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Dr. Most graduated with High Honors from the University of Michigan in Ann Arbor. Subsequently he attended Stanford University School of Medicine, where he received a prestigious Howard Hughes Medical Institute Grant and was honored with the Dean's Award upon graduation. He completed an internship in General Surgery at Yale University School of Medicine before returning to the West Coast. Upon his return, he trained at the University of Washington in Department of Otolaryngology-Head and Neck Surgery, where he received the Lampkin Temporal Bone Dissection Award in 1998, and the awards from the Association for Research in Otolaryngology (ARO) in 1997, 1998, and 1999. In 2000 he joined the Physicians Research Training Committee of the ARO, the first resident to do so. After residency, he was selected for what was, at that time, one of the most competitive fellowships in Facial Plastic and Reconstructive Surgery, also at the University of Washington. He has authored nearly 200 articles, textbook chapters and reviews on the science and practice of Facial Plastic and Reconstructive Surgery. He was appointed Division Chief in Facial Plastic & Reconstructive Surgery at the University of Washington in 2002, a position he also has held at Stanford since his arrival here in 2006.
Pro Bono Reconstructive Surgery
Face to Face/Operation Smile
Evidence-based medicine in Facial Plastic SurgeryThe primary goal of this research program is to develop standard of higher level of evidence in order to provide more precise care for facial plastic surgery patients. The approach to this goal is multi-fold. The first involves development of studies that examine what have been dogmatic practices in facial plastic surgery. In particular we have undertaken randomized trials to examine important clinical care issues in rhinoplasty patients. Current and former projects include:1.Pain management post-rhinoplasty2.Antibiotic use after rhinoplasty3.Utility of nasal steroid use in patients with documented severe septal deviation4.Novel use of a radiofrequency device for treatment of nasal obstructionA second avenue of research is the use of ‘big data’ to examine important questions in facial plastic surgery. In particular, we have used the IBM/Marketscan (formerly Truven) database to examine issues such as:1.Association of cutaneous malignancy with venous thromboembolism (VTE)2.Use of NSAIDS around facial plastic surgery procecures3.Prolonged opioid use after plastic surgery procedures4.Nasal fracture treatment patterns and revision rates5.Risks of complications after plastic surgery procedures in patients with psychiatric diseaseA third avenue of research is the development and characterization of patient-reported outcome measures in facial plastic surgery. Much of the focus in the past 4 years has been development, validation and implementation of a comprehensive PROM for rhinoplasty. This PROM has been translated into multiple languages and is being used worldwide. Next steps for this project include:1.Development of new PROMS in areas of need in facial plastic surgery2.Demonstration of the utility of the rhinoplasty PROM (the SCHNOS) in examining rhinoplasty outcomesA fourth line of research is an effort to better predict positive outcomes in facial plastic surgery procedures. Much of this centers on the role of psychological well-being and preoperative expectations in determining outcome (in addition to surgical techniques). A fifth line of research involves developing an understanding of re-vascularization patterns of interpolated flaps in facial plastic surgery. A developing avenue of research involves the use of machine learning to examine and potentially guide surgical management of patients undergoing facial plastic surgery procedures. As such, we have begun to compile a data set that will allow us to begin to explore these questions.
Antibiotic Prophylaxis in Rhinoplasty
This study compares the efficacy of a single intra-operative (intravenous) dose of
"cephalexin" (first generation cephalosporin) or "clindamycin" (lincosamides), alone versus
both intra-operative (intravenous) dose of "cephalexin" (first generation cephalosporin) or
"clindamycin" (lincosamides) and postoperative oral dose of "cephalexin" or "clindamycin" use
in nasal surgery.
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Postoperative Pain Management in Rhinoplasty
The primary purpose of the study is to determine adequacy of postoperative pain control after
nasal surgery in patients prescribed Acetaminophen (325mg) + Hydrocodone (5mg) compared to
Acetaminophen(325mg) + Ibuprofen (200mg)for a period of 5 days after nasal surgery. To assess
the degree of pain, the participants will score the intensity of their pain on a visual
analog scale(VAS)of 0-100points (0- no pain and 100- most severe pain), preoperatively and
postoperatively (to be documented before each dose) for the duration of the prescribed
Additionally, the study will also seek to track:
1. The total number of pills each patients consume from the prescribed 5 day regimen.
2. Any associated side effects.
3. Additional pain medications prescribed in case of inadequate pain control,