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Safety of Performing Simultaneous Rhytidectomy and Rhinoplasty
Andreas M. Lamelas, MD, E. Hope Weissler, BA, Mark R. Sultan, MD, F.A.C.S.
Mount Sinai Medical Center, New York, NY, USA.

Background: In 2014 there were 217,000 rhinoplasties and 128,000 rhytidectomies performed in the United States. These two procedures are not commonly done simultaneously because the age demographics are much different. Only 2% of rhytidectomies are performed under the age of 29 compared to over 70% of rhinoplasties. Similarly 66% of rhytidectomies are performed on patients over 55 compared to only 10% of rhinoplasties. There have been few papers that report doing the two procedures simultaneously but none have directly addressed safety. We aim to show that performing a rhytidectomy and rhinoplasty simultaneously, in selected patients, is safe and does not result in increased morbidity.
Methods: A retrospective chart review was performed to identify all patients between 2009-2015 who underwent simultaneous rhytidectomy and rhinoplasty by the senior author (M.R.S.). All forms of rhytidectomy, such as primary, secondary, short scar and full SMAS elevation were included. Similarly, all forms of rhinoplasty such as primary, secondary, open and closed were included. The addition of other procedures during the same operation was not reason for exclusion. Demographics, surgical variables, complications and subsequent management were recorded.
Results: Twenty-eight patients underwent simultaneous rhytidectomy and rhinoplasty by the senior author (M.R.S.). All patients were female with an average age of 59. The majority of rhytidectomies were primary (82%) with either full SMAS elevation or SMASectomy. The majority of rhinoplasties were primary (82%) and were performed closed (96%). Twelve patients underwent full rhinoplasties, whereas 16 were restricted to the nasal tip. The majority of patients (93%) underwent additional aesthetic procedures simultaneously such as blepharoplasty, browlift, mentoplasty and fat injections. Complications related to the rhytidectomy included hematoma (7%), minor healing issues (7%), and temporary motor nerve injury, (11%) all of which resolved fully in several weeks. There were no specific complications referable to the rhinoplasty.
The vast majority of patients were pleased with their aesthetic results. Three requested minor revisions of their facelifts and one of their rhinoplasty. All patients were equally pleased with the results of their rhinoplasty as with their facelift. In all cases, the rhinoplasty enhanced the overall aesthetic results.
Conclusions: Performing a rhytidectomy and rhinoplasty simultaneously, with or without additional facial aesthetic procedures, is safe with complication rates similar to rates when performed individually. In properly selected patients, the rhinoplasty will likely enhance the overall aesthetic result significantly.

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