Facial Plastic Surgery最新文献

Prominauris, often known as prominent ears, is one of the most frequent congenital deformities of the head and neck. Therefore, otoplasty has gained significant popularity and is now one of the most performed procedures in the field of facial plastic surgery.Reconstructing and correcting ear abnormalities remains a challenging procedure in facial plastic and reconstructive surgery. These deformities, whether congenital or acquired, have a substantial influence on patients' lives and inflict psychological harm. Addressing the deformity and tissue loss will improve the overall quality of life.Throughout history, various surgical techniques have been reported for treating external ear abnormalities. While most of these surgeries are considered safe, a comprehensive preoperative evaluation and understanding of the different techniques and risks can minimize potential complications.

Background: In the quest of achieving younger and media driven facial aesthetics, the use of fillers in the face has recently expanded exponentially. Therefore, it is inevitable that every facial plastic surgeon (FPS) will be facing patients with facial fillers. A consequence of fillers is a sub-optimal/altered lymphatic drainage, which has a direct impact on post-operative oedema following facial surgery including rhinoplasty. In the senior author's experience (AD), it was observed that patients with facial fillers had persistent oedema post-rhinoplasty. This research hypothesizes that prolonged post-rhinoplasty oedema may be related to fillers and aims to gather evidence from the literature to support this hypothesis. It also investigates whether fillers compromise lymphatic drainage.

Methods: A narrative review was performed on selective articles based on fillers and post-rhinoplasty oedema. Then, it is methodologically analyzed to look for a standard theory and categorize it throughout the discussion.

Discussion: Theoretically, with inherent characteristics of hydrophilic nature, hardness, volume and back-flow phenomena, fillers can lead to prolonged oedema. Additionally, they can either directly block or indirectly exert pressure on the lymphatic pathways and hinder drainage.

Conclusion: This research findings support the hypothesis that facial fillers can impact post-operative facial oedema. Future research is required to objectively measure the effect of fillers on facial lymphatic drainage.

Abbreviations: Facial plastic surgeon (FPS), Hyaluronic acid (HA), submandibular (SM), Lymph nodes (LN), ultrasonography (US).

Key words: Hyaluronic acid fillers, dermal oedema, prolonged post-filler oedema, recurrent oedema, persistent oedema, facial oedema, face lymphatics. 'Conflict of Interest: 'none declared'. No commercial interest or financial support.

Background:  The shape of the forehead is primarily determined by the frontal bone, which holds significance for health and aesthetics. This study evaluated the morphology of the frontal bone in different age groups and genders using computed tomography (CT).

Methods:  This cross-sectional study was conducted on CT scan results of 220 patients divided into three age groups: 20-29.27, 29.27-47.54, and 47.54-95 years. The investigation explored the lower and upper angles compared with the Sella-Nasion (SN) line, the maximum frontal projection with Nasion in the SN plan, and the variations in frontal thickness across different angles (15, 30, 45, 60, 75, and 90 degrees) relative to the SN plane. All data were analyzed using R software, considering the significance level p < 0.05.

Results:  Of 220 patients, 119 were men, and the mean age of the participants was 41.09 ± 18.06 years. The average upper frontal slope (UFS) angle was 56.96 ± 8.17 degrees, which was 59.35 ± 7.92 degrees in females and 54.94 ± 7.86 degrees in males. The mean lower frontal slope (LFS) angle was 86.30 ± 7.96 degrees, which was 90.71 ± 6.67 degrees in females and 82.55 ± 7.00 degrees in males. The average contour nasion (C-N) distance was 7.51 ± 3.72 mm. Also, the frontal thickness at an angle of 15 degrees had the highest value of 13.08 ± 2.68 mm and at 30 degrees had the lowest value of 5.81 ± 1.56 mm. A significant difference was observed between the UFS and LFS among males and females (p < 0.001). Across all age groups, men exhibited a steeper angle, indicating a greater posterior inclination than women. Moreover, males with upper ages reported a significant increase in C-N distance and frontal projection (p < 0.05).

Conclusion:  Our findings emphasize the importance of considering gender-specific variations in frontal bone structure when planning cosmetic or reconstructive procedures involving the forehead.

While Asian noses are generalised as having smaller bones and softer cartilages, thicker skin and soft tissue envelop (SSTE), there exists a diversity of morphology amongst Asian noses. The over-simplification of Asian noses diminishes the validity or generalizability of rhinoplasty research findings and makes comparison of outcomes challenging. A classification system is proposed that reflects the different structures and SSTEs of the nasal subtypes, the techniques required in the management of each of the subtypes, the challenges the surgeon will face intra- and post-operatively, allows for pre-operative counselling of expected outcomes and facilitate valid and fair comparison of study outcomes by comparing like for like. The classification system stratifies noses into four subtypes based on i. the size and strength of the nasal bone and cartilages, and ii. the thickness of the SSTE. Type I noses have thinner SSTE and stronger structure. Type II noses have thinner SSTE and weaker structure. Type III noses have thicker SSTE and stronger structure. Type IV noses have thicker SSTE and weaker structure. Inter-rater variability in classifying noses amongst rhinoplasty surgeons was found to be very high with a kappa coefficient of 0.933 (95% confidence interval 0.852 to 1.014; variance 0.013).

Objective: The purpose of this study is to investigate the facial symmetry aesthetics (FSA) in the Saudi Arabian population using AI.

Materials and methods: 210 people from a range of demographic backgrounds participated in an observational cross-sectional study that was done at a hospital. Standardized posed photos of the face and smile were taken using a Canon camera utilizing a stratified random sample approach. A Webceph software (Korea) with artificial intelligence was used to evaluate macro, micro, and tiny aesthetic factors. The data were analyzed using paired t-tests, posthoc Bonferroni testing, ANOVA, and descriptive statistics. The computation of intra-class correlation coefficients (ICCs) was utilized to assess the dependability of AI evaluations.

Results: All variables had ICCs more than 0.97, indicating exceptional dependability for the AI-based evaluations. Between the Class I and Class III malocclusion groups, there were significant variations in right mandibular body length (p < 0.001), with Class III patients exhibiting greater values. While no significant changes were identified for other characteristics, paired t-tests showed a significant divergence in mandibular body length between the right and left sides (p = 0.001). In Class III malocclusion, there was a significant preference for right deviation in the direction of mandibular deviation (p = 0.005). These results imply that AI is capable of accurately identifying some anatomical characteristics associated with face aesthetics, especially when it comes to differentiating between Class III malocclusions.

Conclusion: In conclusion, the Saudi Arabian population's facial symmetry assessments via AI have demonstrated a high degree of reliability and consistency. Notably, the length of the mandible on the right side has emerged as a crucial feature in discriminating between malocclusion classes. The study emphasises how AI might improve the accuracy of assessments of face aesthetics and our knowledge of facial features connected to malocclusion.

Over the past 20 years, we have designed various types of expanded cervical flaps for large facial defects and achieved excellent tissue matching. This study was performed to propose a treatment strategy for flap selection for the reconstruction of different facial units. The authors retrospectively reviewed the application of cervical expanded flaps for facial rehabilitation in our department between January 2003 and January 2023. The study included 122 patients with unilateral (62.3%) and bilateral (37.7%) facial deformities ranging from the zygomatic arch to the chin. The median area of the tissue defect was 15.2 × 8.5 cm² (ranging from 6 × 4 cm² to 27 × 12 cm²). The expansion period ranged from 61 to 175 days (mean: 86.5 days). Maximum and minimum sizes of pre-expanded cervical flaps were 30 × 13 cm² to 7 × 5 cm². All the flaps could be summarized into type 1, an advanced expanded cervical flap; type 2, a wing-shaped expanded cervical flap with overlapping tissue expansion; and type 3, an expanded single-lobed transposition flap rotated based on the anterior neck. Cervical flaps reliably meet the reconstructive requirements for different facial units, especially for large cutaneous defects in the clinic. The selection of these flaps can be planned preoperatively according to the location and size of the defect or lesion.

Cervical chondrocutaneous branchial remnants (CCBRs) are rare anomalies found in the neck. These remnants can be easily misdiagnosed due to their low incidence, and they are often associated with other anomalies. Previous studies have reported an association with other anomalies in up to 76% of cases. In this article, the authors present a case series of two patients with bilateral CCBRs and investigate the associated anomalies through a literature review. Patients diagnosed with CCBRs who presented with cervical masses were included. Records were reviewed to investigate factors such as sex, location of the CCBRs, associated anomalies, timing of operations, and cartilage pathology. A surgical excision technique was employed, and the study also included a literature review focusing on reports related to CCBRs and associated anomalies. Two patients, a 3-year-old boy and a 17-year-old adolescent girl, with bilateral CCBRs underwent surgical excision. Patient demographics, prevalence, and characteristics of associated anomalies in CCBR cases were documented in the literature review. This case series presented two successful surgical excisions of CCBRs without complications or recurrence at 1 year of follow-up. The study emphasized the importance of thorough evaluation and assessment for associated anomalies in various body systems due to the potential co-occurrence of CCBRs with other anomalies.

Prominent ears (PEs) are the most frequent congenital external ear deformity, occurring in ∼5% of the population. Although the deformity does not usually cause functional difficulties, it can significantly affect the patient's psychological and social health. The authors aim to present the Welsh experience of pinnaplasty, reviewing our outcomes and complications. A retrospective cross-sectional study was performed of all patients undergoing pinnaplasty in Morriston Hospital, Swansea, Wales. We represent the tertiary plastic surgery referral unit across Wales. We included all patients undergoing pinnaplasty between 2015 and 2022 inclusive. We excluded patients undergoing revision procedures or those who had no follow-up. Over the 7-year period, 236 pinnaplasties were performed and 203 were included in the analysis. Ninety-six percent of cases were performed using a cartilage-sparing approach, which represents the mainstay in our unit. The mean follow-up length for our cases was 12 months. Revision procedures were required in 4% of cases. Three hematomas (1.5%) and one (0.5%) wound dehiscence due to infection were recorded and required a return to the operating room. Suture extrusion was noted in 5% of cases (10 patients); 4.5% (9) cases were affected by either hypertrophic or keloid scarring. Across the United Kingdom, cosmetic procedures have come under scrutiny, namely, because of a difficult economic climate. In the era of tight fiscal control in health care, it is pertinent to analyze the outcomes and performance metrics of our operations regularly, thus aiding in the development of an established evidence base to advocate for our respective patients.

Congenital earlobe clefts are the most common lower auricular malformations. They represent a unique reconstructive challenge. The goal of surgery includes restoration of a natural lobular contour and volume as well as a fine surgical scar. Several surgical techniques have been described, most of which only address the cleft deformity but not the soft tissue deficiency. We hereby describe a technique which addresses both the cleft and improves soft tissue deficiency through a conchal cartilage graft.