{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T22:47:32Z","timestamp":1788821252474,"version":"build-2803163510"},"reference-count":44,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,2,1]],"date-time":"2017-02-01T00:00:00Z","timestamp":1485907200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with &gt;200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long\u2010term antibiotics, hospitalization, or lost revenue from hours\/days of missed work.<\/jats:p><jats:p>The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities\/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre\u2010 and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence\u2010based medicine practices and data to build unanimity regarding the peri\u2010 and postoperative strategies to maximize patient safety and to optimize surgical results for patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The primary purpose of this guideline executive summary is to provide evidence\u2010based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged \u226515 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are intended to include the caregiver if the patient is &lt;18 years of age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Action Statements<\/jats:title><jats:p>The Guideline Development Group made the following <jats:italic>recommendations<\/jats:italic>: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon\u2019s designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon\u2019s designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician\u2019s designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon\u2019s designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patient satisfaction with their nasal appearance and with their nasal function at a minimum of 12\u00a0months after rhinoplasty.<\/jats:p><jats:p>The guideline development group made <jats:italic>recommendations against<\/jats:italic> certain actions: (1) When a surgeon, or the surgeon\u2019s designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration &gt;24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery.<\/jats:p><jats:p>The panel group made the following statement an <jats:italic>option<\/jats:italic>: (1) The surgeon, or the surgeon\u2019s designee, may administer perioperative systemic steroids to the rhinoplasty patient.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599816683156","type":"journal-article","created":{"date-parts":[[2017,2,1]],"date-time":"2017-02-01T13:31:35Z","timestamp":1485955895000},"page":"205-219","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty Executive Summary"],"prefix":"10.1002","volume":"156","author":[{"given":"Lisa E.","family":"Ishii","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis T.","family":"Tollefson","sequence":"additional","affiliation":[{"name":"University of California Davis Medical Center Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Basura","sequence":"additional","affiliation":[{"name":"University of Michigan Medical Center Taubman Center Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Rosenfeld","sequence":"additional","affiliation":[{"name":"SUNY Downstate Medical Center Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Abramson","sequence":"additional","affiliation":[{"name":"Ear\u2010Nose\u2010Throat of Georgia Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott R.","family":"Chaiet","sequence":"additional","affiliation":[{"name":"The University of Tennessee Health Science Center Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara S.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Doghramji","sequence":"additional","affiliation":[{"name":"Jefferson Sleep Disorder Center Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward H.","family":"Farrior","sequence":"additional","affiliation":[{"name":"Farrior Facial Plastic and Cosmetic Surgery Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra A.","family":"Finestone","sequence":"additional","affiliation":[{"name":"Consumers United for Evidence\u2010Based Healthcare Fredericton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey L.","family":"Ishman","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Robert X.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network Bethlehem Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.","family":"Park","sequence":"additional","affiliation":[{"name":"Mayo Clinic Center for Sleep Medicine Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Setzen","sequence":"additional","affiliation":[{"name":"New York University School of Medicine New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah J.","family":"Strike","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Iowa Hospital and Clinics Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra A.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Consumers United for Evidence\u2010Based Healthcare Fredericton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy P.","family":"Warner","sequence":"additional","affiliation":[{"name":"Division Plastic and Reconstructive Surgery Northshore University Health System Northbrook Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine C.","family":"Nnacheta","sequence":"additional","affiliation":[{"name":"Department of Research and Quality American Academy of Otolaryngology\u2014Head and Neck Surgery Foundation Alexandria Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,2]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"American Society of Plastic Surgeons.Annual plastic surgery report 2014 surgical statistical report.http:\/\/www.plasticsurgery.org\/Documents\/news\u2010resources\/statistics\/2014\u2010statistics\/cosmetic\u2010procedure\u2010trends\u20102014.pdf. Published2014. Accessed on January 20 2016."},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1347011"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24883"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-013-0207-0"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2014.1492"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-012-2144-y"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X10395507"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599811400977"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599814560139"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000512"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000552"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-013-2792-6"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182818f02"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.2010.96"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2014.1574"},{"issue":"13","key":"e_1_2_14_17_1","first-page":"1828","article-title":"Comparison of the effects of preoperative and intraoperative intravenous application of dexketoprofen on postoperative analgesia in septorhinoplasty patients: randomised double blind clinical trial","volume":"16","author":"Ozer AB","year":"2012","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.8.2.84"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000191181.73298.b3"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599812468849"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181dc54da"},{"key":"e_1_2_14_22_1","first-page":"1","article-title":"Quality of life before and after septoplasty and rhinoplasty","volume":"9","author":"Baumann I.","year":"2010","journal-title":"GMS Curr Top Otorhinolaryngol Head Neck Surg"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000110214.88868.CA"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001264"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfacial.qoa00055.44"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfacial.2012.583"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200204150-00034"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-198610000-00007"},{"key":"e_1_2_14_29_1","first-page":"267","article-title":"The role of antibiotics in rhinoplasty and septoplasty: a literature review","volume":"46","author":"Georgiou I","year":"2008","journal-title":"Rhinology"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/019459989210600307"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.8.2.88"},{"key":"e_1_2_14_32_1","first-page":"1311","article-title":"Obstructive sleep apnea is a common disorder in the population\u2010a review on the epidemiology of sleep apnea","volume":"7","author":"Franklin K","year":"2015","journal-title":"J Thorac Dis"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0b013e3283659e1e"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25336"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2008.11.024"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2011-000172"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-139-6-200309160-00013"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-5-23"},{"key":"e_1_2_14_39_1","unstructured":"Oxford Centre for Evidence\u2010Based Medicine.OCEBM Levels of Evidence Working Group: the Oxford 2011 levels of evidence.http:\/\/www.cebm.net\/index.aspx?o=5653. Published2011. Accessed October 22 2015."},{"key":"e_1_2_14_40_1","unstructured":"HowickJ ChalmersI Glasziou;OCEBM Levels of Evidence Working Group. The Oxford 2011 levels of evidence: Oxford Centre for Evidence\u2010Based Medicine.http:\/\/www.cebm.net\/index.aspx?o=5653. Accessed October 22 2015."},{"key":"e_1_2_14_41_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-1260"},{"key":"e_1_2_14_42_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.5.612"},{"key":"e_1_2_14_43_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.061181"},{"key":"e_1_2_14_44_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1109283"},{"key":"e_1_2_14_45_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0115458"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599816683156","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1177\/0194599816683156","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599816683156","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:23:20Z","timestamp":1760955800000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1177\/0194599816683156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2]]},"references-count":44,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017,2]]}},"alternative-id":["10.1177\/0194599816683156"],"URL":"https:\/\/doi.org\/10.1177\/0194599816683156","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,2]]},"assertion":[{"value":"2016-11-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-11-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-02-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}