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Background: The shape, contour and overall appearance of the human face is based on the integrity of its overlying skin as well as the underlying components of bone, cartilage, and soft/support tissues (dermis with elastin and collagen fibers). The close association between these components result in the three-dimensional contour that distinguishes one person from another. When repairing congenital and traumatic deformities the surgeon must make appropriate modifications to the structural (bone and cartilage) and/or soft tissue anatomy.

Unfortunately, the initial result may be unpredictable because of contour distortion caused by intraoperative and postoperative swelling as well as ongoing scaring beneath the skin during the healing process. The use of 3-D imaging offers both the surgeon and the patient a tool for assessing changes that occur from the pre-operative evaluation through the long-term post-operative result. There are multiple publications supporting the validity of 3D imaging in analyzing the nose and face in plastic surgery.

Objectives: The purpose of this project is to evaluate pre and post-operative 3-dimensional images of subjects who have undergone a variety of surgical procedures of the nose/face by the study PI. The review of the photographs, based on the procedures performed, will help to frame an objective criteria of what can quantitatively be expected following a specific surgical procedure. The information will allow the physician the ability to more accurately describe, share and predict outcomes for and to future patients

Background: The tissue that lines the inside of the nose is called the mucosa. In some individuals the mucosa lining the nose can change due to a number of reasons including heredity, hormonal imbalance, nutritional deficiency, infection, as well as others. The mucosa may decrease in size and consistency (atrophy) resulting in breathing difficulties as well as other quality of life issues. This condition is known as atrophic rhinitis and it affects less than 0.5% of individuals in the United States. Current treatment options include nasal irrigation, antibiotics, vitamin therapy, nasal sprays, surgery, as well as other medical treatments. Previous literature describes the regenerative properties of microfat grafting. The purpose of the study is to evaluate the use of microfat grafting for the treatment and revitalization of the nasal mucosa in patients with atrophic rhinitis.

Objectives: The purpose of the study is to evaluate the use of a novel microfat/tissue graft for the treatment and revitalization of the nasal mucosa in patients with atrophic rhinitis. The hypothesis of this research is that microfat infused soft tissue augmentation of the inferior turbinates will 1) revitalize nasal mucosa in patients with atrophic rhinitis, 2) improve subjective nasal congestion, 3) decrease nasal dryness, 4) increase nasal humidity, 5) decrease pain, and 6) improve quality of life for the patient.

Background: There is significant scientific interest in auto-transplanted/injected fat for its volumizing properties as well as its regenerative/wound healing capabilities. Micro-preparations of fat have been postulated to provide a rejuvenating effect on damaged soft tissues. The mechanism for this action is currently unknown, but it is hypothesized that a population of adult stem cells contained in these preparations promotes neo-adipogenesis in the recipient site.

In appropriate cases the study PI uses a novel fat/tissue graft to manage damaged tissues that require a tissue filler. The PI has found that this approach eliminates the need for repeated fat injections, is more effective in achieving the desired cosmetic results, and may aid in promoting wound/tissue healing in the affected area. To further evaluate the use/viability of these grafts, the fat/grafts are implanted and subsequently harvested at various time points for histological analysis.

Objectives: The aims of the study are to, 1) evaluate the stability and viability of a soft tissue/fat chimeric graft, when placed in a subcutaneous pocket, over 1, 3 and 6 months and, 2) evaluate the degree of neoadipogenesis of the graft following harvest.

Background: Bruising and swelling of the nose and face following rhinoplasty surgery are inevitable. However, the amount and severity of each can be quite variable depending on 1) the procedure performed and 2) the surgeon performing the surgery. Currently, there are no reliable, objective standards for measuring bruising and facial edema following rhinoplasty surgery.

The ability to effectively measure and evaluate post-surgical bruising and swelling after rhinoplasty surgery may yield benefits to both surgeons and patients. An improved appreciation of post-operative tissue response 1) may allow surgeons to better evaluate and share post-operative expectations with patients, and 2) may provide surgeons insight on how best to improve methods/approaches for specific surgical procedures yielding less tissue damage, decreased swelling and bruising, and ultimately a more rapid recovery.

For the purposes of this study, standard of care 3-dimensional photographs will be used to quantify bruising and edema following surgery using an Adobe Photoshop program. The L*a*b* color space Adobe Photoshop program is a three-dimensional system that allows quantification of luminosity, red/green and blue/yellow color hues.

Objectives: The primary aims of the study are to: 1) test a quantitative system of measurement to evaluate bruising and swelling following rhinoplasty surgery, and 2) create a standard measurement and documentation system that can be used by rhinoplasty surgeons to measure bruising and swelling after rhinoplasty surgery. The standardized method of evaluation will enable surgeons to evaluate their results over time, share expectations with patients, as well as compare their results with surgeons performing similar procedures.

Background: Pre-surgical photographic facial imaging is a commonly used tool by facial reconstructive surgeons. The unique computer software imaging program allows preoperative photographs to be modified or "morphed" based on the type of procedure being performed. Ideally, the imaging program will provide both the patient and the surgeon a realistic photographic image of the expected long term post-operative result, prior to undergoing the surgery. Photographic imaging also aids the surgeon in pre-operative analysis and planning for the surgical procedure.

It has been shown that patient satisfaction with cosmetic rhinoplasty following computer imaging was significantly improved compared to patients who did not undergo pre-operative imaging. The literature regarding the use of photographic imaging as a reliable predictor of post-operative results in rhinoplasty outcomes remains limited. Additionally there is currently no objective standard in place for measuring the pre-operative goals and expectations of rhinoplasty procedures with actual results.

Objectives: The purpose of this study is to assess the accuracy of pre-operative computer imaging of rhinoplasty patients compared to actual post-operative results, from both the patient's and surgeon's perspective over a five year period of time. The findings from the study will be used to establish an objective standard for measuring surgical results following rhinoplasty surgery

Background: The lateral cartilages along the sides of the nose are structurally important in holding the nostrils of the nose open for breathing. Failure or collapse of the lateral cartilages along the nasal wall impedes air intake and makes breathing through the nose extremely difficult. Patients who suffer from nasal valve collapse often seek surgical repair for their malady through rhinoplasty.

Nasal valve collapse is a common problem and is currently evaluated preoperatively using a few different methods including a NOSE questionnaire, the cottle maneuver, and the modified cottle maneuver. Previous research with these methods have shown some correlation between pre-operative use of these evaluation methods and post-operative results. This study examines a new preoperative method used to evaluate nasal valve collapse, the Nasal Clip.

Objectives: The purpose of this study is to evaluate a new pre-operative method for evaluating nasal collapse. The Nasal Clip, designed by the study PI, will be evaluated pre-operatively along with the NOSE questionnaire and the modified cottle maneuver. Using the NOSE questionnaire, the results of the pre-operative evaluations will be compared with post-operative results to determine which method of evaluation offers the most consistent and reliable post-operative prediction.

Background: The principal investigator currently places patients undergoing primary rhinoplasty surgery on oral antibiotics postoperatively for infection prevention. Patients undergoing secondary or revision rhinoplasty are also placed on oral antibiotics postoperatively. In addition, the revision patients are instructed to place antibiotic soaks in their nose, following a specific schedule, after surgery

Some studies have suggested that intraoperative antibiotics alone are sufficient to prevent wound infections following rhinoplasty surgery and recommend against the use of postoperative antibiotics. Currently there is no consensus in terms of standard of care among facial plastic surgeons as to the use of postoperative oral antibiotics for infection prevention of primary rhinoplasty patients.

To date, there have been no studies that have evaluated the use of intranasal antibiotic soaks following primary rhinoplasty surgery. This study seeks to determine whether the use of post-surgical antibiotic nasal soaks are more, less or as effective as postoperative oral antibiotics in controlling postoperative infection following primary rhinoplasty.

Objectives: This is both a retrospective and prospective study. The purpose of this study is to evaluate the efficacy of using Ciprofloxacin antibiotic intranasal soaks postoperatively for primary rhinoplasty infection prevention in place of oral antibiotics. The infection rates of patients who previously received oral antibiotics postoperatively will be compared with patients treated with nasal antibiotic soaks postoperatively. If effective, nasal soaks may eliminate the need for, and the side effects associated with, oral antibiotics while providing local coverage against bacteria that may cause infection

Background: The rhinoplasty databank is a compilation of surgical and photographic data gathered during the past decades of the PI’s medical practice.

Objectives: The information entered in the databank will be used to quantitatively and qualitatively evaluate the functional and cosmetic resutls of patients who have undergone a primary or secondary rhinoplasty procedure by the PI. The information will be evaluated based on the surgeons choice of intervenition for each specific surgical case. The data will be used to create an objective measure of assessment that can be used to 1) determine the optimum techniques and types and size of grafts to be used for specific procedures, and 2) to help predict the long term patient result based on objective patient data.

Background: There is significant scientific interest in auto-transplanted/injected fat for its volumizing properties as well as its regenerative capabilities. The mechanism for this action is currently unknown, but it is hypothesized that a population of adult stem cells contained in these preparations promotes neo-adipogenesis in the recipient site. Fat injection directly into dermal tissues is commonly performed in reconstructive procedures to fill minor skin defect sites.

However, in order to maintain an acceptable result several repeat injections are required over time. Fat, temporalis fascia, and biopoymer materials are frequently employed for reconstructive purposes. In this study we propose to investigate a novel fat transfer technique in which a micro-preparation of harvested human fat is injected directly into both a soft tissue substrate (temporalis fascia) and 3 different biopolymer matrices and then implanted into a subcutaneous tissue pocket of an immunodeficient mouse.

Objectives: The aims of the study are to; 1) evaluate the use, stability, and long term survival/viability of a fat/graft when placed in a living model, 2) determine which of 3 novel biopolymer materials function best as a carrier for the microfat, 3) determine which biopolymer yields the best results in terms of fat survivability, 4) determine the rate of graft integration/degradation over time, 5) determine the degree of neoadipogenesis at the graft area and the surrounding recipient site.