Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: This study introduces variations of a limited delamination approach to the deep plane face- and necklift. Objectives: To report surgeons' perceptions of limited delamination deep plane rhytidectomy, define the anatomical basis to support these modifications, and report complication rates. Methods: This retrospective multi-institutional chart review study of patients undergoing a modified classical deep plane face- and necklift. Surgeons' perception of outcomes and self-reported complications were collected. Results: In total, 3964 patients having undergone face- and necklift with six surgeons being included. Most patients were female (87.9%) with an age range of 31-83 years (mean 58 years). Most were primary procedures (2672/3964; 67.4%) with a median follow-up of 425 days (range 21-5470). Preliminary surgeon experience demonstrated increased ease of flap management, improved biomechanics, smaller perceived rates of skin discoloration, and telangiectasia of the skin and lower revisions rate (n = 11; 0.8%). Complication rates were low for hematoma (n = 24; 1.9%) and seroma requiring needle aspiration (n = 26; 2%) and minor infection (n = 18; 1.4%). Conclusions: A multicenter surgeon experience with the limited delamination extended deep plane rhytidectomy is based on anatomical evidence and demonstrates low complication rates and surgeon-perceived improved long-term outcomes. Prospective comparative outcomes of these evolving techniques are warranted.

Background: Chemodenervation is an important means of treating oral-ocular synkinesis, but upper eyelid treatment is avoided due to risk of blepharoptosis. Objective: To measure the change in eyelid position among patients with oral-ocular synkinesis who received botulinum toxin to the upper eyelid orbicularis oculi compared with those who received lateral and lower eyelid treatment alone. Methods: In this retrospective clinical study, patients were categorized as having received lateral and lower eyelid botulinum toxin alone or having received upper eyelid botulinum toxin (to the preseptal and orbital orbicularis oculi) along with lateral and lower eyelid treatment. Pre- and posttreatment margin to reflex distance 1 (MRD1), margin to reflex distance 2 (MRD2), and palpebral height were measured using Emotrics software and compared using t tests and regression analysis. Results: Twenty-five patients were included. Mean age was 48.7 years and 24% were male. Mean duration of paralysis was 29 months (range 9-360 months). Posttreatment resting MRD1 (3.36) was not significantly different than pretreatment resting MRD1 (3.43) for patients who received upper eyelid botulinum toxin (p value = 0.60). Conclusion: Botulinum toxin to the upper eyelid orbicularis oculi injected superficially in small, concentrated aliquots did not result in blepharoptosis and was effective in reducing oral-ocular synkinesis.

Background: The rates and risk factors for wound complications following staged reconstruction after facial lentigo maligna (LM) resection have not been well described. Objectives: (1) To identify the rate and types of wound complications, including infection, graft necrosis, distal flap necrosis, hematoma, superficial epidermolysis, and seroma among patients undergoing staged reconstruction after resection of LM as documented in the surgeon's clinical notes within 30 days of the procedure. (2) To determine a threshold defect size that may predict the development of wound complications. Design and Outcomes: Retrospective review at an academic medical center of patients who underwent staged reconstruction after facial LM resection over a 5-year period. Results: Ninety-eight patients were identified with a mean age of 69.2 ± 13.6 years; 37% of patients were female. The most common defect sites were the cheek (n = 41; 42%) and nose (n = 22; 22%). Twenty-five of 98 patients (26%) demonstrated complications, with the most common being wound infection (36%) and graft necrosis (24%). Those receiving perioperative antibiotics had lower rates of complication (odds ratio [OR]: 0.36; 95% confidence interval [CI]: 0.13,0.96; p = 0.041). Defects greater than 2.7 cm in maximal diameter had the highest sensitivity for predicting complications. Conclusions: Patients undergoing staged reconstruction after facial LM resection have a high rate of wound complication (26%) and defect size > 2.7 cm may be an important risk factor.

In this short communication: (1) A transcutaneous electrical nerve stimulaton stimulator is a cost-effective solution for the predictable stimulation of mimicry and for precise decision-making. (2) Positioning a simple shatterproof mirror in front of an operated facial half enables the primary surgeon to simultaneously see and stimulate at the operative site and to scrutinize the mimicry for decision-making. (3) A misconception in the literature regarding colors used for tagging "branches for transection" and "branches for preservation" is clarified, and a third tag-color is suggested for times of ambiguity. (4) The principle of distal execution of the surgery and technical considerations are underlined for maximal transection and maximal preservation. The modified selective neurectomy surgery is the current golden standard of post facial paralysis synkinesis treatment, and developing a learning curve in this type of surgery is like walking a tightrope, where the surgeon must keep pushing the limits with precise decision-making and a small margin of error. It is important to be reminded that the first aim is primum non nocere, and the second aim is to improve the condition of patients as much as possible. The above-mentioned principles and solutions increase precision and safety, assisting surgeons to achieve better outcomes.

Background: Dorsal preservation rhinoplasty (DPR) has shown promise in Western populations for nasal hump reduction, but its feasibility and long-term outcomes in Asian individuals remain unexplored. Objective: To measure the feasibility, as well as the functional and aesthetic outcomes, of DPR in Asian hump noses and to determine its effectiveness in adaptation to the unique characteristics of the Asian demographic. Methods: A retrospective review analyzed patients who underwent primary DPR between April 2019 and November 2022 with a follow-up period of over 12 months. The study included patients whose photographs met the criteria. Surgical techniques, aesthetic measurements using anthropometric factors, and subjective outcomes were evaluated. Results: Of the 17 patients (11/17, 64.7% female), the mean age was 22.53 years (standard deviation [SD] 5.22 years). The median follow-up period was 36.90 months (range 13-61 months). Measurements from pre- and postoperative photographs showed a significant reduction in both nasofacial angle (7.76°, SD 4.30°) and rhinion angle (0.85°, SD 0.69°) (p < 0.0001). Patient-reported outcome scores with the Nasal Obstruction Symptom Evaluation scale decreased from 61.00 (SD 26.96) to 15.50 (SD 11.65), and Standardized Cosmesis and Health Nasal Outcomes Survey scores postoperatively were 10.90 (SD 7.71) overall, with the functional component at 3.50 (SD 2.64) and the aesthetic component at 7.40 (SD 6.24). No residual hump, recurrence of the hump, or complications were observed. Conclusion: In this study, the use of DPR techniques was effective and may support further development of the inclusion and exclusion criteria for its use in correcting the dorsal hump in Asian patients. Careful patient selection will be imperative to determine the ultimate indications for this technique.