Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: While facial neuromuscular retraining and chemodenervation are effective treatments for facial synkinesis, it is unclear if clinical outcomes are affected by the timing or sequence of treatment initiation. Objective: To compare outcomes between patients with facial synkinesis based on timing of treatment initiation with facial neuromuscular retraining and/or chemodenervation as measured by the Sunnybrook Facial Grading System. Methods: Retrospective review of patients with facial synkinesis. Patient data recorded include demographics, clinical information, and Sunnybrook scores. t-Tests, analysis of variance, and logistic regression were used for analysis. Results: A total of 78 adult patients were included in our study (73% female; median age 50 years with a range of 18-78 years). Median patient follow-up was 16 months (range of 1-56 months). Patients were divided into three groups based on time between paralysis onset and treatment initiation: <12 months, 12-36 months, and >36 months. The use of facial neuromuscular retraining and chemodenervation improved Sunnybrook scores for all patients. The time between paralysis onset to treatment initiation was not associated with a difference in Sunnybrook scores. Conclusion: The duration of facial palsy prior to initiation of facial neuromuscular retraining and/or chemodenervation was not associated with a difference in synkinesis outcomes as determined by Sunnybrook scores.

Introduction: There is significant variability in how rhinoplasty results are presented on social media. This study aims to evaluate the quality and consistency of preoperative and postoperative rhinoplasty photos on the social media platform Instagram. Methods: Instagram was queried on April 4, 2024 using the search term #rhinoplastybeforeandafter. Posts meeting our inclusion criteria were analyzed for inconsistencies in background, makeup, use of personal photo, and variations in face size between preoperative and postoperative images. Account demographics and time since surgery were also noted. Results: A total of 888 sets of before-and-after rhinoplasty photos were included, with nearly all (n = 882) posted by surgeon accounts. Of the posts analyzed, 23.7% had a ≥10% face size discrepancy, and 5.1% had a ≥10% face rotation discrepancy. Only 35.7% of posts were considered "high quality," with no significant photo discrepancies between postop and preop images and with postoperative time interval reported. Conclusion: Instagram before-and-after rhinoplasty photos evaluated in this study exhibited significant heterogeneity in quality and consistency regarding image background, image source, face size, face rotation, and brightness. Surgeons should prioritize consistency between preoperative and postoperative photos when sharing their results to minimize the potential for misleading the public.

Background: Computer-aided design and manufacturing can enhance microvascular mandible reconstruction, particularly in cases with preexisting segmental defects or exophytic tumors where precise in situ plate bending is difficult. However, its high cost may limit its use in high-volume academic centers. Objective: To compare the costs of industry-performed patient-specific milled locking mandibular reconstruction plates (LMRPs) and surgeon-performed plate bending using 3D-printed (3DP) models as measured by billing data. Methods: A retrospective study of patients who underwent mandibular reconstruction with either industry-performed milled plates or with surgeon-bent plates based on a 3DP model. Costs of patient-specific and stock plates were obtained from the hospital's financial database, along with surgical outcomes associated with each protocol. Results: The study included 25 patients (14 males and11 females) undergoing fibula free flap reconstruction for mandibular defects, averaging 6.4 cm in size. Groups were comparable in age, sex, defect size, number of osteosyntheses, and incidence of osseous union. The average cost of milled plates was $7,709, while 3DP models and standard reconstruction plates cost $1,453, a difference of $6,256. The 3D printer's initial investment was $18,998, but readily with models produced for about $10 per model. Conclusion: Surgeon-performed 3D printing for plate bending is less expensive than computer-aided, patient-specific plates for mandibular reconstruction.

Background: Melasma is a chronic skin pigmentation disorder, and intradermal injection of tranexamic acid (TXA) is an effective treatment option for melasma with limited comparative efficacy studies. Objectives: To compare the effectiveness of TXA injections with other treatment modalities for patients with melasma, as measured by Melasma Area and Severity Index (MASI). Methods: A total of 17 eligible randomized controlled trials were included in the meta-analysis. The MASI and the modified MASI served as the primary outcome measures of treatment effectiveness. Patient satisfaction was also evaluated. Results: Among the various administration routes for TXA, intradermal injection and microneedling demonstrated superior effectiveness, followed by oral administration and topical application. As for patient satisfaction, oral administration outperformed the injection method, whereas topical administration significantly underperformed injection. Furthermore, TXA injections were more effective than the majority of non-TXA standard treatments for melasma. Conclusions: This meta-analysis and systematic review suggested that intradermal TXA injection is an effective alternative for melasma treatment, with potential advantages over other administration routes.

Background: Tranexamic acid (TXA) has the ability to reduce intraoperative bleeding and facilitate hemostasis in addition to its anti-inflammatory properties that can potentially aid in recovery among patients who underwent rhytidectomy. Objective: To compare postoperative ecchymosis in patients who underwent rhytidectomy with TXA added to the tumescent anesthetic. Methods: A multi-institutional, single-blind study was performed on patients who underwent rhytidectomy. The sidedness of the face was randomized to receive either local anesthetic with TXA or without, prior to incision for rhytidectomy. The primary outcome was postoperative ecchymosis that was graded by the surgeons at the 1 week postoperative time frame in standard photograph review. Results: A total of 70 patients, mean age 62.1, were enrolled in the study. The surface area of postoperative ecchymosis at 1 week was shown to be significantly less on the side of the face that received local anesthetic infiltration prior to incision with TXA than the side that had local anesthetic without TXA (p < 0.001). These results were consistent with subjective measurements of postoperative ecchymosis graded at 1 week with two blinded investigators to the sidedness of the face that received TXA (p < 0.001). Conclusions: TXA may potentially facilitate a reduction in postoperative ecchymosis in patients undergoing rhytidectomy.

Introduction: Most patients with acute facial palsy initially present to emergency departments (EDs), where clinical practice guidelines (CPGs) recommend steroids, eye care, and follow-up with facial nerve specialists. Objective: To evaluate adherence to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Bell's palsy (BP) CPGs within EDs at a single academic institution. Method: We conducted a retrospective review of all patients diagnosed with acute facial palsy in the EDs of an academic tertiary care center between June 1, 2021, and June 1, 2022. Results: A total of 270 patients met inclusion criteria; most were male (n = 150, 55.9%), diagnosed with BP (n = 243, 90.0%), and presented to community-based emergency rooms (n = 170, 62.96). Although most patients received steroid treatment (n = 243, 90.0%), only 61.5% (n = 166) received the AAO-HNS-recommended course. Older patients and those who received steroids were more likely to receive imaging (p < 0.001, p = 0.03). Treatment with the AAO-HNS-recommended steroid regimen was associated with a higher likelihood of receiving laboratory evaluation (p = 0.02). Providers often advised follow-up; however, only 12.2% of patients were discharged with an electronic referral order. Conclusion: There are opportunities to standardize the treatment of patients in the ED presenting with acute facial palsy according to AAO-HNS CPGs.