Clinical Practice Patterns and Evidence-Based Medicine in Rhinoplasty: A 10-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery

Overview

The American Board of Plastic Surgery has collected tracer data on cosmetic surgery from member surgeons since 2003, giving a view of national practice. The authors compared an early cohort from 2012 to 2016 against a recent cohort from 2017 to 2021, covering demographics and technique, and read the changes against current evidence based guidance.

Sections of note

• Design: comparison of registry tracer data across two periods. Level of evidence III.
• 730 rhinoplasties analyzed: 270 early and 460 recent. Median age 30 years. The most common patient concern was the nasal bridge, at 79 percent.
• Concerns about tip projection fell from 58 to 43 percent, p equal to 0.0002, while functional airway complaints rose from 38 to 49 percent, p equal to 0.004.
• An open approach was used in 83 percent of cases.
• Increases: septoplasty 47 to 52 percent, caudal septum repositioning 14 to 23, tip rotation maneuvers 32 to 49, spreader grafts 35 to 45, columellar strut grafts 42 to 50. Decreases: alar base resection 17 to 10, non-cartilaginous bridge or radix augmentation 9 to 4.

What it means for a patient

• Rhinoplasty in the United States has shifted toward treating breathing alongside appearance, and toward adding structural support rather than removing tissue.
• Non-cartilaginous augmentation of the bridge, which includes synthetic and non-cartilage materials, halved over the decade.
• Alar base resection, which narrows the nostrils, also fell by roughly half.
• Limits: self reported data submitted for board certification, 730 cases over a decade, no outcome or complication data, and no verification of the reported technique details.

Why this paper matters

Practice change in surgery is usually described anecdotally. Registry data tied to certification gives a national picture across time. It records what surgeons say they did, not whether those choices produced better results, so the trend toward more grafting is documented but not validated.

Terms

• Tracer data: standardized case data surgeons submit as part of continuing board certification.
• Septoplasty: surgery to straighten the wall dividing the two sides of the nose.
• Caudal septum: the front lower edge of the septum.
• Spreader graft: a cartilage strip placed alongside the septum to hold the breathing valve open.
• Alar base resection: removing tissue to narrow the base of the nostrils.
• Radix: the root of the nose, the area between the eyes.