Custom Rhinoplasty Splints: A New Standard of Postoperative Care with Dr. John Layke

Dr. John Layke wasn't satisfied with traditional splints or taping. He began using MirrorMe's Splint LT Kit to give his patients a better postoperative experience and to better protect his on-table result during recovery.

Exciting news! We are launching the MirrorMe Surgeon Series, an interview series with surgeons who make patient specific care a priority in their practice. Our first episode features Dr. John Layke, of Beverly Hills Plastic Surgery in conversation with Jordan. They discuss how Dr. Layke first incorporated patient specific care into his practice and how it is benefiting his patients today. Watch the interview or read the transcript below! 

Below is the transcript of the conversation. (Lightly edited for readability)

Getting Started with MirrorMe3D 

[JM] How long have you been using MirrorMe in your practice?  

[Dr. Layke] I’ve been using MirrorMe in my practice for about two years.

[JM] A long time!

[Dr. Layke] Yeah, one of the OG’s.

[JM] For sure, one of the OG’s.

[JM] Do you remember your first MirrorMe case?

[Dr. Layke] I do, actually, because I received the full kit with the before and after models and basically from start to finish, it was the evaluation, kind of deconstructing what needed to be done. It really made me rethink the way I was doing rhinoplasty.

[JM] Nice. And then the product you use the most, by far, is the splint kit. So, a quick primer for anyone new to them, these are postoperative, patient specific splints for rhinoplasty patients. So Dr. Layke, what has been most exciting about incorporating these within your practice?

Why Use Custom Splints?

[Dr. Layke] You know, I always felt that regardless of the planning and the execution of the surgery, that sometimes the postoperative course was so random and varied so much from patient to patient depending on the thickness of skin and the potential procedures that were being done in that operation that the post op recovery was all over the place. So with the traditional means of trying to tailor taping or tailoring the swelling, we were limited to something that seems so archaic. And it was taping the nose, so I felt like, oh my gosh, if a patient missed a day of taping that suddenly, we’ve lost the result. In adopting the 3D splint, what I noticed was that it could really control some of the outcomes. It just became apparent in comparing those two options.

[JM] Got it. And as far as from the few years we’ve been doing this, from the splint kit which is patient specific, to taping, how have patients responded?

[Dr. Layke] Patients love it. You know, the problem with taping is everybody complained about the goop from the adhesive, the tiny little chad that hung down from the end of the tape, and it seemed to be just as obtrusive as the original surgical splint. With the new 3D splint, the fact that it’s clear acrylic—well, it does help that we’re in a pandemic and people are wearing masks—but prior to that, I would find that patients would wear it because it was a clear acrylic splint that just fit onto the nose and they could forget about it. Some people would even go to work with it. 

[JM] That makes it even better for post-op recovery for sure. From your patient population and the types of cases you do, what kinds of patients do you use the splints most often for?

[Dr. Layke] You know, in the early adoptive period, I was using it strictly for primary rhinoplasties, then I said, well that doesn’t make any sense because potential for scar tissue or things like that, so then I used it for secondary, tertiary rhinoplasties, and now I use it for 100%, as many as I can. Really at this point, I don’t even give the patient the option, it’s right in the quote, and I tell them about it. The one important thing that I think that I’ve noticed is that it keeps me honest as well because it really makes you focus intraoperatively on achieving the result that I promised the patient.

[JM] Got it. That’s a great thing to have. One other technical, or more operational, thing for the splints, do you recommend typical wear to patients or how do you help them move through out the kit since it is a series of 3.

[Dr. Layke] So, at their first postoperative visit, for the first week, I still have the traditional phase of the surgical splint, and I do have tape underneath, but as soon as that splint comes off, I know that I’ve got a window of a few hours before the nose starts to swell. We have the 3 splints within the kit, and we start with the largest one, and if for some reason the patient doesn’t swell as much and we can get them into the second one, I try to push the envelope a little bit. I noticed that we can help mold the result and I want them to wear it 24/7 at least for that first week. Then, for the five weeks after, they’re wearing it at night for sure. If they can wear during the day, that’s icing on the cake.

[JM] Very nice. Since you’ve been at this for a while now, are there any firsthand patient experiences you can share or that you’ve heard back from?

[Dr. Layke] As far as positive?

[JM] Yeah!

Patients love the Splint LT Kit.

[Dr. Layke] Most people, I’ll tell you, I can say that 80% of patients don’t want to stop wearing it at the six week mark. It gives them something to do, it protects the nose, it gives them the feeling that they have some control over the outcome. And when you see that you can get a later result much earlier, it’s a no brainer.

[JM] Got it.

[Dr. Layke] So I have two particular patients. The first was on The Doctors, we did a segment on The Doctors tv show. She had an extremely large nose and I knew that we needed something to help mitigate some of the swelling. She was wearing her splints for probably the first four months, I think maybe even to six. Her experience though was it was kind of like an accessory that she was bringing with her and she felt naked without it.

[JM] We actually get a good amount of feedback, that even though it’s a little bit past what you would advise clinically, patients keep wearing them up to six months, some even longer. That part has been really cool from a product development perspective.

[JM] To move on from the splints, any other MirrorMe products that you like to using within your practice?

[Dr. Layke] I do and I think the nasal tip guide is really great because it’s an easy way to hold you accountable, again, for delivering what you’re promising.

[JM] Right.

[Dr. Layke] And so, sometimes when the patient is lying flat, not sometimes, all the time, the nose is different. You know, sometimes I will sit the patient up and take a look because you’re trying assess not only the level of supratip break, you want to make sure the angle of the tip matches what you are promising, and it’s just an easy, 1-second step, where you can lay it on there and it tells you whether or not I need to rotate the tip, add tip projection, reduce the nose, whereas before you were doing it all from your artistic eye. And listen, that is the majority of the surgery, it definitely is, but to execute that sometimes when you’re wearing a headlight, and you’ve got shadows from other areas…sometimes it looks good, until the patient stands up. It’s like “ah, I wish I could have rotated it up just a little bit further. That’s where I think the nasal tip guides comes in.

[JM] Awesome. This has been great. To close out, do you have any advice for surgeons who are just starting to think about using the splint or starting to incorporate the splint kit within their practice, a way to optimize the adoption of it or their patients’ experiences?  

Advice for Plastic Surgeons wanting custom splints

[Dr. Layke] Sure, a couple different things. One is, I would say, is I used to offer it to patients as an extra. And I don’t think it was adopted as easily as when I just added it to my surgical quote and everyone got it. And when you prepare the patient beforehand, and say, “Listen, for decades we’ve been using traditional taping but now we have a clear acrylic splint that is almost like adjustable trays for the teeth and it will slowly help mold the nose and if we can get you a later result earlier…every patient says “I want in” and this is during the consultation. The second thing for the surgeon from a technical aspect, is I think looking at the analysis is great because you know in your head what you need to do, but sometimes, getting the accurate angles, number of millimeters of reduction, percent reduction, these are all things that help you start to realize what it takes to get to the result that you are promising. In the beginning, I’ll be honest, I don’t think I did that for every single case. You would promise something, and what they would get was similar but not quite. Now I really try hitting that simulation. So I would rather have 95% of the time, hit the exact simulation so that when they do put that splint on, the first one fits perfectly. That lets you know that you’ve already made that patient happy because they agreed to that simulation and you already know that it is going to look better than where it is starting at that first postoperative visit.

[JM] That’s amazing. I am so excited to have had this time with you today. I really appreciate it!