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In This Issue of JAMA Facial Plastic Surgery |

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JAMA Facial Plast Surg. 2014;16(4):233. doi:10.1001/jamafacial.2014.634.
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Kristin K. Constantine, MD, and colleagues compare outcomes from Medpor vs rib graft microtia repair in a review of 35 patients. Patient medical charts were reviewed, and blinded observers graded photographs. Patients who underwent repairs with Medpor scored significantly better in terms of ear definition and size match, while those treated with rib graft were scored significantly better in color match. Those treated with rib graft had better protrusion and location (not statistically significant). The mean number of operations was 4.88 for the rib graft group vs 3.35 for the Medpor group (P < .004). Two patients in the Medpor group had postoperative infections and implant extrusion, which required later reconstruction with rib grafts. One patient in the rib graft group developed minor cartilage exposure. Neither technique was shown to be clearly superior in this study.

Anthony Bared, MD, and colleagues perform a prospective study using 3-dimensional imaging to analyze prerhinoplasty and postrhinoplasty nasal tip volume changes. The authors evaluate 31 patients with bulbous nasal tips who underwent lower lateral cartilage repositioning. The mean total nasal tip volume change was a decrease of 0.0503 mL. The volume change showed an overall trend of decreasing throughout the follow-up duration. The authors found that lower lateral cartilage repositioning leads to a significant increase in the angle of the lower lateral cartilage, resulting in a more caudal orientation. Although not statistically significant, the overall decrease in volume is thought to be clinically meaningful when paired with favorable positioning of the lower lateral cartilages.

Peter F. Svider, MD, and colleagues retrospectively analyze malpractice litigation related to laser procedures in the head and neck. The authors reviewed legal databases and determined that most cases (82%) included female plaintiffs, and of 34 cases, 19 (56%) were resolved with a defendant verdict. The median compensation was $150 000, and dermatologists, otolaryngologists, and plastic surgeons were the most commonly named defendants. Seventy-four percent of the cases involved cutaneous procedures, and the most common procedures were performed for age-related changes, acne scarring, hair removal, and vascular lesions. The most common allegations noted included permanent injury (71%), disfigurement/scarring (68%), inadequate informed consent (50%), unnecessary/inappropriate procedure (44%), and burns (32%). Physicians and patients should undergo comprehensive discussions regarding informed consent, expectations, and contingencies should adverse events occur.


Gerald J. Harris, MD, presents a review on the repair of orbital floor fractures. The article discusses timing of repairs along with a stepwise description of surgical approaches accompanied by intraoperative photographs. The author examines the different implant options and discusses considerations when repairing fractures that extend past the orbital floor. The complications of orbital floor fractures are described along with techniques to prevent them.




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