Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: Aesthetic neck contouring is a key component to facial rejuvenation. Objective: To compare patient-reported symptoms after deep neck lift with versus without anterior digastric (AD) myectomy. Methods: Retrospective cohort of patients undergoing neck lift (July 2020-December 2024) grouped by AD myectomy status. Primary outcomes were dysphagia, dysarthria, throat pain, and neck tightness lasting >1 month. Secondary outcomes included hematoma, seroma, scar revision, skin breakdown, and revision neck lift. Results: Of 452 patients with >3 months' follow-up, 142 had no AD myectomy, and 310 had AD myectomy. Median age was 59 (53-65) versus 60 (54-64) years; 92% were female (89% vs. 94%). Median follow-up was 9.60 (4.53-16.69) versus 9.39 (5.78-13.35) months. Combination procedures were performed in 72% (59% vs. 78%), and submandibular gland reduction in 30.5% (0% vs. 44.5%). Primary complaints occurred in 9.9% (95% CI: 6.0-15.9) versus 10.0% (95% CI: 7.1-13.8) with no significant differences in dysphagia, dysarthria, or throat pain. Neck tightness was lower with AD myectomy: 4.8% versus 13.4%, p = 0.0015. Revision neck lift was lower with AD myectomy: 3.9% versus 9.2%, p = 0.027. Conclusions: AD myectomy does not increase functional complications and reduces neck tightness and revision surgery.

Background: Virtual neuromuscular retraining (NMR) has grown rapidly since 2020, with limited evaluation compared with in-person therapy. Objective: To compare outcomes of patients with facial paralysis undergoing virtual and in-person NMR at a single institution, measured by Sunnybrook scores. Methods: Retrospective cohort study of medical records from a tertiary care center between 2018 and 2024. Data on demographics, Sunnybrook scores, therapy initiation, etiology, and visit metrics were collected for 161 patients. A doubly robust estimator evaluated relationships between visit modality, total visits, and therapy timing on Sunnybrook changes. Results: Patients with >50% or <50% virtual appointments showed no difference in age, etiology, or prior intervention. Males were more likely to receive in-person NMR (p = 0.003). Increasing virtual NMR visits by 20% and 40% did not alter Sunnybrook scores (p = 0.856; p = 0.996). Reducing the duration prior to treatment by 1, 5, or 12 months significantly improved Sunnybrook scores (p = 0.013; p = 0.006; p = 0.005). Fewer total visits correlated with significantly lower Sunnybrook scores, emphasizing frequent therapy (p < 0.0001). Conclusion: Virtual NMR generated comparable Sunnybrook scores with in-person therapy, and earlier treatment initiation and greater total visits were associated with improved outcomes independent of modality.

Importance: This review aims to assess the current landscape of implantable and prosthetic devices for dynamic facial reanimation. Evaluation will include mechanisms, reported effectiveness, and clinical feasibility. Observations: This scoping review included 34 primary studies published since 2000, focusing on prosthetic and implantable devices for dynamic facial reanimation. Four major categories emerged: electromyography-functional electrical stimulation (EMG-FES) systems, artificial muscles, electromagnetic actuators, and wearable prosthetics. Most research addressed periocular reanimation, particularly blinking, and several studies discussed midface and smile restoration. EMG-FES systems were the most represented and robust across animal in vivo models. Artificial muscle, electromagnetic actuators, and wearable prosthetics mostly remain in theoretical stages. Conclusions and Relevance: Although not yet fully viable, implantable and prosthetic devices show potential to complement or one day replace current surgical approaches to facial reanimation. EMG-FES systems offer the most viable near-term options. Clinically, these technologies may offer customizable, dynamic facial movement restoration, especially for patients with limited surgical options. Continued innovation and long-term safety studies will be essential.

Importance: Corticosteroids are recommended as first-line treatment for adults with acute Bell's palsy, but their role in children remains uncertain. Objective: To assess the effect of corticosteroid therapy on recovery rates in children with acute Bell's palsy. Evidence Review: PubMed, Scopus, and Cochrane Library were systematically searched from inception to April 2, 2025, for studies on corticosteroids for children with Bell's palsy. Odds ratios and risk ratios with 95% confidence intervals were pooled using R software (version 4.2.3). Risk of bias was assessed with RoB2 and ROBINS-I. Findings: Eleven studies were included, comprising 750 children, of whom 495 (66%) received corticosteroids. The analysis across final follow-ups showed no significant difference. Because follow-ups ranged from 1 to 24 months, 1, 3, and 6 months were used as key points to create comparable intervals. The following subgroups were analyzed for each interval: corticosteroid monotherapy and corticosteroids plus adjunctive therapy. Corticosteroid monotherapy was associated with higher complete recovery rates beyond 1 month and a lower risk of incomplete recovery after 6 months. Conclusions and Relevance: Corticosteroid monotherapy in children with acute Bell's palsy may improve recovery rates beyond the first month, supporting its implementation in treatment protocols.

Background: Hematoma is a known complication of rhytidectomy, and improved understanding of its incidence and the impact of adjunctive measures is essential to guide evidence-based practice. Objective: Compare hematoma rates among patients undergoing deep plane facelift in those where either tranexamic acid (TXA), hemostatic nets, or tissue sealants are used. Methods: A review was conducted in Ovid MEDLINE, EMBASE, PubMed MEDLINE, Cochrane, and SCOPUS to identify studies that employed deep plane facelifts and reported hematomas. The primary outcome was hematoma rates. Secondary endpoints included rate of revision surgeries and use of preventative measures (hemostatic nets, tissue sealant, and TXA). Meta-analyses were conducted to determine the probability of postoperative hematoma and the effectiveness of preventative measures. Results: Overall, 8,841 patients from 31 studies were included. Ages ranged from 31 to 84 years, and 85.2% (4,330/5,080) were women. Meta-analysis showed an overall hematoma rate of 2.7% (95% CI: 2.2-3.4%), with major hematomas at 0.97% (95% CI: 0.61-1.53%). Subgroup analysis showed major hematoma rates of 1.53% with TXA, 1.25% with sealants, and 1.23% with hemostatic nets. Conclusions: Evidence from this review suggests that deep plane facelifts have a 2.7% overall and 0.97% major hematoma rate, with no clearly superior adjunct among TXA, sealants, or hemostatic nets.

Background: Accurate assessment of facial paralysis is crucial for patient management and research, yet current clinician-graded scales are limited by subjectivity and variability. Objective: To evaluate whether an automated video analysis pipeline using hemifacial mirroring and Facial Action Unit (AU) quantification could accurately classify facial paralysis severity (None, Incomplete, and Complete) when validated against expert clinical grading. Methods: A custom Python pipeline processed 112 clinical videos (100 paralysis patients, 12 controls), generating mirrored hemifacial constructs. OpenFace 2.0 extracted AU intensities from these constructs, linked to voice-command-defined action epochs. Peak expression features trained XGBoost machine learning models to predict paralysis severity (None, Incomplete, and Complete) per facial zone (upper, mid, and lower), validated against multi-expert clinical assessment. Results: On held-out test sets, models achieved: upper face accuracy 0.83, weighted F1-score 0.83; mid-face accuracy 0.93, weighted F1-score 0.92; and lower face accuracy 0.84, weighted F1-score 0.82. Mirrored AU intensities significantly differed across expert-defined severity groups, validating feature relevance. Conclusion: The automated pipeline using hemifacial mirroring and mirrored AU analysis accurately predicted facial paralysis severity from standard clinical videos.

Purpose: Pediatric neoplastic facial paralysis presents challenges in planning surgical reanimation. Methods: A review of pediatric patients with facial paralysis secondary to malignant tumors was conducted. Oncological data, functional status, chronology, and degree of paralysis were recorded. Surgical indications and techniques were documented. Postoperative outcomes included facial nerve function and survival. Results: A total of 14 patients were analyzed. The most common tumor location was the posterior fossa (n = 12). Most patients showed stability of the tumoral disease (n = 11). Facial paralysis occurred mainly after tumor surgery (n = 12). The House-Brackmann (HB) grade at diagnosis was IV (n = 2), V (n = 3), and VI (n = 7). Two patients had bilateral paralysis, with HB grade V (n = 1) and VI (n = 1) respectively. Facial reanimation was performed on 10 patients, with a median paralysis-to-surgery interval of 15 months (2-21). Surgical techniques included interposition nerve grafts, cross-facial nerve grafts, or regional nerve transfers. At 12 months, 9 patients improved to HB grades III-IV, the Sunnybrook score improving from 7.5 (5-55) to 44 (34-67). The deaths of 3 patients were documented. The remaining patients maintained stable facial function. Conclusion: Our experience with facial reanimation surgery in oncological patients is positive, most patients remaining with stable oncological status and good functional outcomes.