Facial Plastic Surgery & Aesthetic Medicine最新文献

Women surgeons face disproportionately high rates of burnout, depression, and suicide, with a shortened life expectancy compared with those outside of medicine. These outcomes are driven by systemic inequities rather than individual shortcomings. Despite equal representation in medical school, women remain underrepresented in leadership, overburdened by domestic responsibilities, victims of sexual harassment and biases, and inadequately supported by our institutions. These challenges lead to decreased career satisfaction and higher attrition rates. The overuse of terms such as "burnout" without meaningful action has left many of us feeling acknowledged but unsupported. To improve both career and health longevity, we must focus on system-level reform utilizing evidence-based interventions, including paid parental leave, access to childcare and lactation policies, harassment protections, flexible work structures, mentorship, and leadership development. Addressing these barriers is not only essential for gender equity but also pivotal to outstanding patient care.

Background: There is a paucity of validated, patient-reported outcome measures for quality-of-life (QOL) in craniomaxillofacial (CMF) trauma. Objective: To determine whether the Integrated Modular Patient-Reported Outcome Assessment for Craniomaxillofacial Trauma (IMPACT) independently measures QOL in patients presenting for routine follow-up within 3 months of injury by comparing with the 15-Dimension QOL survey (15D). Methods: A mixed-methods, pilot validation was performed via literature review, expert opinion, patient interviews, and prospective survey collection. Criterion validity was determined by multivariable adjusted correlation coefficients (B) between IMPACT and 15D scores. Reliability was assessed by Cronbach's alpha (A). Results: General (IMPACT-G), Nasal (IMPACT-N), Orbit (IMPACT-O), and Jaw (IMPACT-J) modules were developed. Domains include overall satisfaction, facial function, facial appearance, psychosocial function, general symptoms, and pain. Validation was performed in 53 patients with CMF trauma who had mandible (n = 27, 50.1%), nasal (n = 10, 18.9%), zygomaticomaxillary complex (n = 7, 13.2%), Le Fort (n = 6, 11.3%), and/or other fracture patterns. IMPACT scores independently predicted QOL (B > |0.4|; p < 0.05) and reliability was high (A >0.8; p < 0.05). Conclusions: The IMPACT was developed to measure QOL in patients suffering CMF trauma, and results from this initial validation study warrant expansion to a larger, diversified cohort.

Injury to the depressor labii inferioris (DLI) is a frequent cause of lower lip asymmetry following deep plane facelift and structural neck contouring. This study characterizes the in vivo innervation of the DLI through intraoperative facial nerve mapping during selective facial neurectomy in 20 consecutive patients. In all cases, dual innervation of the DLI was observed: a superficial branch of the marginal mandibular nerve (MMN) supplies the lateral DLI, while an inferomedial cervical branch innervates the medial DLI. Both branches are located superficially and closely adherent to the deep surface of the superficial musculoaponeurotic system (SMAS) and platysma, placing them at risk during sub-SMAS and subplatysmal dissections. These findings challenge the conventional anatomical teaching that the DLI is solely innervated by the MMN. Incorporating this understanding of the DLI's dual innervation into surgical planning may help reduce the incidence of iatrogenic nerve injury and improve both functional and aesthetic outcomes in lower facial rejuvenation procedures.

Introduction: Facial palsy (FP) can impair nonverbal communication, and patients often report difficulty recognizing emotional expressions in others. Objective: To compare early cortical processing of emotional facial expressions in healthy controls, FP patients, and patients who had undergone facial reanimation surgery using magnetoencephalography (MEG) and analyzing the M170 component, a face-sensitive neuromagnetic response. Methods: Neuromagnetic responses were recorded with a whole-head 306-sensors MEG system. We studied M170 responses to angry, happy, sad, and neutral faces in 10 healthy controls, 5 untreated FP patients, 11 patients with hypoglossal-facial nerve transfer (HFNT), and 4 patients with temporalis muscle transfer. Results: Untreated FP patients had delayed M170 latencies (174.8 ± 14.5 ms) and increased amplitudes (430.2 ± 214.2 fT) compared with controls (162.8 ± 8.6 ms and 306.0 ± 185.0 fT). HFNT patients demonstrated reduced latencies (167.7 ± 12.5 ms) and amplitudes (285.5 ± 125.2 fT) relative to FP patients, approximating control values. No significant hemispheric effects or emotion-specific modulation were observed. Conclusion: These findings suggest that facial reanimation via HFNT may promote partial normalization of cortical processing of facial emotions, reflecting adaptive neuroplasticity. This study supports the facial feedback hypothesis, whereby the ability to express facial emotions contributes to effective emotion recognition.

Background: Variable terminology is used in the literature to describe facial synkinesis and hypertonicity following incomplete recovery from facial paralysis and its associated medical and surgical treatments. Study Objectives: Establish a nomenclature consensus for this condition among a group of facial nerve experts. Design Type: Consensus study. Methods: Using modified Delphi methodology, an international, multidisciplinary group of facial nerve experts reviewed the terminology for the name of the clinical condition and treatments of interest. Online surveys and a virtual discussion were performed to establish consensus, defined a priori as agreement by 80% of the group. Results: Twenty-five facial nerve experts established consensus after three Delphi rounds. Consensus terminology for the condition is "facial synkinesis" with 84% agreement. Medical treatment is termed "chemodenervation" with 100% agreement. Surgical treatments including "selective facial neurectomy," "selective facial neurotomy," "selective facial myectomy," and "selective facial myotomy," were defined and reached agreement of 100%. Conclusions: This international group of facial nerve experts has recommended standardized nomenclature for the condition of facial synkinesis and its various treatments. While "facial synkinesis" reached consensus as the preferred term, some experts noted it may insufficiently describe the full clinical spectrum, which includes muscle hypertonicity, weakness, and spontaneous twitching.