Top

Aesthetic Plastic Surgery

Published in:

01-10-2021 | Rhinoplasty | Original Article

Forehead Contouring as an Adjunct to Rhinoplasty: Evaluation of the Effect on Facial Appearance, Personal Traits and Patient Satisfaction

Author: Oguzhan Demirel

Published in: Aesthetic Plastic Surgery | Issue 5/2021

Abstract

Background

The nose has a great impact on facial beauty and appearance. Therefore rhinoplasty is one of the most performed procedures worldwide. However, considering the varying degrees of cosmetic operations holistic approach to face is essential to achieve more successful results. In order to this, the forehead is noteworthy with its gender-related features and important relation to the nose. The purpose of this study is to assess the effect of forehead contouring with fat grafting adjunct to rhinoplasty on personal traits, facial appearance and patient satisfaction.

Methods

A total of 15 patients who underwent rhinoplasty and forehead contouring with fat grafting were enrolled in this retrospective study. Facial appearance and personal traits were evaluated via subject Global Aesthetic Improvement Scale (S-GAIS), and patient satisfaction was assessed with custom design Forehead Rhinoplasty Outcome Evaluation Questionnaire (F/ROE-Q). Forehead inclination was calculated as an objective indicator of fat graft survival and contour improvement. Pre- and postoperative photographs were taken and used for evaluation.

Results

According to the F/ROE-Q score, mean total preoperative score was 9,13 and the mean total postoperative score was 24,86 (p < 0,01). High postoperative satisfaction scores were observed in all patients. Statistically significant improvement was observed in attractiveness, femininity, youthfulness, facial harmony, forehead contour, facial profile view parameters based on S-GAIS assessment. The mean forehead inclination angle was 19,04^o preoperatively and 16,74° postoperatively.

Conclusion

With the important benefits such as higher patient satisfaction and improvement on facial appearance and personal traits, forehead contouring with fat grafting was an efficient and applicable procedure adjunct to rhinoplasty.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Little AC, Jones BC, DeBruine LM (2011) Facial attractiveness: evolutionary based research. Philos Trans R Soc Lond B Biol Sci 366(1571):1638–1659. https://doi.org/10.1098/rstb.2010.0404CrossRefPubMedPubMedCentral

Todorov A, Olivola CY, Dotsch R, Mende-Siedlecki P (2015) Social attributions from faces: determinants, consequences, accuracy, and functional significance. Annu Rev Psychol 66:519–545. https://doi.org/10.1146/annurev-psych-113011-143831CrossRefPubMed

Liew S, Wu WTL, Chan HH et al (2020) Consensus on changing trends, attitudes, and concepts of Asian beauty. Aesthetic Plast Surg 44(4):1186–1194. https://doi.org/10.1007/s00266-020-01808-wCrossRefPubMed

Internatıonal survey on aesthetıc/cosmetıc procedures performed ın 2019. https://www.isaps.org/wp-content/uploads/2020/12/Global-Survey-2019.pdf. Accessed 3 Jan 2020

Ascha M, Swanson MA, Massie JP, Evans MW, Chambers C, Ginsberg BA, Gatherwright J, Satterwhite T, Morrison SD, Gougoutas AJ (2019) Nonsurgical management of facial masculinization and feminization. Aesthet Surg J 39(5):NP123–NP137. https://doi.org/10.1093/asj/sjy253CrossRefPubMed

Somenek M (2018) Gender-related facial surgical goals. Facial Plast Surg 34(5):474–479. https://doi.org/10.1055/s-0038-1670648CrossRefPubMed

Spiegel JH (2011) Facial determinants of female gender and feminizing forehead cranioplasty. Laryngoscope 121:250–261CrossRef

Przylipiak M, Przylipiak J, Terlikowski R, Lubowicka E, Chrostek L, Przylipiak A (2018) Impact of face proportions on face attractiveness. J Cosmet Dermatol 17(6):954–959. https://doi.org/10.1111/jocd.12783CrossRefPubMed

Park J, Suhk J, Nguyen AH (2015) Nasal analysis and anatomy: anthropometric proportional assessment in asians-aesthetic balance from forehead to chin part II. Semin Plast Surg. 29(4):226–231. https://doi.org/10.1055/s-0035-1564818CrossRefPubMedPubMedCentral

10.

Andretto AC (2007) The central role of the nose in the face and the psyche: review of the nose and the psyche. Aesthet Plast Surg. 31(4):406–410. https://doi.org/10.1007/s00266-006-0241-2CrossRef

11.

Khansa I, Khansa L, Pearson GD (2016) Patient satisfaction after rhinoplasty: a social media analysis. Aesthet Surg J 36(1):1–5. https://doi.org/10.1093/asj/sjv095CrossRef

12.

Van Schijndel O, Tasman AJ, Litschel R (2015) The nose influences visual and personality perception. Facial Plast Surg 31(5):439–445. https://doi.org/10.1055/s-0035-1565009CrossRefPubMed

13.

Nellis JC, Ishii M, Bater KL et al (2018) Association of rhinoplasty with perceived attractiveness, success, and overall health. JAMA Facial Plast Surg 20(2):97–102. https://doi.org/10.1001/jamafacial.2017.1453CrossRefPubMed

14.

Morrison SD, Vyas KS, Motakef S, Gast KM, Chung MT, Rashidi V, Satterwhite T, Kuzon W, Cederna PS (2016) Facial feminization: systematic review of the literature. Plast Reconstr Surg. 137(6):1759–1770. https://doi.org/10.1097/PRS.0000000000002171CrossRefPubMed

15.

Facque AR, Atencio D, Schechter LS (2019) Anatomical basis and surgical techniques employed in facial feminization and masculinization. J Craniofac Surg 30(5):1406–1408. https://doi.org/10.1097/SCS.0000000000005535CrossRefPubMed

16.

Marten T, Elyassnia D (2018) Facial fat grafting: why, where, how, and how much. Aesthetic Plast Surg 42(5):1278–1297. https://doi.org/10.1007/s00266-018-1179-xCrossRefPubMed

17.

Eppley BL (2019) Forehead/brow reduction or augmentation with custom implants for enhanced facial profileplasty. Facial Plast Surg 35(5):430–445. https://doi.org/10.1055/s-0039-1697962CrossRefPubMed

18.

Bae B, Lee G, Oh S, Hong K (2016) Safety and long-term efficacy of forehead contouring with a polycaprolactone-based dermal filler. Dermatol Surg 42(11):1256–1260. https://doi.org/10.1097/DSS.0000000000000913CrossRefPubMed

19.

Alegre-Sánchez A, Bernárdez C (2020) A new nonhydrophilic agarose gel as subdermal filler for facial rejuvenation: aesthetic results and patient satisfaction. J Cosmet Dermatol 19(8):1900–1906. https://doi.org/10.1111/jocd.13529CrossRefPubMed

20.

Park YJ, Cha JH, Han SE (2020) Maximizing thread usage for facial rejuvenation: a preliminary patient study. Aesthet Plast Surg. https://doi.org/10.1007/s00266-020-01919-4CrossRef

21.

Alsarraf R (2000) Outcomes research in facial plastic surgery: a review and new directions. Aesthet Plast Surg 24(3):192–197. https://doi.org/10.1007/s002660010031CrossRef

22.

Andrews WA (2008) AP relationship of the maxillary central incisors to the forehead in adult white females. Angle Orthod 78(4):662–669. https://doi.org/10.2319/0003-3219(2008)078[0662:AROTMC]2.0.CO;2CrossRefPubMed

23.

Romm S (1989) The changing face of beauty. Aesthet Plast Surg 13(2):91–98. https://doi.org/10.1007/BF01571475CrossRef

24.

Harrar H, Myers S, Ghanem AM (2018) Art or science? An evidence-based approach to human facial beauty a quantitative analysis towards an informed clinical aesthetic practice. Aesthet Plast Surg 42(1):137–146. https://doi.org/10.1007/s00266-017-1032-7CrossRef

25.

Arab K, Barasain O, Altaweel A et al (2019) Influence of social media on the decision to undergo a cosmetic procedure. Plast Reconstr Surg Glob Open 7(8):e2333. https://doi.org/10.1097/GOX.0000000000002333CrossRefPubMedPubMedCentral

26.

Zojaji R, Sobhani E, Keshavarzmanesh M, Dehghan P, Meshkat M (2019) The association between facial proportions and patient satisfaction after rhinoplasty: a prospective study. Plast Surg (Oakv). 27(2):167–172. https://doi.org/10.1177/2292550319826097CrossRefPubMedPubMedCentral

27.

Parsa KM, Charipova K, Coerdt K, Clark CM, Wang H, Chu E, Reilly MJ (2020) The role of age and gender on perception of women after cosmetic rhinoplasty. Aesthet Plast Surg. https://doi.org/10.1007/s00266-020-02030-4CrossRef

28.

Nuyen B, Kandathil CK, Saltychev M, Most SP (2019) Social perception of the nasal dorsal contour in male rhinoplasty. JAMA Facial Plast Surg. 21(5):419–425. https://doi.org/10.1001/jamafacial.2019.0321CrossRefPubMedPubMedCentral

29.

Lu SM, Hsu DT, Perry AD et al (2018) The public face of rhinoplasty: impact on perceived attractiveness and personality. Plast Reconstr Surg 142(4):881–887. https://doi.org/10.1097/PRS.0000000000004731CrossRefPubMed

30.

Roxbury C, Ishii M, Godoy A et al (2012) Impact of crooked nose rhinoplasty on observer perceptions of attractiveness. Laryngoscope 122(4):773–778. https://doi.org/10.1002/lary.23191CrossRefPubMed

31.

Khansa I, Khansa L, Pearson GD (2016) Patient satisfaction after rhinoplasty: a social media analysis. Aesthet Surg J. 36(1):NP1-5. https://doi.org/10.1093/asj/sjv095CrossRefPubMed

32.

Li D, Xu H, Xu L, Huang X, Yuan J, Wei M (2015) The aesthetic proportion index of facial contour surgery [published correction appears in J Craniofac Surg 2015 Jul; 26(5):e466]. J Craniofac Surg 26(2):586–589. https://doi.org/10.1097/SCS.0000000000001475CrossRefPubMed

33.

Li X, Kubiak CA, Yang X, Kemp SWP, Cederna PS, Ma J (2019) Forehead fat grafting: Asian facial contouring and augmentation. Plast Reconstr Surg 144(5):1057–1065. https://doi.org/10.1097/PRS.0000000000006122CrossRefPubMed

34.

Chou CK, Lee SS, Lin TY et al (2017) Micro-autologous Fat Transplantation (MAFT) for forehead volumizing and contouring. Aesthetic Plast Surg 41(4):845–855. https://doi.org/10.1007/s00266-017-0883-2CrossRefPubMedPubMedCentral

35.

Kang GC, Hsiao YC, Huang JJ et al (2019) Aesthetic durable forehead contouring in Asians with fat grafting and botulinum toxin. Ann Plast Surg 82(1S Suppl 1):59–65. https://doi.org/10.1097/SAP.0000000000001704CrossRef

36.

Ousterhout DK (1987) Feminization of the forehead: contour changing to improve female aesthetics. Plast Reconstr Surg 79(5):701–713. https://doi.org/10.1097/00006534-198705000-00003CrossRefPubMed

37.

Spiegel JH (2019) Facial feminization for the transgender patient. J Craniofac Surg 30(5):1399–1402. https://doi.org/10.1097/SCS.0000000000005645CrossRefPubMed

38.

Buckingham ED, Glasgold R, Kontis T et al (2015) Volume rejuvenation of the facial upper third. Facial Plast Surg 31(1):43–54. https://doi.org/10.1055/s-0035-1544943CrossRefPubMed

39.

Kornstein AN, Nikfarjam JS (2015) Fat grafting to the forehead/glabella/radix complex and pyriform aperture: aesthetic and anti-aging ımplications. Plast Reconstr Surg Glob Open 3(8):e500. https://doi.org/10.1097/GOX.0000000000000470 (Published 2015 Aug 27)CrossRefPubMedPubMedCentral

40.

Isik S, Sahin I (2012) Contour restoration of the forehead by lipofilling: our experience. Aesthet Plast Surg 36(4):761–766. https://doi.org/10.1007/s00266-011-9800-2CrossRef

41.

Peleman JR, Chung MT, Johnson J et al (2020) Surgical adjuncts to rhinoplasty: an algorithmic approach. Aesthet Plast Surg 44(5):1694–1704. https://doi.org/10.1007/s00266-020-01744-9CrossRef

42.

Guerrero-Apolo JD, Navarro-Pastor JB, Bulbena-Vilarrasa A, Gabarre-Mir J (2018) The slant of the forehead as a craniofacial feature of impulsiveness. Braz J Psychiatry 40(3):270–276. https://doi.org/10.1590/1516-4446-2017-2339CrossRefPubMedPubMedCentral

43.

Farkas LG, Sohm P, Kolar JC, Katic MJ, Munro IR (1985) Inclinations of the facial profile: art versus reality. Plast Reconstr Surg 75(4):509–519. https://doi.org/10.1097/00006534-198504000-00011CrossRefPubMed

44.

Han DS, Park JH (2014) Aesthetic correction of a protrusive forehead through repositioning of the anterior wall of the frontal sinus. Arch Craniofac Surg 15(3):129–132. https://doi.org/10.7181/acfs.2014.15.3.129CrossRefPubMedPubMedCentral

45.

Sözen T, Dizdar D, Göksel A (2020) Awareness of facial asymmetry and its impact on postoperative satisfaction of rhinoplasty patient. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-020-01968-9CrossRefPubMed

46.

Cotofana S, Mian A, Sykes JM et al (2017) An update on the anatomy of the forehead compartments. Plast Reconstr Surg 139(4):864e–872e. https://doi.org/10.1097/PRS.0000000000003174CrossRefPubMed

47.

Cong LY, Phothong W, Lee SH et al (2017) Topographic analysis of the supratrochlear artery and the supraorbital artery: implication for improving the safety of forehead augmentation. Plast Reconstr Surg 139(3):620e–627e. https://doi.org/10.1097/PRS.0000000000003060CrossRefPubMed

Title: Forehead Contouring as an Adjunct to Rhinoplasty: Evaluation of the Effect on Facial Appearance, Personal Traits and Patient Satisfaction
Author: Oguzhan Demirel
Publication date: 01-10-2021
Publisher: Springer US
Keywords: Rhinoplasty
Fat Grafting
Rhinoplasty
Rhinoplasty
Published in: Aesthetic Plastic Surgery / Issue 5/2021
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI: https://doi.org/10.1007/s00266-021-02236-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Forehead Contouring as an Adjunct to Rhinoplasty: Evaluation of the Effect on Facial Appearance, Personal Traits and Patient Satisfaction

Abstract

Background

Methods

Results

Conclusion

Level of Evidence IV

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of Evidence IV

Please log in to get access to this content

Other articles of this Issue 5/2021

Invited Response on: Nanofat Injection for the Treatment of Depressed Facial Scars

Correction to: Gummy Smile: Mercado-Rosso Classification System and Dynamic Restructuring with Hyaluronic Acid

Invited Discussion on: “One Stage Mastopexy-Lipofilling in Cosmetic Breast Surgery: A Prospective Study”

Invited Discussion on: The First Use of Human-Derived ADM in Prepectoral Direct-to-Implant Breast Reconstruction after Skin-Reducing Mastectomy

BDD Knowledge, Attitude and Practice Among Aesthetic Plastic Surgeons Worldwide

Invited Response on: Commentary on “Aesthetic Comparison of Abdominal Donor Site Scar Between Absorbable Dermal Staple and Subcutaneous Suture after Autologous Breast Reconstruction: A Prospective Randomized Controlled, Double-Blinded Study”