Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: Defects following Mohs micrographic surgery often require complex facial reconstruction, with timing varying between immediate (<24 h) and staged (>24 h) reconstruction. Objective: To compare the risk of postoperative complications between immediate and staged reconstruction of Mohs defects for facial nonmelanoma skin cancer (NMSC). Methods: Patients with NMSC who underwent Mohs and facial reconstruction were identified using a health network database (TriNetX). Complications including flap loss, skin necrosis, hyperpigmentation, hypertrophic scarring, infection, hematoma, seroma, dehiscence, overall complication, and revision surgery were compared at 1, 6, and 12 months postoperatively. Results: A total of 48,229 patients (mean [SD] age, 71.6 [11.5] years; 31,862 [66%] male) underwent immediate reconstruction, and 48,229 patients (71.5 [11.5] years; 31,997 [66%] male) underwent staged reconstruction. Immediate reconstruction had a lower risk of overall complication at 6 months postoperatively (odds ratio [OR]: 0.95, p = 0.04) and wound dehiscence (OR: 0.58, p < 0.001) at 1 month postoperatively but no difference in flap loss or hematoma. No difference in skin necrosis between groups at 6 months postoperatively was observed. At 12 months, immediate reconstruction demonstrated a lower risk of revision surgery (OR: 0.826, p < 0.0001). There was no difference in hypertrophic scarring or hyperpigmentation at 12 months postreconstruction. Conclusion: Although complications are rare, this study demonstrates advantages of immediate or staged defect reconstruction.

Background: Equal attention must be given to nasal aesthetics and function when reconstructing nasal defects after skin cancer resection. Little data exist on functional nasal outcomes following nasal reconstruction. Learning/Study Objective: Describe and analyze factors contributing to functional outcomes following nasal skin cancer defect reconstruction. Design Type: Retrospective review. Methods: Patients who underwent reconstruction of Mohs nasal defects were included. Reconstruction methods included primary closure, skin grafts, and local and interpolated flaps. Both subjective reports and physician-noted exam findings suggestive of nasal obstruction were noted. The obstructive domain of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS-O) was administered preoperatively and at follow-up intervals. Results: In total, 193 patients met the inclusion criteria. Female sex, medial or lateral ala primary defect subunit, and auricular cartilage use were associated with increased risk of postoperative nasal obstruction within the first year on multivariate analysis, while reconstruction with a skin/composite graft was associated with lower risk of obstruction. Average time from reconstructive surgery to first report of obstruction was 116 days, and time to reported resolution was 235 days. Conclusion: The incidence of nasal obstruction following nasal defect reconstruction is low. Female sex, ala involvement, and auricular cartilage may increase the risk of nasal obstruction postoperatively.

Background: Selective neurectomy (SN) typically leaves cut nerve endings to be either free-floating or buried in facial muscles. Regenerative peripheral nerve interfaces (RPNIs) use autologous skeletal muscle grafts to provide a nonfacial muscle target for reinnervation. Objective: To evaluate the effectiveness of RPNI surgery with SN for improving postoperative facial function through botulinum toxin use and facial movement metrics. Methods: This was a retrospective cohort study comparing patients with synkinesis undergoing SN with and without RPNI surgery. Outcomes included assessing botulinum toxin dosage/frequency and facial movement metrics (margin to reflex distance, brow movement, smile excursion). Statistical tests were applied based on variable distribution. Results: Twenty-four patients were included (12 with RPNI surgery and 12 without; average age, 52.3 and 55.0 years, respectively; p = 0.552). No significant differences were observed in etiology or nerves sacrificed. Patients with RPNI surgery required lower botulinum toxin dosage (72.2 vs. 90.3 units; p = 0.031) and had longer treatment intervals (83.5%, 5.6 months vs. 17.9%, 4.6 months; p = 0.015). No significant differences were observed in facial movement metrics. Conclusion: RPNI surgery with SN may improve facial function as measured by a proxy of reduction in postoperative botulinum toxin dosage and frequency.

Background: There is limited literature assessing cosmetic lip size preferences in darker-skinned individuals. Objective: To measure preinjection lip augmentation preferences and postinjection satisfaction using the revised Lip Fullness Scale (LFS) in female participants with Fitzpatrick Skin Type V and VI. Methods: Females, aged 21 and over, with Fitzpatrick Skin Type V and VI desiring lip augmentation were recruited from a high-volume outpatient facial plastic surgery clinic. The LFS scale was administered pre- and postinjection. FACE-Q scales which measure patient reported outcomes for facial cosmetic procedures were administered postinjection. Results: Twenty-two female subjects participated in the study. The average age was 33.2 years (SD = 8.1). Fourteen participants (14) were Fitzpatrick V and eight (8) were Fitzpatrick VI. The average preinjection self-assessment LFS was 3.5. The final average postinjection self-assessment LFS score was 4.3. The increase in final postinjection LFS scores was found to be statistically significant with a p-value <0.001 when compared with preinjection LFS scores. Patients reported high satisfaction on postinjection FACE-Q. Conclusion: Patients with darker skin may prefer marked to very marked lip fullness, and physicians should be conscientious in understanding patients' individual perspectives and aesthetic goals.[Box: see text].

Background: The rise of social media parallels a mental health epidemic. The effect of social media usage on rates and severity of body dysmorphic disorder is not well-understood. Objective: To determine if an association exists between social media engagement, body dysmorphia symptoms, and/or interest in cosmetic surgery in a demographically diverse cross-section of the U.S. adult population. Methods: In a Qualtrics platform-based survey study of the general U.S. adult population, responses to demographic information, social media activity questionnaire and the body dysmorphic disorder screening questionnaire, and interest in cosmetic surgery were collected. Descriptive statistics and a multivariate logistic regression model were carried out. Results: A total of 1,013 respondents completed the survey. The average age was 40.9 (SD, 14.8) years, 72% were women. Median time spent on social media (IQR) was 4 (2-7) h/day. Respondents who screened positive for symptoms of body dysmorphia had higher daily mean social media usage time (odds ratio [OR] 1.49), tend to be female (OR 2.17), younger (OR 0.97), identify as Caucasian (OR 1.65), and are more likely considering a cosmetic procedure in the next year (OR 2.98). Conclusion: This study demonstrates a positive association between daily social media usage, self-reported symptoms of body dysmorphia, and interest in cosmetic procedures.