Facial Plastic Surgery & Aesthetic Medicine最新文献

Introduction: Outcomes for chemodenervation treatment of facial synkinesis are well described, and evidence for surgical interventions such as selective neurectomy and myectomy is growing. There is minimal comparative data on outcomes between selective neurectomy and/or myectomy versus chemodenervation.

Objectives: To compare facial synkinesis treatment with chemodenervation compared with surgery as measured by standardized outcome measures.

Methods: A systematic review of three databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Included studies used validated facial nerve outcome measurements (patient-graded, physician-graded, or semiautomatic) for chemodenervation or surgical treatment for patients with facial synkinesis. Studies were excluded if free muscle transfer was performed. Meta-analysis was performed on studies using the same outcome measure, and risk of bias assessment was performed using Cochrane Review systems.

Results: In total, 36 studies (1171 total patients) were included in the review. Chemodenervation and surgery both demonstrated benefit as measured by the Facial Clinimetric Evaluation Scale and Sunnybrook scale, without a difference between treatment types (p = 0.76 and p = 0.061, respectively). Synkinesis Assessment Questionnaire scores improved more with chemodenervation than with surgical treatment (mean 15.45 vs. 5.90 improvement, p < 0.0001). For semiautomated objective measurements using Emotrics software, myectomy produced more improvement in dental show compared to neurectomy (13.28 mm vs. -4.89 mm, p < 0.0001) and more oral commissure excursion than neurectomy or chemodenervation (3.79 mm vs. 1.60 mm vs. 1.00 mm, respectively, p < 0.0001).

Conclusions: Although most commonly used together, comparative analysis suggests that selective neurectomy and/or myectomy produce similar improvements in facial synkinesis compared to chemodenervation when assessed with patient surveys or clinician-graded tools. However, high interstudy heterogeneity and confounding covariates limit definitive conclusions, and more data from surgical treatments are needed.

Background: Artificial intelligence (AI) and machine-learning technology are on the rise, including ChatGPT and Google's Gemini, previously known as Bard. While recent studies have begun to explore the role of AI in medicine, there are no studies to date on the application of large language models to facial feminization surgery.

Objective: Establish the reliability of ChatGPT and Google AI (Bard) in providing patient education and describing surgical techniques specific to facial feminization surgery.

Methods: This was a prospective observational study. Both ChatGPT and Bard were queried with 9 questions. The same series of questions was asked 3 months later. Five expert reviewers were asked to rate responses in a blinded fashion using the modified AI-DISCERN criteria. One-way ANOVA and Tukey's HSD were used for analysis.

Results: ChatGPT outperformed Google Bard in areas of harmlessness, truthfulness, relevance, bias, sources, and aims at baseline. However, Bard was often able to resolve this discrepancy in 3 months.

Conclusions: While large language models show promise in disseminating patient education and general information on facial feminization, caution must be exercised reviewing outputs as inaccurate medical content may be encountered. However, repeated exposure seems to improve the quality of responses over time.

Background: Auricular asymmetry affects facial aesthetics; yet, the degree of asymmetry discernible by a casual observer remains poorly defined.

Objective: To measure the casual observer's perception of auricular size, angulation, protrusion, and vertical position.

Methods: Artificial intelligence-generated facial images were utilized and unilateral variations created in (1) size, (2) angulation, (3) protrusion, and (4) vertical position. A total of 200 responders reviewed 46 images, rating the ear appearance on a Likert scale of 0-10.

Results: Causal observers rated a ≥10% change in size significantly different than baseline (p < 0.001). Retrograde angulation ≥10° and anterograde angulation at 20° were rated significantly different than baseline (p < 0.001). Positive asymmetrical protrusion was rated more severely than negative asymmetrical protrusion. The vertical position difference was rated least critically on average compared with baseline.

Conclusion: Casual observers more critically perceived auricular size asymmetry and retrograde angulation when compared with protrusion and vertical position asymmetry.

Background: Comparative evidence regarding the effectiveness of adjuvant intralesional triamcinolone versus radiotherapy for auricular keloids remains limited.

Objective: To compare adjuvant triamcinolone injection and radiotherapy in preventing recurrence after auricular keloid excision as measured by regrowth of keloid tissue with a minimum follow-up of 6 months.

Methods: A systematic review and meta-analysis of PubMed, Embase, Cochrane Library, and Scopus identified studies of auricular keloids treated with excision plus adjuvant radiotherapy or triamcinolone. Non-English articles, case series with fewer than 10 patients, and combined treatments were excluded. Risk of bias was assessed using Cochrane Risk of Bias 2.0 and the Newcastle-Ottawa Scale, and pooled recurrence rates were calculated with random-effects models.

Results: Forty-five studies (1,885 lesions) were analyzed. Overall recurrence was comparable (triamcinolone: 12% [95% CI: 0.06-0.18] vs. radiotherapy: 13% [0.06-0.21]; p = 0.83). Triamcinolone recurrence varied by follow-up (≤1 year: 36% [0.24-0.49] vs. >3 years: 20% [0.11-0.33]; p < 0.001), while radiotherapy remained stable. Subgroup analyses showed no significant differences for injection timing or radiation dose.

Conclusions: In this study, the findings suggest that radiotherapy provides durable and superior effectiveness per treatment, whereas triamcinolone requires 4-6 monthly injections and shows progressive loss of long-term effectiveness. Individualized treatment selection that prioritizes long-term stability and treatment frequency is recommended.

Introduction: Facial palsy in facioscapulohumeral muscular dystrophy (FSHD) significantly affects function and quality-of-life.

Objective: To measure facial palsy burden in FSHD and assess its relationship to patient-reported outcomes and treatment-seeking behavior.

Methods: In a cross-sectional study, adults with FSHD completed FACE-Q (a validated patient-reported instrument assessing perceived facial appearance, function, and quality-of-life). A subset underwent objective facial movement analysis with DynaFace analysis software. Group differences in FACE-Q scores were compared between participants with/without facial symptoms (Student's T-test), and Pearson correlations linked objective metrics to FACE-Q domains.

Results: Among 191 respondents (mean age 52 ± 16.5 years), those with facial symptoms (n = 105) reported lower FACE-Q scores for smile, lips, appearance distress, and facial movement (p < 0.001). Participants who sought treatment reported greater appearance-related distress (p < 0.001), yet overall treatment use was low, with 48% receiving eye care and 1% undergoing surgery. Objective analysis demonstrated reduced eye closure and diminished smile dynamics; abnormalities in dental display and commissure excursion correlated with worse FACE-Q scores.

Conclusion: Objective facial assessments revealed marked facial movement deficits in FSHD and were closely aligned with lower FACE-Q scores, implicating the functional and aesthetic burden of facial palsy in FSHD.