Galiano, Robert D.

Background: Inappropriate facial scarring can lead to significant physical and psychosocial morbidity. There is a need to better understand how scar perception varies across ethnic groups, and how it impacts broader quality-of-life domains such as career and sexual well-being. This study evaluates White and Asian patients’ perceptions of facial scars related to symptoms, appearance, psychosocial health, and career/sexual well-being. Methods: Facial surgery patients from 5 providers were recruited to complete the SCAR-Q and Career/Sexual Well-Being (CS) scales through phone or email. Higher scores on both assessments indicate more positive patient perceptions. Results: Among the 147 respondents, 50.3% were Asian and 49.7% were White. Procedures included blepharoplasty (n=56), rhinoplasty (n=20), eyelid revision (n=19), facelift (n=18), Mohs surgery (n=7), chin augmentation (n=6), craniotomy (n=6), and other facial procedures (n=16). White patients scored significantly higher than Asian patients on the SCAR-Q total (median=260 versus 234), appearance (76 versus 59), psychosocial (100 versus 87), and CS (16 versus 12.5) scales ( P =0.004, P <0.001, P =0.026, and P <0.001, respectively). Symptom scores positively correlated with time since surgery in both groups (Asian: r =0.326, P =0.004; White: r =0.319, P =0.011). Conclusions: Asian patients reported more negative perceptions of scar appearance, symptoms, psychosocial impact, and career/sexual well-being than White patients. These findings underscore the importance of tailored follow-up care and counseling to address ethnic differences in scar perception and quality-of-life outcomes.

Background: Skin cancer patients who undergo Mohs surgery may require subsequent reconstructive rhinoplasty for large nasal defects. Autologous cartilage is the primary source of supporting cartilage grafts, but carries the risk of potential donor-site complications. In this study, we demonstrate the safety and efficacy of nonterminally irradiated fresh frozen human costal cartilage allografts (CCAs) in reconstructive rhinoplasty after skin cancer removal. Methods: A retrospective chart review of 25 patients who underwent reconstructive rhinoplasties using human CCA after basal cell carcinoma resection was conducted. Human CCA undergoes a process of sterilization without terminal irradiation and is stored frozen (−40°C to −80°C). Anthropometric measurements were taken on pre- and postoperative photographs to evaluate nasal tip projection. Adverse events were evaluated. Results: There were 25 participants, with an average age of 71 years at the time of surgery (range: 42–90). The average follow-up duration was 12 months (range: 3–66 mo). Types of grafts used included alar batten graft (n = 17, 68%), nasal tip graft (n = 7, 28%), and alar batten graft with nasal tip graft (n = 1, 4%). Measurements on the 2-dimensional photographs of the patients showed no significant resorption or deviation at the 6- or 12-month follow-up. No significant complications related to the use of the cartilage were noted. Conclusions: Our data highlight the low complication rate and aesthetically positive outcomes from using nonterminally irradiated human CCA for reconstructive rhinoplasties in post-Mohs surgery for older patients. This approach offers a reliable source of high-quality cartilage for reconstruction.

Abstract This historical narrative presents a comprehensive historical journey delving into the diverse facets of gender identity and expression across ancient cultures. It explores these civilizations' perspectives on gender diversity, highlighting instances that challenged conventional gender norms. Transitioning to the modern era, the narrative examines the dynamic landscape of LGBTQ+ and trans movements, spotlighting influential figures whose advocacy has significantly influenced societal perceptions and advanced the rights of gender diverse individuals. Their contributions continue to shape contemporary affirming care practices. Exploring the emergence of gender-affirming surgery, the narrative highlights pioneering surgeons and original techniques employed in these transformative procedures. It shows the courage and innovation of early surgeons who laid the groundwork for contemporary practices. At the core of this historical narrative lies the pivotal role of plastic surgeons in gender-affirming care. It emphasizes the significance of a collaborative multidisciplinary approach among medical professionals to ensure comprehensive and patient-centered care for transgender individuals seeking affirming interventions. However, intertwined with this narrative are legislative barriers that have hindered progress in gender-affirming care. The narrative navigates these obstacles, highlighting their complexities and emphasizing the urgent need for sustained medical advocacy and legislative reforms to foster an inclusive healthcare landscape. Ultimately, this narrative stands as a testament to the ongoing struggle and resilience within the realm of gender-affirming care, shedding light on its profound impact on individuals' lives, emphasizing the ongoing need for compassionate, comprehensive, and inclusive healthcare practices.

Background: There are different types of grafts for rhinoplasty, each with certain advantages and disadvantages. Fresh frozen cadaveric costal allograft (CCA) provides an alternative to rhinoplasties. The aim of this study was to compare the outcomes of fresh frozen CCA and traditional autologous costal cartilage in cosmetic and reconstructive rhinoplasty procedures. Methods: This is a prospective, single-center, nonrandomized, open-label clinical trial. Objective assessment to evaluate warping, resorption, and displacement of the cartilage was achieved by measuring the differences of standardized values (deviation angle, nasofrontal angle, total facial convexity, nasofacial angle, and nasolabial angle) obtained at 6-months and 12-months postoperative follow-up on standard two-dimensional photographs (Δ = ∣measurement6 − measurement12∣). Subjective assessment was measured by the FACE-Q assessment. Results: Fifty eligible patients between March 2017 and October 2020 were included. The average age was 43.9 ± 16.6 years and the mean follow-up period was 14.8 months. In the control group, the changes (Δ) in the deviation angle and nasolabial angle were greater than in the CCA group (P < 0.05). In the CCA group, the mean score of satisfaction with nose improved at 6 months and 1 year postoperatively (P < 0.05). The mean score of satisfaction with nostrils and overall facial appearance also increased in the CCA group at 6 months postoperatively (P < 0.05). Six patients from the CCA group and 10 patients from the control group experienced postoperative complications. Conclusions: Fresh frozen CCA is a safe and reliable source of rhinoplasty grafts. It is aseptic, readily available, and free of donor site complications.

Abstract Across scar studies, there is a lack of dark‐skinned individuals, who have a predisposition for keloid formation, altered pigmentation and poorer quality of life (QOL). There is a need for patients of colour to be included in scar scale development and validation. In this study, we evaluate the racial diversity of patients included in the validation of scar assessment scales. A systematic review was conducted for articles reporting on the validation of a scar assessment tool. Racial, ethnic and Fitzpatrick skin type (FST) data were extracted. Fifteen scar scale validation studies were included. Nine of the studies did not mention FST, race or ethnicity of the patients. Two of the studies that reported FST or race information only included White patients or included no FST V/VI patients: mapping assessment of scars (MAPS) and University of North Carolina ‘4P’. Only four studies included non‐White patients or dark‐skinned patients in the validation of their scar scale: the modified Vancouver Scar Scale (VSS), modified Patient and Observer Scar Assessment Scale (POSAS), acne QOL and SCAR‐Q scales. The patients included in the modified VSS validation were 7% and 13% FST V/VI, 14% African in the modified POSAS and 4.5% FST V/VI in the SCAR‐Q. We highlight the severe lack of diversity in scar scale validation, with only 4 out of 15 studies including dark‐skinned patients. Given the susceptibility of darker‐skinned individuals to have poorer scarring outcomes, it is critical to include patients of colour in the very assessment tools that determine their scar prognosis. Inclusion of patients of colour in scar scale development will improve scar assessment and clinical decision‐making.

Summary: Asian rhinoplasty generally requires augmentation procedures rather than reduction. Alloplastic grafts are fraught with higher complication rates. Autologous cartilage grafts are safer. However, Asian patients typically do not have adequate septal cartilages, and other autologous cartilage grafts may cause surgical site morbidities, prolonged surgical time, and complications, including warping and infection. Asian rhinoplasties were performed using fresh frozen cartilage by the senior author. Patients’ demographics and medical histories were recorded. Anthropometric measurements (nasofrontal angle, nasofacial angle, nasolabial angle, and Goode ratio) were taken on two-dimensional photographs. FACE-Q scales were used to assess patient-reported outcomes. Five Asian patients underwent rhinoplasty using the fresh frozen cartilage and were followed up for an average period of 14.2 ± 3.35 months. There was no resorption, warping, or infection. Anthropometric measurements showed no significant changes 2–4 months or 8–20 months after surgery. At the time of the 1-year follow-up, mean FACE-Q Satisfaction with Nose, and Satisfaction with Nostrils scores improved from 35.2 ± 10.06 to 60 ± 15.48 (P = 0.0002), and 42.6 ± 20.31 to 59.8 ± 38.21 (P = 0.12), respectively. Fresh frozen cadaveric cartilage is a novel option for Asian rhinoplasty. Our study demonstrated its safety and satisfying surgical outcomes.