Clinical Focus

  • Craniofacial Abnormalities
  • Facial Fractures
  • Rhinoplasty
  • Skin cancer reconstruction
  • Mohs reconstruction
  • Aesthetic Surgery
  • Pediatric Plastic Surgery
  • Facial rejuvination
  • Brow lift
  • Eyelid surgery (Blepharoplasty)
  • Facelift
  • Facial implants
  • Nose surgery
  • Chin augmentation
  • Ear pinning (Otoplasty)
  • Neck lift
  • Liposuction
  • Liposculpture
  • Breast Augmentation
  • Breast Lift (Mastopexy)
  • Tummy tuck (Abdominoplasty)
  • Fat grafting
  • Microsurgery
  • Facial Bones
  • Facial Trauma
  • Craniofacial trauma
  • Cleft Lip
  • Cleft Palate
  • Craniomandibular Disorders
  • Craniosynostoses
  • Osteogenesis, Distraction
  • Hemangioma
  • Vascular Malformations
  • Nevus
  • Acquired Nasal Deformities
  • Nasal Reconstruction
  • Facial Paralysis
  • Facial Reanimation
  • Facial Asymmetry
  • Gynecomastia
  • Abdominoplasty
  • Cosmetic Surgery
  • Infant ear molding
  • Cosmetic Reconstructive Surgical Procedures
  • Nasal Septum
  • septoplasty
  • craniofacial surgery
  • Plastic and Reconstructive Surgery

Academic Appointments

Professional Education

  • Board Certification: Plastic and Reconstructive Surgery, American Board of Plastic Surgery (2009)
  • Fellowship:University of Washington (2008) WA
  • Residency:University of Texas Southwestern Medical Center (2007) TX
  • Residency:University of Texas Southwestern Medical Center (2005) TX
  • Medical Education:University of Connecticut-School of Medicine (2002) CT


2017-18 Courses


All Publications

  • Rhinoplasty Education Using a Standardized Patient Encounter. Archives of plastic surgery Wright, E. J., Khosla, R. K., Howell, L., Lee, G. K. 2016; 43 (5): 451-456


    Comprehensive aesthetic surgery training continues to be a challenge for residency programs. Our residency program developed a rhinoplasty-based objective structured clinical examination (OSCE) based upon validated methods as part of the residency education curriculum. We report our experience with the rhinoplasty-based OSCE and offer guidance to its incorporation within residency programs.The encounter involved resident evaluation and operative planning for a standardized patient desiring a rhinoplasty procedure. Validated OSCE methods currently used at our medical school were implemented. Residents were evaluated on appropriate history taking, physical examination, and explanation to the patient of treatment options. Examination results were evaluated using analysis of variance (statistical significance P<0.05).Twelve residents completed the rhinoplasty OSCE. Medical knowledge assessment showed increasing performance with clinical year, 50% versus 84% for postgraduate year 3 and 6, respectively (P<0.005). Systems-based practice scores showed that all residents incorrectly submitted forms for billing and operative scheduling. All residents confirmed that the OSCE realistically represents an actual patient encounter. All faculty confirmed the utility of evaluating resident performance during the OSCE as a useful assessment tool for determining the Next Accreditation System Milestone level.Aesthetic surgery training for residents will require innovative methods for education. Our examination showed a program-educational weakness in billing/coding, an area that will be improved upon by topic-specific lectures. A thoroughly developed OSCE can provide a realistic educational opportunity to improve residents' performance on the nonoperative aspects of rhinoplasty and should be considered as an adjunct to resident education.

    View details for DOI 10.5999/aps.2016.43.5.451

    View details for PubMedID 27689053

    View details for PubMedCentralID PMC5040848

  • Facial Twist (Asymmetry) in Isolated Unilateral Coronal Synostosis: Does Premature Facial Suture Fusion Play a Role? JOURNAL OF CRANIOFACIAL SURGERY Miri, S., Mittermiller, P., Buchanan, E. P., Khosla, R. K. 2015; 26 (3): 655-657


    Unilateral coronal synostosis (UCS) often causes notable facial twist in affected patients. This condition occurs when the midface deviates toward the synostotic side, and the lower face deviates away from the synostotic side. The exact underlying mechanism for this phenomenon remains unclear. It has been proposed that premature fusion of facial sutures may play a role in the formation of facial twist. The purpose of this study was to determine whether asymmetrical facial suture fusion is present in patients with UCS.A single-center retrospective study was designed. Our study group consisted of 23 patients with a confirmed diagnosis of isolated UCS. Our control group consisted of 17 age-matched patients with deformational plagiocephaly and 11 normocephalic control subjects. The computed tomography scans of the faces were examined for the presence of facial suture fusions on both synostotic and nonsynostotic sides. All results with P < 0.05 were considered statistically significant.We found an increased incidence of fusion of the frontomaxillary, nasofrontal, and nasomaxillary sutures on the side of synostosis in UCS when compared with the nonsynostotic side and when compared with patients with deformational plagiocephaly or normocephalic patients.Asymmetrical premature fusion of facial sutures can potentially be contributing to the facial twist that is seen in patients with UCS.

    View details for DOI 10.1097/SCS.0000000000001436

    View details for Web of Science ID 000355236700046

    View details for PubMedID 25974768

  • Chondromyxoid Fibroma of the Mandible in an Adolescent: Case Report and Microsurgical Reconstructive Option CLEFT PALATE-CRANIOFACIAL JOURNAL Khosla, R. K., Nguyen, C., Messner, A. H., Lorenz, P. 2015; 52 (2): 223-228


    Chondromyxoid fibroma is a rare bony tumor that usually presents in the lower extremities of middle-aged adults. Involvement of the craniofacial skeleton is extremely rare. We present the unique case of an adolescent boy with a chondromyxoid fibroma of the mandible. The chondromyxoid fibroma in this patient recurred after initial treatment with curettage. We treated the recurrence with resection of the involved mandible and immediate reconstruction using a vascularized musculo-osseus seventh rib flap ("Eve procedure"). Despite complex reconstruction in adolescents due to skeletal immaturity, the rib flap has successfully grown with the patient up to 3 years postoperatively. Therefore, we believe the musculo-osseus rib flap is a feasible solution for complex ramus and condyle reconstruction of the growing mandible in the adolescent patient.

    View details for DOI 10.1597/13-243

    View details for Web of Science ID 000352143500015

    View details for PubMedID 24625223

  • Cleft palate surgery: an evaluation of length of stay, complications, and costs by hospital type. Cleft palate-craniofacial journal Nguyen, C., Hernandez-Boussard, T., Davies, S. M., Bhattacharya, J., Khosla, R. K., Curtin, C. M. 2014; 51 (4): 412-419


    Objective : The purpose of this study was to assess length of stay (LOS), complication rates, costs, and charges of cleft palate repair by various hospital types. We hypothesized that pediatric hospitals would have shorter LOS, fewer complications, and lower costs and charges. Methods : Patients were identified by ICD-9-CM code for cleft palate repair (27.62) using databases from the Agency for Health Research and Quality Healthcare Cost and Utilization Project Kids' Inpatient Database from 1997, 2000, 2003, and 2006. Patient characteristics (age, race, gender, insurer, comorbidities) and facility resources (hospital beds, cleft palate surgery volume, nurse-to-bed ratio, pediatric intensive care unit [PICU], PICU intensivist, burn unit) were examined. Hospitals types included pediatric hospitals, general hospitals, and nonaccredited children's hospital. For each hospital type, mean LOS, extended LOS (LOS > 2), and complications were assessed. Results : A total of 14,153 patients had cleft repair with a mean LOS of 2 days (SD, 0.04), mortality 0.01%, transfusion 0.3%, and complication <3%. Pediatric hospitals had fewer patients with extended hospital stays. Patients with an LOS >2 days were associated with fourfold higher complications. Comorbidities increased the relative rate of LOS >2 days by 90%. Pediatric hospitals had the highest comorbidities, yet 35% decreased the relative rate of LOS >2 days. Median total charges of $10,835 increased to $15,104 with LOS >2 days; median total costs of $4367 increased to $6148 with a LOS >2 days. Conclusion : Pediatric hospitals had higher comorbidities yet shorter LOS. Pediatric resources significantly decreased the relative rate of LOS >2 days. Median costs and charges increased by 41% with LOS >2 days. Further research is needed to understand additional aspects of pediatric hospitals associated with lower LOS.

    View details for DOI 10.1597/12-150

    View details for PubMedID 24063682

  • Current Concepts for Eyelid Reanimation in Facial Palsy ANNALS OF PLASTIC SURGERY Momeni, A., Khosla, R. K. 2014; 72 (2): 242-245
  • A National Study on Craniosynostosis Surgical Repair CLEFT PALATE-CRANIOFACIAL JOURNAL Christine Nguyen, C., Hernandez-Boussard, T., Khosla, R. K., Curtin, C. M. 2013; 50 (5): 555-560

    View details for DOI 10.1597/11-324

    View details for Web of Science ID 000327536100011

  • Emergency surgical treatment of an ulcerative and hemorrhagic congenital/infantile fibrosarcoma of the lower leg: case report and literature review JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B Kraneburg, U. M., Rinsky, L. A., Chisholm, K. M., Khosla, R. K. 2013; 22 (3): 228-232


    Fibrosarcomas are rare malignant soft-tissue tumors occurring mostly in infants younger than 1 year of age. Fibrosarcomas can ulcerate and cause various complications, which could threaten a fetus in utero or a child in the early neonatal period. We report a unique case of congenital infantile fibrosarcoma of the lower leg, its treatment and pathology. The large expansive and destructive lesion was not appreciated on routine prenatal ultrasound exams at 20 and 33 weeks gestation. The newborn required immediate emergency surgical intervention after delivery to prevent death by hemorrhagic shock. Initial debulking of the tumor was performed and hemostasis was attained on the day of birth. The child was resuscitated and definitive treatment of the leg was deferred until a pathologic diagnosis was obtained. Given the extent of the fibrosarcoma, the lower leg was not salvageable and the patient received a through-the-knee amputation in the neonatal period. The patient is free of disease at 2 years of age.

    View details for DOI 10.1097/BPB.0b013e3283536908

    View details for Web of Science ID 000316801200010

    View details for PubMedID 22568962

  • Microsurgical reconstruction of the smilecontemporary trends MICROSURGERY Momeni, A., Chang, J., Khosla, R. K. 2013; 33 (1): 69-76


    The treatment of facial palsy is a complex and challenging area of plastic surgery. Microsurgical innovation has introduced the modern age of dynamic reconstruction for facial palsy. This review will focus on microsurgical reconstruction for smile restoration in patients with long-standing facial palsy. The most common donor muscles and nerves will be presented. The advantages and disadvantages of single-stage versus multi-stage reconstruction will be discussed. Contemporary trends will be highlighted and the authors' preferred practice outlined.

    View details for DOI 10.1002/micr.22042

    View details for Web of Science ID 000313812600013

    View details for PubMedID 22976539

  • Contemporary concepts for the bilateral cleft lip and nasal repair. Seminars in plastic surgery Khosla, R. K., McGregor, J., Kelley, P. K., Gruss, J. S. 2012; 26 (4): 156-163


    The bilateral cleft lip and nasal deformity presents a complex challenge for repair. Surgical techniques continue to evolve and are focused on primary anatomic realignment of the tissues. This can be accomplished in a single-stage or two-stage repair early in infancy to provide a foundation for future growth of the lip and nasal tissue. Most cleft surgeons currently perform a single-stage repair for simplifying patient care. Certain institutions utilize presurgical orthopedics for alignment of the maxillary segments and nasal shaping. Methods for the bilateral cleft lip repair are combined with various open and closed rhinoplasty techniques to achieve improved correction of the primary nasal deformity. There is recent focus on shaping the nose for columellar and tip support, as well as alar contour and alar base position. The authors will present a new technique for closure of the nasal floor to prevent the alveolar cleft fistula. Although the alveolar fistula is closed, alveolar bone grafting is still required at the usual time in dental development to fuse the maxilla. It is paramount to try and minimize the stigmata of secondary deformities that historically have been characteristic of the repaired bilateral cleft lip. A properly planned and executed repair reduces the number of revisions and can spare a child from living with secondary deformities.

    View details for DOI 10.1055/s-0033-1333885

    View details for PubMedID 24179448

  • Nonsyndromic craniosynostosis. Seminars in plastic surgery Garza, R. M., Khosla, R. K. 2012; 26 (2): 53-63


    Nonsyndromic craniosynostosis is more commonly encountered than syndromic cases in pediatric craniofacial surgery. Affected children display characteristic phenotypes according to the suture or sutures involved. Restricted normal growth of the skull can lead to increased intracranial pressure and changes in brain morphology, which in turn may contribute to neurocognitive deficiency. Management has primarily focused on surgical correction of fused sutures prior to 12 months of age to optimize correction of the deformity and to ameliorate the effects of increased intracranial pressure. However, emphasis has recently shifted to better understanding the pathogenesis of neurocognitive impairment observed in these children, along with genetic mutations that contribute to premature suture fusion. Such understanding will provide opportunities for earlier and more specific neurocognitive interventions and for the development of targeted genetic therapy to prevent pathologic suture fusion. The authors review the common types of nonsyndromic craniosynostosis and the epidemiological, genetic, and neurodevelopmental details that are currently known from the literature. In addition, they present the rationale for surgical correction, offer suggestions for timing of intervention, and present some nuances of techniques that they find important in producing consistent results.

    View details for DOI 10.1055/s-0032-1320063

    View details for PubMedID 23633932

  • Changes in Frontal Morphology after Single-Stage Open Posterior-Middle Vault Expansion for Sagittal Craniosynostosis 89th Annual Meeting of the American-Association-of-Plastic-Surgeons Khechoyan, D., Schook, C., Birgfeld, C. B., Khosla, R. K., Saltzman, B., Teng, C. C., Ettinger, R., Gruss, J. S., Ellenbogen, R., Hopper, R. A. LIPPINCOTT WILLIAMS & WILKINS. 2012: 504–16


    There is controversy regarding whether the frontal bossing associated with sagittal synostosis requires direct surgical correction or spontaneously remodels after isolated posterior cranial expansion. The authors retrospectively measured changes in frontal bone morphology in patients with isolated sagittal synostosis 2 years after open posterior and midvault cranial expansion and compared these changes with those occurring in age-comparable healthy control groups.Forty-three patients age 1 year or younger (mean, 6 months) with sagittal synostosis underwent computed tomography scan digital analysis immediately after and 2 years after posterior-middle cranial vault expansion. Quantitative angular and linear measures were taken along the midsagittal and axial planes to capture both aspects of frontal bossing. The change in values over the 2 years were compared with healthy controls with normal computed tomography scans taken to rule out head trauma.All measures indicative of frontal bossing decreased significantly from the time of posterior-middle vault expansion to 2 years postoperatively. Whereas the majority of patients at time of the operation had frontal bossing measures greater than two standard deviations outside the age-comparable control mean, almost all patients were within two standard deviations of the norm 2 years later. Lateral forehead bossing and anterior cranial growth was greater the older the patient was at the time of the operation, suggesting that the more time that passed before the operation, the more compensatory anterior fossa growth occurred. Central forehead position relative to the anterior cranial base was greatest in the younger patients at the time of operation, suggesting that a central forehead bulge was an early compensatory response to premature sagittal fusion.As a group, patients with sagittal synostosis start to normalize their forehead morphology within 2 years if an isolated posterior operation is performed at 1 year of age or younger, and this occurs by a combination of restriction of growth and reduction relative to patients without synostosis. This protocol decreases the risks of intraoperative positioning, forehead contour deformities, and two-stage operations.Therapeutic, III.

    View details for DOI 10.1097/PRS.0b013e31823aec1d

    View details for Web of Science ID 000300240000086

    View details for PubMedID 22286431

  • Current Concepts for Eyelid Reanimation in Facial Palsy. Annals of plastic surgery 2012


    ABSTRACT: The treatment of facial palsy is a complex and challenging area of plastic surgery. Two distinct anatomical regions and functions are the focus of interest when managing facial palsy: (1) reanimation of the eyelids and (2) reconstruction of the smile. This review will focus on the treatment of ocular manifestations of facial palsy. The principles of eyelid rehabilitation will be presented along with a discussion of surgical and nonsurgical treatment options.

    View details for DOI 10.1097/SAP.0b013e318264fcba

    View details for PubMedID 23241787

  • Combination Jessner's Solution and Trichloroacetic Acid Chemical Peel: Technique and Outcomes PLASTIC AND RECONSTRUCTIVE SURGERY Herbig, K., Trussler, A. P., Khosla, R. K., Rohrich, R. J. 2009; 124 (3): 955-964


    Trichloroacetic acid is a commonly utilized agent for chemical resurfacing of the face. Jessner's solution in combination with trichloroacetic acid has been previously described for the treatment of facial rhytids in the dermatology literature. The purpose of this study was to describe the application technique and examine the clinical results of Jessner's solution in combination with trichloroacetic acid in a diverse plastic surgery patient population.A retrospective chart evaluation of 105 patients undergoing combination Jessner's and 35% trichloroacetic acid facial peel procedures by the senior author was performed. Patient demographics, anatomic location of peel, concomitant surgical procedures, and postoperative complications were noted. Technique and endpoints are described.Between January of 2000 and April of 2007, 115 chemical peels were performed by the senior author. All patients were female, ranging in age from 32 to 83 years (mean, 54 years). Of the 115 chemical peels performed, 104 were done with concomitant procedures. Eleven peels were performed alone. The most significant complications related to the combination peel were fungal infections (7.8 percent overall rate). In addition, the senior author performed 27 face/neck lifts with superficial musculoaponeurotic system (SMAS)-ectomy or SMAS plication along with full face combination peel, with minimal postoperative complications and no evidence of hypertrophic scarring.The combination of Jessner's solution and 35% trichloroacetic acid is an effective, safe resurfacing tool that can treat superficial to moderate rhytids. Despite the apparent simplicity of the procedure, there is a significant learning curve to understand the intricacies of chemical penetration in the skin. Consistency in results is achieved with experience and proper preoperative patient evaluation and selection.

    View details for DOI 10.1097/PRS.0b013e3181addcf5

    View details for Web of Science ID 000269485200033

    View details for PubMedID 19730318

  • Bilateral cleft lip and nasal repair PLASTIC AND RECONSTRUCTIVE SURGERY Byrd, H. S., Ha, R. Y., Khosla, R. K., Gosman, A. A. 2008; 122 (4): 1181-1190


    The bilateral cleft lip and nasal repair has remained a challenging endeavor. Techniques have evolved to address concerns over unsatisfactory features and stigmata of the surgery. The authors present an approach to this complex clinical problem that modifies traditional repairs described by Millard and Manchester. The senior author (H.S.B.) has developed this technique with over 25 years of surgical experience dealing with the bilateral cleft lip. This staged lip and nasal repair provides excellent nasal projection, lip function, and aesthetic outcomes. Lip repair is performed at 3 months of age. Columellar lengthening is performed at approximately 18 months of age. A key component of this repair focuses on reconstruction of the central tubercle. A triangular prolabial dry vermilion flap is augmented by lateral lip vermilion flaps that include the profundus muscle of the orbicularis oris. This minimizes lateral lip segment sacrifice and provides improved central vermilion fullness, which is often deficient in traditional repairs. The authors present the surgical technique and examples of their clinical results.

    View details for DOI 10.1097/PRS.0b013e3181858f33

    View details for Web of Science ID 000259811700025

    View details for PubMedID 18827654