Reevaluating the Current Model of Rhinoplasty Training and Future Directions: A Role for Focused, Maneuver-Specific Simulation

Zammit D, Ponnudurai N, Safran T, Gilardino M.

What this paper says

Surveying 138 North American plastic surgery residents, 72% of seniors reported adequate rhinoplasty exposure but 73.9% had never performed a key step more than five times, and the three hardest steps were osteotomy (76.1%), caudal septum work (65.2%) and tip sutures (55.8%).

Overview

Residents learn rhinoplasty theory adequately but hands-on skill lags. The McGill authors combined a PRISMA systematic review with an online survey of Canadian and US plastic surgery residents on comfort and training.

Sections of note

138 residents: 62 junior (years 1-3), 76 senior (years 4-6).
Adequate exposure reported by 72% of seniors (95% of sixth-years) versus 13% of juniors.
75% of seniors participated mostly as observers or first assistants; 25% as co-surgeons.
73.9% had not performed a key step more than five times.
Hardest steps: osteotomy 76.1%, caudal septum/anterior nasal spine 65.2%, tip sutures 55.8%; 73.9% felt simulators would substantially improve confidence.

What it means for a patient

A newly graduated plastic surgeon may have watched many rhinoplasties but done few of the critical steps; fellowship training and case volume matter.
Residents themselves identify bone cuts and tip suturing as the steps they are least prepared for.
The paper proposes targeted simulators for these steps.

Why this paper matters

It quantifies the gap between exposure and competence in rhinoplasty training. Limits: self-report survey, plastic surgery only (not otolaryngology), response rate not stated.

Terms

Resident: a doctor in postgraduate surgical training.
Osteotomy: a controlled cut of the nasal bones.
Caudal septum / anterior nasal spine: the front of the septum and the bony point it rests on.
Competency-based training: assessment by demonstrated skills rather than time served.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Rhinoplasty is known for its complexity in planning and execution. For trainees, knowledge acquisition is often adequately attained. The mastery of skills, however, occurs by means of hands-on exposure, which continues to be a challenge. This article discusses the positive progress made in rhinoplasty training, and…”

Excerpt; the full abstract is on PubMed.