In reply We reviewed the Letter by Michael and Kwok, which pointed out 2 major concerns: (1) the reason for the low incidence of pneumothorax and (2) neglect of pain as one of the complication.
Although “considered surgical technique” could dramatically lower the incidence of pneumothorax, we do not think it prevents the complication completely. We recently experienced 2 cases of pneumothorax; however, we have encountered no complications through hundreds of rib cartilage harvesting until recently. Pneumothorax developed after we confirmed there was no air leakage with active Valsalva maneuver in the operating room. The possibilities we considered were either a spontaneous rupture of bleb or bulla or incomplete detection of the surgical leak. The incidence of pneumothorax can be lowered dramatically with careful dissection; however, taking into account our experience and statistical analysis, we concluded that none of the cases of pneumothorax reported were due to a publication bias.
Wee JH, Park M, Jin H. Post–Rib Harvesting Pain Should be Considered as a Potential Significant Morbidity in Reconstructive Rhinoplasty—Reply. JAMA Facial Plast Surg. 2015;17(3):226. doi:10.1001/jamafacial.2015.1