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Due to its central location, the nose plays a prominent role in facial aesthetics. As tastes have shifted and techniques have advanced, the accepted "ideal" appearance and proportions of the nose have evolved over time. By assessing the aesthetics of the nasal dorsum through the use of lines and angles, one can more precisely elucidate a goal for the patient's postoperative nasal shape, which should, in turn, guide the surgeon to execute specific operative maneuvers needed to achieve that contour. In assessing the aesthetics of the nasal dorsum, practitioners calculate and observe aspects such as the paired dorsal aesthetic lines, the nasofrontal angle, and the nasofacial angle. There is also additional consideration given to nasal tip position as this must fit harmoniously with the shape of the dorsum. In contrast to the established aesthetic lines and angles, using nasal geometric polygons for the aesthetic evaluation and development of operative goals in rhinoplasty has recently been described in the literature. Constructed ideals, in the form of proportions, lines, and angles, should be used with caution, as there are many factors to consider in the aesthetic analysis of the nasal dorsum, including ethnic differences, and subjective and changing views of beauty.

Objective To compare morbidity and aesthetic outcomes of full-thickness skin grafts (FTSGs) and split-thickness skin grafts (STSGs) in the reconstruction of the forearm free flap donor site. Study Design Case series, retrospective chart review. Setting Institutional microvascular database. Subjects and Methods Subjects who underwent forearm free flaps and FTSGs for donor site reconstruction from April 2016 to November 2017 were included. FTSGs were obtained from the donor forearm with a proximal S-shaped incision, thereby avoiding additional wound creation. Morbidity outcomes were compared to 68 consecutive patients with STSG reconstruction from January 2009 to May 2010. Complications, including tendon exposure, subjective functional impairment, complete graft loss, partial graft loss, infection, paresthesias, and hematoma/seroma, were evaluated, as were aesthetic outcomes. Results Sixty-eight patients underwent FTSG reconstruction. No significant differences between FTSGs and STSGs were demonstrated in terms of graft loss ≥40% (4% vs 4%, P = 1.000), partial graft loss (<40%) (29% vs 40%, P = .207), tendon exposure (9% vs 12%, P = .573), infection (15% vs 13%, P = .805), paresthesias (12% vs 7%, P = .382), subjective functional impairment (0% vs 2%, P = .316), or hematoma/seroma (2% vs 0%, P = .316). Aesthetic outcomes were better in the FTSG group compared to the STSG group, as determined by both patients ( P = .004) and surgeon ( P < .001). Conclusions Our results advocate for the consideration of FTSGs in the reconstruction of the forearm free flap donor site given superior aesthetic results without additional donor site morbidity or additional wound creation when compared to STSGs.

Objective: 1) Determine the correlation of awake tonsil scores and pre-adenotonsillectomy sleep endoscopy findings and 2) Assess the relationship between polysomnographic adenotonsillectomy outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. Study Design: Retrospective case series with chart review Setting: Tertiary care children’s hospital Subjects and Methods: Children ages 1–18 years who underwent sleep endoscopy and adenotonsillectomy from 1/1/2013 to 8/30/2016 were included. Pre-adenotonsillectomy sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared using Spearman correlation. Associations between changes in pre- and post-adenotonsillectomy polysomnography parameters and a) awake tonsil scoring and b) sleep endoscopy scoring were assessed using one-way analysis-of-variance and linear regression. Results: N = 36, mean age 6.8 ± 4.3 years, 68% male, 44% obese. Awake tonsil scores and sleep endoscopy ratings were strongly correlated (R = 0.58, P=0.003). Awake tonsil scores were not associated with changes in any polysomnography parameters after adenotonsillectomy (all p > 0.05) while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all p < 0.05, R-squared 0.16–0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change −8.2 ± 11.5 vs. −15.9 ± 14.3 and −46.8 ± 31.3, respectively, p<0.001). Conclusions: In children at risk for adenotonsillectomy failure, assessment of dynamic collapse using sleep endoscopy may better predict the outcome of adenotonsillectomy than awake tonsil size assessment, thus helping to inform surgical expectations.