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IMPORTANCE To improve preoperative counseling for patients considering endoscopic brow-lift (EBL). OBJECTIVES To understand patient-reported outcomes, satisfaction, and recovery after EBL surgery to improve preoperative counseling. DESIGN, SETTING, AND PARTICIPANTS A retrospective telephone survey of 57 patients who had EBL or EBL with concurrent rhytidectomy to assess cosmetic and functional outcomes using 47 questions. MAIN OUTCOME AND MEASURE Questions evaluated outcomes, satisfaction, and recovery. RESULTS Fifty-three patients (93%) reported the procedure was successful, and 55 patients (96%) would recommend undergoing this procedure. Forty-two (74%) were incidentally told they looked younger; 37 patients (65%) were told they looked less tired. Forty-two patients (74%) reported increased confidence. Fifty-one patients (89%) required analgesics for less than 1 week, 44 patients (77%) reported scars as unnoticeable, 54 patients (95%) reported postoperative edema lasting less than 2 weeks, 16 patients (28%) reported alopecia at an incision site, and 36 patients (63%) had some numbness. In the 16 patients who reported headaches before surgery, 8 patients (50%) reported an improvement in either frequency or intensity. Patients who underwent rhytidectomy were significantly more likely to take 2 weeks or longer to return to normal activities. No differences were noted between rhytidectomy with EBL compared with EBL alone in analgesic use, edema, numbness, alopecia, and satisfaction. CONCLUSIONS AND RELEVANCE Endoscopic brow-lift is well tolerated and most patients are happy with the outcome. Relying on patient-reported information helps us to better understand the surgical experience and to improve preoperative counseling. LEVEL OF EVIDENCE 4.

Background:Compared with other malignancies, nonmelanoma skin cancer (NMSC) is associated with much less morbidity and mortality. NMSC is, however, far more common than other malignancies. The cost of managing NMSC has not been assessed. Objective:The purpose of our study was to determine where the cost of NMSC management ranks among other cancers in the Medicare population. Design:Representative Medicare part A and B claims data were obtained from the Medicare current beneficiary survey, 1992 to 1995. Claims associated with cancer costs were identified using the International Classification of Diseases, Ninth Revision, Clinical Modificationcodes. Weights were applied to obtain nationally representative estimates. Results:Average Medicare expenditure on cancer management was $13 billion per year. The 5 most costly cancers to Medicare were lung and bronchus, prostate, colon and rectum, breast, and NMSC. The mean annual cost per patient using Medicare for all cancers was $17,094. Malignancies of lung and bronchus, colon and rectum, breast, and prostate were 11 to 19 times more costly per affected patient than NMSC. Conclusion:In addition to classifying cancers by number of cases and number of deaths, the financial impact of treatment can also be used to prioritize different malignancies. Such a scheme ranks NMSC far higher than would death statistics. In light of its already high and rising incidence, the cost of NMSC care to Medicare is likely to increase. However, to maintain the cost-effective management of NMSC, it is essential to preserve the current low per-patient cost of its management. (J Am Acad Dermatol 2003;48:425-9.)

Traumatic nasal deformities, from cutaneous injuries to major structural deficits, can be repaired by correct diagnosis of the defect followed by systematic repair of each layer of injured or deformed tissue. From the minor abrasions requiring only re-epithelialization to the major anatomic deficiencies of the ravaged nose, meticulous attention to restoration of each component of the defect will result in the best opportunity for satisfactory nasal contour and function.

The major point of upper airway resistance occurs at the area of the nasal valve. Physics has demonstrated that increasing the diameter therefore decreases the energy required for inspiration of the same volume of air. These are the principles that have driven the development of nasal dilators from ancient times to the present. From the nasal bougies, nasal insufflators, and nasal vibrators of the past to the Breathe Right strips, Breathe with Eez, and Nozovent of the present, mechanical devices have been devised to improve the nasal airway. They offer an alternative for patients who are poor candidates for or are unwilling to undergo surgical treatment of the nasal airway and the nasal valve.