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In This Issue of JAMA Facial Plastic Surgery
Sept/Oct 2015


JAMA Facial Plast Surg. 2015;17(5):319. doi:10.1001/jamafacial.2014.954

Walliczek and colleagues sought to measure keloid recurrence rate and changes in quality of life, using the Glasgow Benefit Inventory (GBI) scale after multimodal therapy, which included surgical excision followed by steroid injections and pressure therapy. A total of 33 patients (42 auricle keloids) were treated, with the recurrence rate reported as 8%. Insecure handling of the pressure splint significantly correlated with a higher relapse rate. Improvement in quality of life as measured by GBI after keloid treatment was significant in recurrence-free patients.

Barham and coauthors evaluated the effectiveness of cephalic crural turn-in maneuver and costal cartilage lateral crural strut grafts for correcting external nasal valve dysfunction. Assessment of patient benefit was based on the 22-item Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation scale (NOSE) scores. A Likert scale was also used to assess overall function and cosmesis. Objective assessment included postdecongestion nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. Both techniques were found to be effective in improving patient-reported outcomes and nasal peak inspiratory flow for correction of external valve dysfunction. In the accompanying Invited Commentary, Most frames these findings in the context of the broader issue of the need to unify terminology for lateral nasal wall insufficiency.

Invited Commentary

Chambers and colleagues conducted a prospective observational study to evaluate the change in disease-specific quality of life and to determine whether identifiable anatomical risk factors were more common in patients who underwent nasal valve correction after failed septoplasty. Forty patients were enrolled with Nasal Obstruction Symptom Evaluation (NOSE) scores collected preoperatively and at 2, 4, and more than 6 months after surgery. The most common anatomical cause of obstruction was internal nasal valve narrowing in 38 patients (95%), dorsal septum deflection in 26 (65%), and narrowed middle vault in 16 (40%). Surgical nasal valve correction demonstrated a significant improvement in NOSE scores in patients for whom a previous septoplasty had failed.

Harris and Sundaram conducted a prospective, open-label trial to assess the safety and efficacy of microfocused ultrasonography with visualization for improving laxity of the skin of the face and neck in 52 adults with Fitzpatrick skin types III to VI. There were 3 reported adverse events described as raised areas of mild edema or welts (2 events) and moderately severe prolonged erythema with mild scabbing (1 event). All events resolved after 90 days without sequelae. In the accompanying Invited Commentary, Arosarena discusses the importance of and need for additional clinical trials in patients with darker skin types.

Invited Commentary