Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: Chemodenervation is widely used for management of synkinesis in patients with facial palsy, but there is limited objective data assessing treatment effect. Objective: To measure the eyelid palpebral fissure height at rest and during movement after chemodenervation of the orbicularis oculi muscle among patients with ocular synkinesis, as measured on photographs with computerized facial analysis application. Methods: A retrospective review of patients who underwent initial chemodenervation to the orbicularis oculi for synkinesis was conducted from January 1, 2015, and July 26, 2023. Changes in palpebral height following injection "at rest" and during "pucker" (activation of ocular synkinesis) were calculated using the Emotrics+ program. Results: Nineteen patients were identified: 78.9% female, 73.7% White, and a mean age of 49.74  ±  13.62yrs. They received a mean of 11.45  ±  3.57 units to the orbicularis oculi. A mean 37.63  ±  11.21 days elapsed between injection and postinjection photograph. Palpebral fissure height increased by a mean of 1.16  ±  1.86 mm while "at rest" (p = 0.014) and 2.31  ±  1.35 mm during "pucker" (p < 0.01). Injected dose was not associated with changes in palpebral fissure height "at rest" (p = 0.141) or during "pucker" (p = 0.125). Conclusions: Our findings suggest that chemodenervation of the orbicularis oculi improves palpebral fissure height in ocular synkinesis, more so during dynamic motion.

The objective of this study was to describe the surgeons who have incorporated dorsal preservation (DP) into their practice and their techniques. An anonymous form reviewed by the Evidence-Based Rhinoplasty Research Group board was shared on its Telegram group. The study population was divided into three groups based on their answers: "Preservers," "Mainly Structural," and "Structural exclusively." This study included the answers of 145 worldwide surgeons. DP was more common among plastic surgeons than otolaryngologists/facial plastic surgeons; DP techniques were mostly preferred by surgeons with 10-20 years of experience, while structural techniques were mostly preferred by surgeons with > 20 years of experience; 50.8% of the surgeons who prefer DP techniques use it in more than 90% of primaries; surface techniques (ST) have been more used, mainly by surgeons who prefer structural techniques (p < 0.001). ST were considered more stable (p < 0.001), more predictable (p < 0.001), and shorter learning curve (p < 0.001). Many surgeons using DP still perform structural rhinoplasty. The most cited concern was hump persistence/recurrence. DP rhinoplasty is gaining acceptance, and ST are favored for their perceived short learning curve, stability, and predictability. However, concerns about hump recurrence cause some to continue using structural methods alongside DP.

Importance: Systematic review will improve understanding of nonsurgical facial feminization techniques, which are useful alternatives or adjuncts to surgical gender affirmation. Objective: To determine the effectiveness of nonsurgical facial feminization techniques in patients seeking gender-affirming feminization by reviewing the literature for patient-reported, subjective, and objective outcomes of feminization. Evidence Review: A comprehensive database search was conducted through July 28, 2022. A total of 264 titles and abstracts were screened by two independent reviewers in Covidence. Of all, 48 met the inclusion criteria for full-text review, and 20 articles were included in the final data extraction. Findings: The most described nonsurgical facial feminization techniques were neurotoxins, fillers, and hair removal. Techniques were derived from cisgender cosmetic procedures to achieve feminine qualities. The most common study type was expert opinion or literature reviews. There were only two studies that analyzed measurable nonsurgical facial feminization techniques. Conclusions and Relevance: There is a lack of high-quality prospective research and randomized, controlled trials specific to the transgender patient population that evaluate outcomes, patient satisfaction, or complications. Such studies are needed to inform evidence-based practices.

Background: Facial aberrant reinnervation syndrome is characterized by aberrant facial muscle reinnervation after facial nerve injury producing facial synkinesis, hypertonicity, and muscle spasm. Objective: To systematically review the surgical treatments for facial aberrant reinnervation syndrome and assess their effectiveness as measured by patient-reported outcomes, physician-graded outcomes, or computer-automated grading systems. Methods: We conducted a systematic review using PubMed, Embase, and Cochrane CENTRAL in accordance with PRISMA guidelines. Texts reporting outcomes of any surgical treatment for facial aberrant reinnervation syndrome from 2003 to 2023 were included. Results: After screening, 25 studies with 731 patients were included. Surgical procedures included selective neurectomy (SN), selective myectomy (SM), cross-facial nerve graft, masseter nerve transfer, and gracilis muscle transfer. All surgical techniques and combinations showed significant improvement in at least one clinical outcome measure from baseline (p < 0.05), although one study found no significant improvement. Thirty different outcome measures were used, the most common being the FaCE and eFACE scales (seven studies each). Conclusions: All surgical procedures in this review yield improved clinical outcome measures for facial aberrant reinnervation syndrome, with SN and SM being the dominant surgical treatments. Standardized outcome assessment and more nuanced patient evaluation are necessary to determine the most effective surgical treatments.