Bio

Clinical Focus


  • Reconstruction after mohs surgery
  • Facial Plastic Surgery
  • Mohs Surgery
  • Blepharoplasty
  • Facial nerve paralysis
  • Facelift
  • Rhinoplasty
  • Functional rhinoplasty
  • Eyelid surgery
  • Otolaryngology - Head & Neck Surgery (Ear, Nose and Throat)
  • Otolaryngology
  • Facial reconstructive surgery
  • Facial aesthetic surgery

Academic Appointments


Administrative Appointments


  • Medical Director, Multidisciplinary Cosmetic Surgery Center, University of Washington Medical Center (2004 - 2006)
  • Division Chief, Facial Plastic & Reconstructive Surgery, University of Washington School of Medicine (2002 - 2006)
  • Division Chief, Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine (2006 - Present)
  • Faculty senate, Stanford University School of Medicine (2011 - 2013)

Honors & Awards


  • Clinician Teacher of the Year, Department of Otolaryngology-HNS, University of Washington, Seattle, WA (2003)
  • Ben Shuster Award, American Academy of Facial Plastic & Reconstructive Surgery (2003)

Boards, Advisory Committees, Professional Organizations


  • Editorial Board, JAMA-Facial Plastic Surgery (2007 - Present)
  • Fellow Member, American Academy of Facial Plastic & Reconstructive Surgery (2006 - Present)
  • Fellowship Director, American Academy of Facial Plastic & Reconstructive Surgery (2006 - Present)
  • Board Member, American Academy of Facial Plastic & Reconstructive Surgery (2009 - Present)

Professional Education


  • Fellowship:University of Washington Medical Center (2002) WA
  • Residency:University of Washington Medical Center (2001) WA
  • Board Certification: Otolaryngology, American Board of Otolaryngology (2002)
  • Internship:Yale - New Haven Hospital (1996) CT
  • Medical Education:Stanford University School of Medicine (1995) CA
  • M.D., Stanford University, Medicine (1995)
  • B.S., University of Michigan-Ann Arbor Honors College, Biology (Neuroscience) (1990)

Research & Scholarship

Current Research and Scholarly Interests


Division of Facial Plastic and Reconstructive Surgery-Research Program Summary

Evidence-based medicine in Facial Plastic Surgery
The primary goal of this research program is to develop a higher standard of care for facial plastic surgery patients. The approach to this goal is two-fold. The first involves development of prospective studies that examine the efficacy of new or existing surgical techniques in facial plastic surgery. One clinical problem we have already begun to examine is nasal obstruction. Functional rhinoplasty techniques have been a mainstay of otolaryngology, and facial plastic surgery in particular, for decades. While many have attempted, with mixed success, to examine nasal function using quantitative measures, few prospective studies of quality of life have been performed. To this end, we have begun to examine prospectively various functional rhinoplasty techniques.

The second approach to development of a higher standard of care for our patients is the testing of various over-the-counter ‘cosmeceutical’ products. Generally, products that are touted as effective by industry have little or no clinical evidence to back up said claims. Two of these studies have been completed and have resulted in remarkable response from industry as well as the media. More importantly, these types of studies provide valuable information about product efficacy to physicians and patients alike.

Facial Nerve Recovery after Injury
Facial nerve injury after trauma or extirpative surgery can be devastating to patients. The Division seeks to develop a clinical and basic research program studying facial nerve recovery after such injuries. The basic research program within the Division will use a previously developed animal (mouse) model for facial nerve injury to examine the age-dependence of motor neuron survival in the facial nucleus and its correlation to facial nerve recovery. Furthermore, the role of apoptotic cell death in the facial nerve nucleus will be studied, with the hope that anti-apoptotic processes may aid in facial nerve recovery. The clinical research program will study quality of life issues in facial nerve injury patients.

Teaching

2013-14 Courses


Publications

Journal Articles


  • Transient, afferent input-dependent, postnatal niche for neural progenitor cells in the cochlear nucleus. Proceedings of the National Academy of Sciences of the United States of America Volkenstein, S., Oshima, K., Sinkkonen, S. T., Corrales, C. E., Most, S. P., Chai, R., Jan, T. A., Cheng, A. G., Heller, S. 2013; 110 (35): 14456-14461

    Abstract

    In the cochlear nucleus (CN), the first central relay of the auditory pathway, the survival of neurons during the first weeks after birth depends on afferent innervation from the cochlea. Although input-dependent neuron survival has been extensively studied in the CN, neurogenesis has not been evaluated as a possible mechanism of postnatal plasticity. Here we show that new neurons are born in the CN during the critical period of postnatal plasticity. Coincidently, we found a population of neural progenitor cells that are controlled by a complex interplay of Wnt, Notch, and TGF?/BMP signaling, in which low levels of TGF?/BMP signaling are permissive for progenitor proliferation that is promoted by Wnt and Notch activation. We further show that cells with activated Wnt signaling reside in the CN and that these cells have high propensity for neurosphere formation. Cochlear ablation resulted in diminishment of progenitors and Wnt/?-catenin-active cells, suggesting that the neonatal CN maintains an afferent innervation-dependent population of progenitor cells that display active canonical Wnt signaling.

    View details for DOI 10.1073/pnas.1307376110

    View details for PubMedID 23940359

  • Upper lid blepharoplasty. Facial plastic surgery Weissman, J. D., Most, S. P. 2013; 29 (1): 16-21

    Abstract

    Blepharoplasty is one of the most commonly performed aesthetic procedures in the realm of aging face surgery. Although not prohibitively challenging from a technical perspective, upper blepharoplasty remains a surgical procedure that requires comprehensive knowledge of intricate eyelid anatomy. In addition, the surgeon must pay attention to adjacent areas, notably the brow, which may also need to be addressed to achieve optimal results. These features, along with changes associated with aging and important aspects of the clinical evaluation are reviewed herein. A thorough history and physical exam are required, along with a frank discussion of the patient's expectation and the surgeon's ability to address them. The authors' approach to preoperative marking and surgical procedure are included, along with discussion of variations in technique. Complications that may be seen after upper blepharoplasty are also discussed.

    View details for DOI 10.1055/s-0033-1333833

    View details for PubMedID 23426747

  • Development of a Severity Classification System for Subjective Nasal Obstruction. JAMA facial plastic surgery Lipan, M. J., Most, S. P. 2013

    Abstract

    IMPORTANCE Nasal airway obstruction is a common presenting symptom in otolaryngology and facial plastic surgery practices, and the potential for multiple contributing causes requires extensive evaluation. OBJECTIVE To develop a classification system for nasal obstruction using a subjective, validated quality-of-life instrument. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of patients' responses on the Nasal Obstruction Symptom Evaluation (NOSE) instrument performed from July 2011 through May 2012. All patients were seen at a university-based tertiary medical center. MAIN OUTCOMES AND MEASURES Scores from patients with or without nasal obstruction were used to develop a classification system after receiver operating characteristic curve analysis. The classification subdivides nasal obstruction scores into a range of defined classes. RESULTS Data analysis was performed using results from 345 patients. A score of 30 on the NOSE survey best differentiated patients with and without nasal obstruction. This threshold also provided intervals used to define the other class ranges. Patients were categorized as having mild (range, 5-25), moderate (range, 30-50), severe (range, 55-75), or extreme (range, 80-100) nasal obstruction, depending on responses on the NOSE survey. CONCLUSIONS AND RELEVANCE The NOSE scale is an important tool for gauging symptoms in patients with nasal obstruction. The proposed classification system will improve patient care by providing a framework for the severity of their symptoms and helping them understand potential treatment effects. If the classification is used in future outcomes research, it will allow physicians to better understand the study patient population and the effect of treatment on each severity class. LEVEL OF EVIDENCE NA.

    View details for PubMedID 23846399

  • Cadaveric analysis of nasal valve suspension. Allergy & rhinology (Providence, R.I.) Bae, J. H., Most, S. P. 2012; 3 (2): e91-3

    Abstract

    This study was designed to measure the efficacy of a nasal valve suspension technique and determine the adequate traction length without creation of nasofacial fullness in a cadaveric model. Seven fresh frozen cadaveric heads were evaluated. Minimal cross-sectional (MCA) areas were measured with a transient-signal acoustic rhinometer (Ecco Vision; Hood Instruments, Pembroke, MA) before and after suspension. The adequate traction length, which did not cause obvious changes, was determined. Five millimeters of lateral nasal valve traction was determined to be the maximal traction achievable without creating facial fullness. After lateral nasal suspension, average MCA increased by 13.7%. Average distance to the MCA from the nostril changed from 1.57 to 1.76 cm. Postsuspension values were significantly higher than the presuspension values (p < 0.05). Nasal valve suspension with 5 mm of lateral traction has a significant impact on nasal valve area without obvious nasofacial changes.

    View details for DOI 10.2500/ar.2012.3.0037

    View details for PubMedID 23342294

  • The Double-Half Bilobe Flap: An Alternative for Midline Defects of the Tip and Supratip Region OTOLARYNGOLOGY-HEAD AND NECK SURGERY Woodard, C. R., Most, S. P. 2012; 147 (4): 668-670

    View details for DOI 10.1177/0194599812455313

    View details for Web of Science ID 000314283700012

    View details for PubMedID 23015636

  • Intraoperative Angiography Using Laser-Assisted Indocyanine Green Imaging to Map Perfusion of Forehead Flaps ARCHIVES OF FACIAL PLASTIC SURGERY Woodard, C. R., Most, S. P. 2012; 14 (4): 263-269

    Abstract

    To quantify the perfusion of forehead flaps and compare blood flow from the supratrochlear artery with vascular in-growth at the recipient bed.Patients with nasal defects necessitating forehead flap closure were prospectively enrolled to study flap perfusion dynamics. Laser-assisted indocyanine green angiography was used to obtain the measurements. When possible, patients returned for weekly recording of flap perfusion from the recipient bed with the pedicle clamped. Analysis of the data was performed using SPY-Q software.Six patients were prospectively enrolled. All patients had intraoperative angiography at flap transfer, pedicle division, and at least 1 postoperative visit between these surgical procedures. Flow was measured as a percentage of perfusion of normal surrounding tissue. A higher percentage of perfusion was seen at the distal end of the flap when compared with the pedicle when the pedicle was clamped. This phenomenon was seen as early as the 1-week postoperative visit.This is the first study attempting to quantify forehead flap perfusion from the supratrochlear artery and recipient bed. Data obtained suggest evidence of vascular in-growth 1 week following flap transfer.

    View details for DOI 10.1001/archfacial.2011.1540

    View details for Web of Science ID 000306380400007

    View details for PubMedID 22351848

  • Preservation of the Nasal Valve Area With a Lateral Crural Hinged Flap: A Cadaveric Study AESTHETIC PLASTIC SURGERY Sazgar, A. A., Woodard, C., Most, S. P. 2012; 36 (2): 244-247

    Abstract

    Overresection of the lateral crura of the lower lateral cartilages is referred to as the most common cause of nasal valve collapse after rhinoplasty. The modern approach to functional rhinoplasty recognizes the importance of the tip framework's structural integrity and preserves tip support.Traditional cephalic resections of lateral crura were performed on one side of five adult cadaver noses. On the opposite sides, hinged flaps of lateral crura were created. The noses were cross-sectioned at or near the internal nasal valve level, and the difference between the two sides was described.The study findings demonstrated improvement in the postoperation nasal valve area of the hinged flap side compared with the cephalic trim side.This preliminary study showed that the hinged flap is an option in nasal tip reduction surgery that may provide improved long-term aesthetic and functional outcomes through preservation of the nasal valve area.

    View details for DOI 10.1007/s00266-011-9797-6

    View details for Web of Science ID 000302411700004

    View details for PubMedID 21853403

  • Stabilization of nasal tip support in nasal tip reduction surgery. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Sazgar, A. A., Most, S. P. 2011; 145 (6): 932-934

    View details for DOI 10.1177/0194599811417227

    View details for PubMedID 21817158

  • Nasal Airway Preservation Using the Autospreader Technique Analysis of Outcomes Using a Disease-Specific Quality-of-Life Instrument ARCHIVES OF FACIAL PLASTIC SURGERY Yoo, S., Most, S. P. 2011; 13 (4): 231-233

    Abstract

    To measure the efficacy of a specific midvault reconstruction technique (the autospreader flap) in dorsal reductive rhinoplasty with a validated quality-of-life instrument.A prospective observational outcomes study of patients desiring reduction of the nasal dorsum who either (1) had no breathing obstruction, who underwent purely aesthetic rhinoplasty, or (2) had concomitant severe nasal obstruction due to septal deviation, internal valve narrowing, and/or turbinate hypertrophy, who subsequently underwent combined functional and aesthetic rhinoplasty. Preoperative and postoperative evaluation was performed using the Nasal Obstruction Symptoms Evaluation (NOSE) scale.Thirty-eight patients completed preoperative and postoperative evaluation. No complications occurred. Patients in the purely aesthetic group were noted to have low preoperative NOSE scores, with no change postoperatively. There was a significant improvement in mean NOSE score postoperatively for the combined functional and aesthetic group (P < .001).Midvault reconstruction using the autospreader graft may help prevent postoperative nasal obstruction due to midvault collapse. Combining this procedure with dorsal reduction in functional rhinoplasty patients with traditional airway reconstruction techniques is effective in improving nasal airway function as measured by a patient-based, disease-specific quality-of-life instrument.

    View details for DOI 10.1001/archfacial.2011.7

    View details for Web of Science ID 000292839000001

    View details for PubMedID 21339471

  • Correlation of Asymmetric Facial Growth with Deviated Nasal Septum LARYNGOSCOPE Kim, Y. M., Rha, K., Weissman, J. D., Hwang, P. H., Most, S. P. 2011; 121 (6): 1144-1148

    Abstract

    To evaluate the correlation between growth differences of the face and nasal septal deviation, and to evaluate whether developmental differences of the face have an effect on nontraumatic nasal septal deviation (DNS).Retrospective study.Twenty-five patients with DNS who underwent facial aesthetic surgery and had an ostiomeatal unit-computed tomography (OMU-CT) scan and photos for facial analysis were included in the study. Coronal views of the OMU-CT scan where the nasal septum was most severely deviated were selected and from which five parameters (angle of septal deviation [ASD], angle of nasal floor [ANF], angle of lateral nasal wall [ALW], angle of inferior turbinate [AIT], and width of IT [WIT]) were measured. Preoperative frontal views of the patients were analyzed by comparing the distances between the following points on both sides of the faces: midsagittal plane to Zygion (MSP-Zy), Glabella to Exocanthion (G-Ex), Exocanthion to Cheilion (Ex-Ch), and Zygion to Cheilion (Zy-Ch).The differences between the right and left MSP-Zy, G-Ex, and Ch-Zy distance were significantly associated with the direction of septal deviation. The difference between the right and left AIT and WIT were also significantly associated with the direction of septal deviation. Using bivariate correlation, it was found that the absolute difference between the right and left MSP-Zy, G-Ex, and WIT showed significant correlation with the amount of septal deviation.We demonstrate that there is a strong relationship between deviated nasal septum and facial growth asymmetry.

    View details for DOI 10.1002/lary.21785

    View details for Web of Science ID 000291259900004

    View details for PubMedID 21495046

  • Effects of Corticosteroids on Functional Recovery and Neuron Survival After Facial Nerve Injury in Mice ARCHIVES OF FACIAL PLASTIC SURGERY Lieberman, D. M., Jan, T. A., Ahmad, S. O., Most, S. P. 2011; 13 (2): 117-124

    Abstract

    To assess the effects of corticosteroid administration on functional recovery and cell survival in the facial motor nucleus (FMN) following crush injury in adult and juvenile mice and to evaluate the relationship between functional recovery and facial motoneuron survival.A prospective blinded analysis of functional recovery and cell survival in the FMN after crush injury in juvenile and adult mice was carried out. All mice underwent a unilateral facial nerve crush injury and received 7 doses of daily injections. Adults received normal saline or low-dose or high-dose corticosteroid treatment. Juveniles received either normal saline or low-dose corticosteroid treatment. Whisker function was monitored to assess functional recovery. Stereologic analysis was performed to determine neuron and glial survival in the FMN following recovery.Following facial nerve injury, all adult mice recovered fully, while juvenile mice recovered slower and incompletely. This corresponded to a significantly greater neuron loss in the FMN of juveniles compared with adults. Corticosteroid treatment slowed functional recovery in adult mice. This corresponded with significantly greater neuron loss in the FMN in corticosteroid-treated mice. In juvenile mice, corticosteroid treatment showed a trend, which was significant at several time points, toward a more robust functional recovery compared with controls.Corticosteroid treatment slows functional recovery and impairs neuron survival following facial nerve crush injury in adult mice. The degree of motor neuron survival corresponds with functional status. In juvenile mice, crush injury results in overall poor functional recovery and profound cell loss in the FMN. With low-dose corticosteroid treatment, there is a significantly enhanced functional recovery after injury in these mice (P < .05).

    View details for DOI 10.1001/archfacial.2010.98

    View details for Web of Science ID 000288610600008

    View details for PubMedID 21079107

  • An Introduction to Stem Cell Biology FACIAL PLASTIC SURGERY Hemmat, S., Lieberman, D. M., Most, S. P. 2010; 26 (5): 343-349

    Abstract

    The field of stem cell biology has undergone tremendous expansion over the past two decades. Scientific investigation has continued to expand our understanding of these complex cells at a rapidly increasing rate. This understanding has produced a vast array of potential clinical applications. This article will serve as an overview of the current state of stem cell research as it applies to scientific and medical applications. Included in the discussion is a review of the many different types of stem cells, including but not limited to adult, embryonic, and perinatal stem cells. Also, this article describes somatic cell nuclear transfer, an exciting technology that allows the production of totipotent stem cells from fully differentiated cells, thereby eliminating the use of embryonic sources. This discussion should serve as a review of the field of stem cell biology and provide a foundation for the reader to better understand the interface of stem cell technology and facial plastic and reconstructive surgery.

    View details for DOI 10.1055/s-0030-1265015

    View details for Web of Science ID 000282253500002

    View details for PubMedID 20853224

  • Three-dimensional analysis of zygomatic-maxillary complex fracture patterns. Craniomaxillofacial trauma & reconstruction Pau, C. Y., Barrera, J. E., Kwon, J., Most, S. P. 2010; 3 (3): 167-176

    Abstract

    Zygomatic-maxillary (ZMC) complex fractures are a common consequence of facial trauma. In this retrospective study, we present a novel method of ZMC fracture pattern analysis, utilizing three-dimensional visualization of computed tomography (CT) images to record displacement of the malar eminence in a three-dimensional coordinate plane. The pattern of fracture was then correlated with treatment outcome. Facial CT scans were obtained from 29 patients with unilateral ZMC fractures and 30 subjects without fractures and analyzed. Briefly, displacement of the malar eminence (ME) on the fractured side was measured in medial-lateral (x), superior-inferior (y), and anterior-posterior (z) dimensions, as well as Euclidean distance, by comparison to ME location on the unfractured side. Baseline natural variance in asymmetry was accounted for by comparing ME location on the left and right sides in subjects without fractures. Patients who required open reduction and internal fixation (ORIF) to repair the ZMC fracture alone had significantly greater cumulative ME displacements than patients who did not require ORIF (p?=?0.02). Additionally, patients with a high fracture score of 3, 4, or 5 (assigned based on severity displacement in each dimension) had significantly higher rates of ORIF than patients with a low fracture score of 0, 1, or 2 (p?=?0.05). Severe displacement in one or more dimensions was associated with higher rates of ORIF than seen in patients with only neutral or mild displacements in all dimensions (p?=?0.05). Severe x displacement was most strongly correlated with surgical intervention (p?=?0.02). Overall, orbital floor repair was less strongly associated with most displacement measures than ZMC repair alone; however, patients requiring orbital floor repair had greater Euclidean ME displacements than patients who did not require orbital floor repair (p?=?0.02). Fracture severity, as determined by multiple parameters in this novel evaluation system, is associated with higher rates of ORIF in patients with unilateral ZMC fractures. Determination of ZMC fracture pattern may thus be informative when considering treatment options.

    View details for DOI 10.1055/s-0030-1263082

    View details for PubMedID 22110833

  • An Alternative Method for Reconstruction of Large Intranasal Lining Defects The Farina Method Revisited ARCHIVES OF FACIAL PLASTIC SURGERY Parikh, S., Futran, N. D., Most, S. P. 2010; 12 (5): 311-314

    Abstract

    To examine use of the paramedian forehead flap for intranasal lining.The medical records and photographs were reviewed for patients who underwent a nasal reconstruction involving a paramedian forehead flap used for internal lining.Three patients underwent this procedure. In all patients, the flap provided excellent intranasal lining. External incisions were acceptable in all the patients.The paramedian forehead flap may be used for internal lining of large intranasal defects. An external rhinoplasty approach facilitates reconstruction.

    View details for Web of Science ID 000282005600006

    View details for PubMedID 20855772

  • Rejuvenation of the upper eyelid. Facial plastic surgery clinics of North America Parikh, S., Most, S. P. 2010; 18 (3): 427-433

    Abstract

    The eyes are the most captivating feature of the face. Many of the early signs of aging occur in the periocular region. This article focuses on surgical rejuvenation of the upper eyelid with an emphasis on the eyelid anatomy, aging of the eyes, clinical evaluation, surgical technique, and postoperative complications. The paradigm has shifted to a more conservative resection of skin, muscle, and fat to preserve fullness to the upper eyelid that portrays youthfulness.

    View details for DOI 10.1016/j.fsc.2010.04.005

    View details for PubMedID 20659675

  • Adult Xanthogranuloma Causing Nasal Obstruction ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Worden, B. F., Barrera, J. E., Most, S. P. 2010; 136 (5): 509-512

    View details for Web of Science ID 000277510300017

    View details for PubMedID 20479384

  • Pre- and postoperative portrait photography: standardized photos for various procedures. Facial plastic surgery clinics of North America Swamy, R. S., Most, S. P. 2010; 18 (2): 245-?

    Abstract

    Photodocumentation in facial plastic surgery is essential in the perioperative setting, and with meticulous uniformity and standardization it serves as the primary tool for surgical planning and critical analysis of results. Accurate photodocumentation is dependent on strict and consistent use of equipment, lighting, and patient positioning. The purpose of this article is to review the principles of standardization in perioperative patient photography for common facial plastic procedures and to provide the facial plastic surgeon with the tools necessary to develop consistent and accurate patient photographs.

    View details for DOI 10.1016/j.fsc.2010.01.004

    View details for PubMedID 20511074

  • Principles of Photography in Rhinoplasty for the Digital Photographer CLINICS IN PLASTIC SURGERY Swamy, R. S., Sykes, J. M., Most, S. P. 2010; 37 (2): 213-?

    Abstract

    The art and technology of photography can be overwhelming to the facial plastic surgeon. Photographic documentation of patients undergoing rhinoplasty is essential for patient consultation, perioperative planning, and postsurgical evaluation. Possession of a basic understanding of photographic principles, technique, equipment, as well as consideration regarding consistency of patient positioning is essential for producing the best photographic results. This article reviews the basic principles of photography and discusses their application to facial plastic surgery practice, and rhinoplasty in particular.

    View details for DOI 10.1016/j.cps.2009.12.003

    View details for Web of Science ID 000276600000005

    View details for PubMedID 20206739

  • Lateral nasal wall suspension using a bone-anchored suture technique. Archives of facial plastic surgery Lieberman, D. M., Most, S. P. 2010; 12 (2): 113-?

    View details for DOI 10.1001/archfacial.2010.9

    View details for PubMedID 20231592

  • Comparative Computation of Orbital Volume From Axial and Coronal CT Using Three-Dimensional Image Analysis OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY Kwon, J., Barrera, J. E., Most, S. P. 2010; 26 (1): 26-29

    Abstract

    Volume measurements calculated from axial and coronal CT scans were compared to determine which method more accurately determines orbital volume.Thirty facial CT scans were used to measure 30 normal orbits using an image analysis program (Dextroscope, Singapore). The 3-dimensional volumes determined from axial scans and coronal scans were analyzed. The coronal scan volume measurements were further subdivided based on anterior limit criteria (termed C1 and C2). Three novel cephalometric angular measurements of the anterior orbital aperture were calculated and used to analyze the volumetric methodologies described above.The calculated orbital volume was greatest on axial scan, 25.6 +/- 2.4 ml, followed by volume based on coronal calculations with C1 delimitation (23.8 +/- 2.9 ml) and C2 delimitation (16.6 +/- 2.2 ml). We measured 3 novel orbital aperture angles on sagittal 3-dimensional reconstruction images, anterovertical, posterovertical, and horizontal orbital aperture angles that are related to the volume measurement underestimation.The orbital volume from coronal scans is underestimated compared with that from the axial scans, and the criterion for anterior limit of measurement can affect volume determination. Three novel cephalometric angle measurements may account for inaccuracies in orbital volume measurements.

    View details for DOI 10.1097/IOP.0b013e3181b80c6a

    View details for Web of Science ID 000273999500007

    View details for PubMedID 20090480

  • Measurements of Orbital Volume Change Using Computed Tomography in Isolated Orbital Blowout Fractures ARCHIVES OF FACIAL PLASTIC SURGERY Kwon, J., Barrera, J. E., Jung, T., Most, S. P. 2009; 11 (6): 395-398

    Abstract

    To measure the orbital volume of unilateral pure blowout fractures with computed tomography before and after surgery and to compare 3-dimensional (3-D) imaging systems.Twenty-four patients were evaluated with facial computed tomographic scans before and after surgery. Both the orbital volume and the displaced soft tissue volume were measured by 2 operators using 2 different 3-D software programs (Vitrea; Vital Images Inc, Minnetonka, Minnesota; and Dextroscope; Bracco AMT Inc, Princeton, NJ).The mean (SD) normal orbital volumes calculated by Vitrea and Dextroscope were 25.5 (2.4) mL and 24.8 (3.0) mL, respectively. The average preoperative orbital volumes were 28.3 (2.3) mL and 27.6 (3.1) mL, while the postoperative volumes were 25.8 (2.5) mL and 24.9 (3.0) mL. Vitrea showed that the average volume of displaced orbital soft tissue was 2.8 (1.9) mL before surgery and that it was reduced to 0.3 (1.3) mL after surgery, while Dextroscope showed that the average displaced orbital soft tissue was 2.9 (1.4) mL before surgery and that it was reduced to 0.1 (1.2) mL after surgery. There was no statistical difference between the 3-D analysis programs.Consistent volume measurements can be obtained using different 3-D image analysis programs. Measuring preoperative and postoperative volume changes and postoperative reduction can ensure a good surgical result and thereby decrease the incidence of enophthalmos.

    View details for Web of Science ID 000271861100004

    View details for PubMedID 19917900

  • Decompression of the Orbital Apex An Alternate Approach to Surgical Excision for Radiographically Benign Orbital Apex Tumors ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Almond, M. C., Cheng, A. G., Schiedler, V., Sires, B. S., Most, S. P., Jian-Amadi, A. 2009; 135 (10): 1015-1018

    Abstract

    To study the outcome of patients with orbital apex lesions treated with endoscopic decompression alone.Retrospective medical chart review with a mean follow-up of 25.6 months.Departments of Ophthalmology and Otolaryngology, University of Washington, Seattle.Five individuals seen at the University of Washington Medical Center from November 2003 through December 2005 with visual disturbance caused by orbital apex lesions as documented by preoperative magnetic resonance imaging or computed tomographic scan.All patients underwent endoscopic decompression of the medial wall of the orbital apex with incision of the periorbita.Postoperative visual acuity, presence or absence of a relative afferent pupillary defect, color vision, and visual field were recorded.All 5 patients presented with visual field deficits, 4 of whom improved postoperatively. Three patients had dyschromatopsia preoperatively, 2 of whom improved postoperatively. Visual acuity improved or stabilized in 4 of 5 patients postoperatively. One patient had progressive visual loss during the course of her follow-up, which, after obtaining postoperative imaging, was attributed to inadequate decompression of the apex at its most posterior aspect. This same patient also developed postoperative sinusitis that resolved with antibiotic treatment. Two patients developed diplopia, 1 in primary gaze requiring treatment with prismatic lenses. All patients presented with and maintained normal intraocular pressures.Orbital apex lesions can often be effectively and relatively safely treated by endoscopic decompression alone.

    View details for Web of Science ID 000270777800010

    View details for PubMedID 19841341

  • A Prospective Evaluation of the Efficacy of Topical Adhesive Pads for the Reduction of Facial Rhytids ARCHIVES OF FACIAL PLASTIC SURGERY Ryan, W. R., Most, S. P. 2009; 11 (4): 252-256

    Abstract

    To determine the efficacy of an over-the-counter topical skin adhesive pad for reducing central forehead and glabellar rhytids over a 4-week period.Prospective series involving 30 healthy volunteers with central forehead and glabellar rhytids at a tertiary care academic medical center. The participants used topical skin adhesive pads over the central forehead area and the glabella for 4 weeks in an effort to reduce rhytids. Before and after treatment, the participants had facial photographs taken and completed a questionnaire assessing the severity of their rhytids. Blinded to the timing of the photographs, 2 independent facial plastic surgeons scored the pretreatment and posttreatment rhytid severity using the Glogau scale (1-4) and a wrinkle severity scale (1-10) to evaluate treatment effect.Twenty-six participants (87%) completed follow-up with an average of 7.4 hours of use of the topical adhesive pads per night. The independent evaluators found minimal improvements in the Glogau scores (mean [SD], 0.12 [0.33] [P = .08] and 0.06 [0.22] [P = .18] for the central forehead area and the glabella, respectively). The same evaluators also found minimal change in the wrinkle severity scores (mean [SD], 0.21 [1.28] [P = .41] and 0.25 [0.75] [P = .10] out of 10 for central forehead rhytids and glabellar rhytids, respectively). None of these measures were statistically significant. The study participants' self-evaluations demonstrated changes in the wrinkle severity scores of 0.35 (2.10) (P = .41) in the central forehead area and 0.73 (1.7) (P = .04) in the glabella.Subjective self-evaluation of topical adhesive pads demonstrates improvement in glabellar rhytids but may be affected by bias. Independent, blinded evaluation by facial plastic surgeons showed no statistical benefit in the reduction of rhytids in the central forehead area or the glabella.

    View details for Web of Science ID 000268137300006

    View details for PubMedID 19620531

  • Treatment of Nasal Obstruction in the Posttraumatic Nose OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Corey, C. L., Most, S. P. 2009; 42 (3): 567-?

    Abstract

    The sequelae of trauma to the nose include nasal deformity and nasal obstruction that can have a long-term negative impact on patient quality of life. Successful management of posttraumatic nasal obstruction relies on a detailed history, careful analysis, and accurate diagnosis. Dividing the nose into horizontal thirds assists in preoperative analysis as well as surgical treatment. Adequate treatment of posttraumatic nasal obstruction must address deflection of the bony nasal pyramid, septal deformities (especially caudal or dorsal), turbinate hypertrophy, and incompetence of internal and external nasal valves. Treatment must balance the seemingly disparate goals of re-establishing structure, improving contour and esthetics, as well as restoring the nasal airway.

    View details for DOI 10.1016/j.otc.2009.03.002

    View details for Web of Science ID 000267508500013

    View details for PubMedID 19486751

  • Long-term outcomes of a rhinolift procedure for obstructive symptoms in the aging nose in 2 patients. Ear, nose, & throat journal Roofe, S. B., Most, S. P. 2009; 88 (4): E29-32

    Abstract

    Age-related changes in the structure of the nose can obstruct the nasal airway and adversely affect quality of life. Several procedures are available to restore the patency of the airway, but not all are appropriate for all patients. Also, long-term outcomes data on such procedures are lacking. We describe our use of a rhinolift procedure with local anesthesia to correct nasal obstruction caused by nasal tip ptosis in 2 elderly men. In both cases, the procedure resulted in a complete or near-complete resolution of obstructive symptoms. We also conducted long-term follow-up of these 2 patients. Both experienced a recurrence of symptoms 1 to 2 years postoperatively. We conclude that the rhinolift procedure we describe is safe and effective for the short-term relief of age-related nasal obstruction in selected patients.

    View details for PubMedID 19358117

  • Preserving Structural Integrity of the Alar Cartilage in Aesthetic Rhinoplasty Using a Cephalic Turn-in Flap ARCHIVES OF FACIAL PLASTIC SURGERY Murakami, C. S., Barrera, J. E., Most, S. P. 2009; 11 (2): 126-128

    Abstract

    Resection of the alar cartilage has long been a mainstay of aesthetic rhinoplasty. One drawback of this technique is the destabilization of the ala/lateral nasal wall complex. Herein we describe the cephalic turn-in flap, a technique for reinforcement of the alar cartilage after removal of its cephalic portion.

    View details for Web of Science ID 000264218500009

    View details for PubMedID 19289686

  • Preoperative, anesthetic, and postoperative care for rhinoplasty patients. Facial plastic surgery clinics of North America Swamy, R. S., Most, S. P. 2009; 17 (1): 7-?

    Abstract

    The perioperative period can be anxiety provoking for rhinoplasty patients. Patients rely on the skill and confidence of the surgeon to attain optimal results. Having an established strategy for the preoperative, anesthetic, and postoperative care of this patient population is critical to achieving a successful outcome and to ensuring a positive experience for the patient. Establishing a sincere rapport in the preoperative period and being able to properly address patient concerns regarding anesthesia helps patients develop a positive frame of mind and aids in their recovery. This presentation reviews important elements of the preoperative, anesthetic, and postoperative care of rhinoplasty patients and provides insight to making the experience a positive one for the patient and the surgeon.

    View details for DOI 10.1016/j.fsc.2008.09.006

    View details for PubMedID 19181277

  • Trends in Functional Rhinoplasty ARCHIVES OF FACIAL PLASTIC SURGERY Most, S. P. 2008; 10 (6): 410-413

    View details for Web of Science ID 000262558600009

    View details for PubMedID 19018063

  • Repair of the Philtrum: An Illustrative Case Series JOURNAL OF CUTANEOUS MEDICINE AND SURGERY Housman, T. S., Berg, D., Most, S. P., Odland, P. B., Stoddard, E. 2008; 12 (6): 288-294

    Abstract

    Distortion of the philtrum, which lends considerable symmetry to the midface, leads to a poor esthetic outcome.This case series describes reconstructive approaches to six philtral defects after Mohs micrographic surgery. Reconstructive approaches including advancement flaps, full-thickness skin grafts, and second-intention healing are illustrated. Postoperative complications included graft hypertrophy, irregularity of the graft surface, graft color mismatch, tenderness, and slight eclabium, which improved with dermabrasion or intralesional triamcinolone.The reasonable success of full-thickness skin grafts demonstrated here provides an additional approach to philtral repairs, especially when combined with traditional advancement flaps.

    View details for DOI 10.2310/7750.2008.07043

    View details for Web of Science ID 000268108600005

    View details for PubMedID 19317951

  • Management of the lower lid in male blepharoplasty. Facial plastic surgery clinics of North America Barrera, J. E., Most, S. P. 2008; 16 (3): 313-?

    Abstract

    Rejuvenation of the lower eyelid blepharoplasty in men requires consideration of different esthetic norms than those considered in women. Although both require a thorough understanding of anatomy, and the process of aging in each includes descent of the globe, pseudoherniation of the orbital fat, and skeletonization of the inferior bony rim, the goals for male blepharoplasty differ. The authors review the primary surgical approaches in lower lid blepharoplasty (transconjunctival skin-muscle flap) and the currently described techniques used to address displaced orbital fat, with special consideration of the male patient.

    View details for DOI 10.1016/j.fsc.2008.05.001

    View details for PubMedID 18620982

  • Volumetric imaging of the malar fat pad and implications for facial plastic surgery ARCHIVES OF FACIAL PLASTIC SURGERY Barrera, J. E., Most, S. P. 2008; 10 (2): 140-142

    View details for Web of Science ID 000254057400011

    View details for PubMedID 18347243

  • Prospective examination of the efficacy of 2 topical over-the-counter cosmeceutical creams for rapid treatment of facial rhytids ARCHIVES OF FACIAL PLASTIC SURGERY Most, S. P. 2007; 9 (5): 340-343

    Abstract

    To examine the efficacy of 2 over-the-counter cosmeceutical creams in reducing facial rhytids-Freeze 24/7 Anti-Wrinkle Cream (Freeze 24/7 International LLC, New York, New York) and LiftFusion Micro-Injected M-Tox Transdermal Face Lift (Fusionbeauty, Inc, Boca Raton, Florida)-against placebo (Nutraderm Therapeutic Lotion; Healthpoint, Inc, San Antonio, Texas).A prospective, blinded clinical trial was performed on 42 subjects, comparing 2 cosmeceutical creams that each represent a class of purported rapid rhytid reduction formulas with placebo. Independent analysis by 2 facial plastic surgeons was performed as well as completion of self-assessment questionnaires by the participants.No complications occurred. Self-evaluation of cream effectiveness was no different for test creams compared with placebo. Neither cream produced substantial reduction of rhytids when examined critically by 2 independent facial plastic surgeons. Stratification by Glogau (photoaging) class did not reveal increased effectiveness based on rhytid severity.Two typical over-the-counter rhytid reduction products are ineffective at substantially reducing facial rhytids.

    View details for Web of Science ID 000249515600006

    View details for PubMedID 17875827

  • Placement of a lateral nasal suspension suture via an external rhinoplasty approach ARCHIVES OF FACIAL PLASTIC SURGERY Roofe, S. B., Most, S. P. 2007; 9 (3): 214-216

    View details for Web of Science ID 000246581300011

    View details for PubMedID 17515499

  • Analysis of outcomes after functional rhinoplasty using a disease-specific quality-of-life instrument ARCHIVES OF FACIAL PLASTIC SURGERY Most, S. P. 2006; 8 (5): 306-309

    Abstract

    To measure the efficacy of functional rhinoplasty techniques with a validated quality-of-life instrument.Prospective observational outcomes study of patients with severe nasal obstruction owing to septal deviation, internal or external valve collapse, and turbinate hypertrophy who subsequently underwent functional rhinoplasty. Preoperative and postoperative evaluations were performed using the Nasal Obstruction Symptoms Evaluation scale.Forty-one patients completed preoperative and postoperative evaluations. No complications occurred. There was a significant improvement in mean Nasal Obstruction Symptoms Evaluation score postoperatively for the entire cohort (P<.01). Nasal Obstruction Symptoms Evaluation scores were also examined based on the procedure performed, such as spreader grafting, septoplasty, external valve suspension, and turbinectomy. Each subgroup also demonstrated airway improvement.Functional rhinoplasty techniques are effective in improving nasal airway function as measured by a patient-based, disease-specific, quality-of-life instrument. The specific techniques considered to treat nasal obstruction can be tailored to address the areas of concern, including septal deviation, internal or external valve collapse, and turbinate hypertrophy.

    View details for Web of Science ID 000240593300003

    View details for PubMedID 16982985

  • Anterior septal reconstruction - Outcomes after a modified extracorporeal septoplasty technique ARCHIVES OF FACIAL PLASTIC SURGERY Most, S. P. 2006; 8 (3): 202-207

    Abstract

    To describe a modified extracorporeal septoplasty technique and measure its efficacy with a validated quality-of-life instrument.A prospective observational outcomes study of patients with severe septal deviation who subsequently underwent anterior septal reconstruction. Preoperative and postoperative evaluation was performed using photographs and the Nasal Obstruction Symptoms Evaluation scale.Twelve consecutive patients were enrolled. No complications occurred. All patients noted improved airway function postoperatively. There was a significant improvement in mean Nasal Obstruction Symptoms Evaluation score postoperatively (76.6 vs 12.9; P<.01). Examination of postoperative photographs revealed improved midvault and tip anatomy.The anterior septal reconstruction technique is effective in improving both nasal airway function and aesthetics in patients with severe septonasal deviation. The technique avoids the most common complication of standard extracorporeal septoplasty by preserving the dorsal strut of septal cartilage and its attachment to the nasal bones at the keystone area.

    View details for Web of Science ID 000237543300007

    View details for PubMedID 16702533

  • A prospective examination of the efficacy of 2 noninvasive devices for treatment of the aging face ARCHIVES OF FACIAL PLASTIC SURGERY Lee, S., Most, S. P. 2006; 8 (1): 66-68

    View details for Web of Science ID 000234658000010

    View details for PubMedID 16415451

  • Anatomy of the eyelids. Facial plastic surgery clinics of North America Most, S. P., Mobley, S. R., Larrabee, W. F. 2005; 13 (4): 487-?

    Abstract

    The variety and complexity of periorbital surgical procedures continue to increase. Successful completion of reconstructive and esthetic ocular procedures requires an exacting knowledge of the relevant anatomy. Interestingly, the definition of ocular and periorbital anatomy continues to evolve, including more recent descriptions of the orbitomalar ligament and a new understanding of eyelid lymphatics. This article presents the most recent descriptions of periorbital anatomy.

    View details for PubMedID 16253835

  • Porous high-density polyethylene for orbital reconstruction ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Lee, S., Maronian, N., Most, S. P., Whipple, M. E., McCulloch, T. M., Stanley, R. B., Farwell, G. 2005; 131 (5): 446-450

    Abstract

    To determine the safety and efficacy of using porous high-density polyethylene (PHDPE) in the repair of orbital defects.Retrospective case series.Academic tertiary care trauma center. Patients One hundred seventy patients with orbital defects requiring surgical repair. Intervention Orbital defect repair with PHDPE. Main Outcome Measure Our review documents surgical results and complications associated with the use of PHDPE.There was a 6.4% complication rate associated with the use of PHDPE. The infection rate was 1.8%. The persistent orbital malposition rate was 3.5%. The extrusion rate was 0%.This report represents the largest case series in the literature using PHDPE for orbital reconstructions. The use of PHDPE resulted in a low complication rate and excellent functional and cosmetic reconstructive results. Because of our success with the use of PHDPE, we have changed our clinical practice to minimize the use of autologous graft material, thereby eliminating donor site morbidity in cases involving orbital reconstruction.

    View details for Web of Science ID 000229001800013

    View details for PubMedID 15897425

  • Efficacy of an over-the-counter lip enhancer in lip augmentation ARCHIVES OF FACIAL PLASTIC SURGERY Lee, S., Most, S. P. 2005; 7 (3): 203-205

    View details for Web of Science ID 000233221500010

    View details for PubMedID 15897412

  • A modern approach to nasal osteotomies. Facial plastic surgery clinics of North America Most, S. P., Murakami, C. S. 2005; 13 (1): 85-92

    Abstract

    A thorough understanding of the anatomy of the nose is paramount in rhinoplasty. Correction of deformities of the nasal vault presents a challenge to the facial plastic surgeon. Suboptimal aesthetic results may occur when either inadequate or excessive mobilization of the nasal bony-cartilaginous framework is performed. Furthermore, postoperative complications such as collapse of the nasal airway may occur. A number of techniques are available to appropriately mobilize and reposition the bony nasal vault. In this article, we will review pertinent anatomy, technical considerations and clinical perspectives on mobilization of the nasal bones.

    View details for PubMedID 15519930

  • Facial nerve recovery in bcl2 overexpression mice after crush injury. Archives of facial plastic surgery Most, S. P. 2004; 6 (2): 82-87

    Abstract

    To develop a mouse model for measuring facial nerve injury and recovery and to test the hypothesis that overexpression of the antiapoptotic gene, bcl2, enhances recovery of facial nerve function after peripheral crush injury.Prospective analysis of recovery of function after facial nerve crush injury in mice at juvenile (postnatal day 7) and adult (postnatal day 30) ages with blind comparison of wild-type and transgenic bcl2 overexpression littermates at both ages and immunohistologic confirmation of overexpression of bcl2 in facial motoneurons in transgenic animals.Adult wild-type mice demonstrated full recovery of facial nerve function (measured as eye blink and whisker movement) within 3 weeks of injury. Juvenile wild-type mice demonstrated diminished recovery of function. Juvenile transgenic bcl2 overexpression mice demonstrated more rapid and complete recovery of eye blink but not whisker movement in comparison with wild-type littermates.Measurement of facial nerve function in mice after injury is feasible. Enhanced recovery of facial nerve function in adult mice and mice overexpressing bcl2 indicates that preservation of central motoneurons after injury may improve function after peripheral nerve injury.

    View details for PubMedID 15023794

  • Nasal osteotomies: anatomy, planning, and technique. Facial plastic surgery clinics of North America Most, S. P., Murakami, C. S. 2002; 10 (3): 279-285

    View details for PubMedID 15062309

  • The Abbe flap in secondary cleft lip repair. Archives of facial plastic surgery Bagatin, M., Most, S. P. 2002; 4 (3): 194-197

    Abstract

    The Abble flap is a full-thickness composite flap, involving the transfer of the skin, muscle, and mucosa of the central part of the lover lip to the upper lip. This vermilionpedicled flap, based on the inferior labial vessels, has been used for secondary corrections in cleft deformities, more often in bilateral cases. Indications for its use include deficiency of scarring of the central part of the upper lip. thinness of the vermilion with a nonexistent lip tuberculum, or the absence of a Cupid's bow. The procedure may be combined with other reconstructive procedures.

    View details for PubMedID 12167080

  • Outcomes of facial cosmetic procedures. Facial plastic surgery Most, S. P., Alsarraf, R., Larrabee, W. F. 2002; 18 (2): 119-124

    Abstract

    Facial cosmetic procedures lend themselves to outcomes studies in ways that traditional reconstructive procedures may not. The most important measures of outcome in facial cosmetic surgery are quality of life and patient satisfaction, in contrast to other, more objective measures such as complications or mortality rates. For this reason, outcomes research in facial cosmetic surgery deserves a special focus of attention. In this article, we review outcomes studies for the more common facial cosmetic procedures, discuss in depth what aspects of patient-related satisfaction have been quantified by these existing studies, and highlight the direction that future outcomes research projects may wish to follow. There exists an abundance of potential interesting areas of study in facial cosmetic surgery, and the application of outcomes research methodology to these realms may allow the facial plastic surgeon to better define the success or failure of each individual facial cosmetic surgery procedure.

    View details for PubMedID 12063659

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