in three Asian rhinoplasty candidates, underscoring the need for standardized diagnostic protocols and culturally sensitive preoperative assessment to improve patient outcomes and safety.

Auricular keloids, particularly in the upper third of the ear, often recur after treatment and can cause aesthetic and functional deformities. This study assesses the effectiveness of stellate excision in reducing recurrence and improving cosmetic outcomes. Stellate excisions evolved from 19th-century wedge excisions, refined by 1960s otoplasty techniques to preserve ear shape and prevent deformities. Traditional skin flap techniques frequently show high recurrence rates and can compromise auricular contour, leading to unsatisfactory results. The ear, and specifically the upper third, is a challenging site for keloids due to its characteristic anatomy and susceptibility to mechanical stress during healing. Stellate excision allows for precise resection of keloids with back cuts and wedge extension to preserve ear shape and reduce tension. Forty adult patients with upper third keloids were retrospectively studied. All underwent stellate excision and standardized steroid injection follow-up. Complete excision with cartilage wedge resection, local flap closure, and layered suturing was performed under local anesthesia. Triamcinolone injections were administered at 2, 4, and 8 weeks postoperatively; follow-up continued for 24 months. Stellate excision showed a 95% success rate; future studies should assess broader anatomical applicability. Stellate excision is a reliable and cosmetically favorable method for managing upper third ear keloids, with a low recurrence rate.

Structural nasal obstruction is an important modifier of sleep-disordered breathing (SDB), but the specific impact of functional rhinoplasty on validated sleep-related outcomes has not been quantitatively synthesized. To systematically review and meta-analyze studies of adults with SDB undergoing functional rhinoplasty or septorhinoplasty, testing the hypothesis that surgery yields large improvements in nasal obstruction and modest improvements in sleep-related symptoms. PROSPERO-registered systematic review and random-effects meta-analysis conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. PubMed, Embase and Cochrane Library were searched to September 2025 for studies reporting validated symptom scores before and after functional rhinoplasty or septorhinoplasty in adults with SDB. Standardized mean differences (SMDs) with Hartung–Knapp-adjusted confidence intervals were pooled; risk of bias and publication bias were formally assessed. Eight studies (27 cohorts; n = 1,192) met inclusion criteria. Surgery was associated with large improvement in nasal obstruction (Nasal Obstruction Symptom Evaluation SMD: −4.99; 95% CI: −9.12 to −0.85), moderate reductions in daytime sleepiness (Epworth Sleepiness Scale SMD: −1.09; 95% CI: −2.33 to 0.15) and global sleep disturbance (Pittsburgh Sleep Quality Index SMD: −0.74; 95% CI: −1.21 to −0.26), and modest gains in functional status (Functional Outcomes of Sleep Questionnaire-10 SMD: 0.41; 95% CI: 0.16–0.65). Heterogeneity was substantial for most outcomes and small-study effects were detected. Functional rhinoplasty and septorhinoplasty appear to improve nasal obstruction and sleep-related patient-reported outcomes in adults with SDB, supporting their role as adjunctive procedures in selected patients. High heterogeneity and predominantly observational data highlight the need for larger, phenotype-driven studies to refine effect estimates and patient selection (PROSPERO registration number: CRD420251168358).

Thick skin-soft tissue envelope (SSTE) and weak cartilage make nasal tip definition challenging in many Asian rhinoplasty patients. We aimed to assess whether the Princess and the Pea (PP) graft–a solid, conical costal cartilage tip graft–can improve tip projection and definition in thick-SSTE patients. We hypothesized that it would yield reliable aesthetic and functional results with minimal complications. Prospective clinical study with 12-month postoperative follow-up. Sixty patients of East, South, and Southeast Asian descent received a PP graft anchored to the lower lateral cartilages. Outcomes were measured using SCHNOS and a 5-point Likert satisfaction scale. Mean satisfaction was 4.5/5, average SCHNOS score 0.54, and no graft-related complications occurred. The PP graft is a safe and effective method for enhancing nasal tip projection and definition in thick-SSTE patients.