Facial Analysis Software Research Articles

The Influence of Social Context on Adolescents’ use of Prototypical Facial Expressions

Adolescents’ social behaviour varies by social context (e.g., who they are with); they might ‘play it cool’ with peers while displaying vulnerability with caregivers. Yet, the way in which social context affects teenagers’ nonverbal expression is unknown. The current study addresses this knowledge gap by examining how teenagers’ facial expressions differs when discussing emotionally charged topics with a friend vs. with a caregiver. Thirty-one 11 to 16-year-old participants engaged in two separate conversations, with their caregiver and friend, respectively (social context). Within each context, they spoke about emotionally charged topics (happy vs angry) of their choosing (emotional type). Facial analysis software (iMotions) was employed to quantify the prototypicality of angry and happy facial expressions. Two separate within-subject factorial (2x2) ANOVAs were conducted to assess the effect of social context and emotional type on the prototypicality of happy and angry facial expressions. There was a significant main effect of social context on prototypical facial cues of anger (F(1, 30) = 5.45, p = .026) with adolescents exhibiting more prototypical angry expressions with their friends than with their caregivers. Moreover, there was a significant main effect of emotional type on prototypical facial cues of happiness (F(1, 30) = 4.72, p = .038) with adolescents displaying more prototypical happy facial expressions when discussing happy topics compared to angry topics. No other effects were significant. The above main effects were rendered non-significant after accounting for sex assigned at birth and age. As the current study is ongoing, the next steps will be to increase our sample size to boost statistical power and to investigate whether the change in non-verbal encoding we observe across social context relates to teens' socio-emotional functioning. With these results, we can better support teenagers in their emotional expression to foster relationship formation and social success throughout adolescence.

Examining the Role of Physician Characteristics in Web-Based Verified Primary Care Physician Reviews: Observational Study.

Doctor review websites have become increasingly popular as a source of information for patients looking to select a primary care provider. Zocdoc is one such platform that allows patients to not only rate and review their experiences with doctors but also directly schedule appointments. This study examines how several physician characteristics including gender, age, race, languages spoken in a physician's office, education, and facial attractiveness impact the average numerical rating of primary care doctors on Zocdoc. The aim of this study was to investigate the association between physician characteristics and patient satisfaction ratings on Zocdoc. A data set of 1455 primary care doctor profiles across 30 cities was scraped from Zocdoc. The profiles contained information on the physician's gender, education, and languages spoken in their office. Age, facial attractiveness, and race were imputed from profile pictures using commercial facial analysis software. Each doctor profile listed an average overall satisfaction rating, bedside manner rating, and wait time rating from verified patients. Descriptive statistics, the Wilcoxon rank sum test, and multivariate logistic regression were used to analyze the data. The average overall rating on Zocdoc was highly positive, with older age, lower facial attractiveness, foreign degrees, allopathic degrees, and speaking more languages negatively associated with the average rating. However, the effect sizes of these factors were relatively small. For example, graduates of Latin American medical schools had a mean overall rating of 4.63 compared to a 4.77 rating for US graduates (P<.001), a difference roughly equivalent to a 2.8% decrease in appointments. On multivariate analysis, being Asian and having a doctor of osteopathic medicine degree were positively associated with higher overall ratings, while attending a South Asian medical school and speaking more European and Middle Eastern languages in the office were negatively associated with higher overall ratings. Overall, the findings suggest that age, facial attractiveness, education, and multilingualism do have some impact on web-based doctor reviews, but the numerical effect is small. Notably, bias may play out in many forms. For example, a physician's appearance or accent may impact a patient's trust, confidence, or satisfaction with their physician, which could in turn influence their take-up of preventative services and lead to either better or worse health outcomes. The study highlights the need for further research in how physician characteristics influence patient ratings of care.

Reliability and Agreement of Free Web-Based 3D Software for Computing Facial Area and Volume Measurements

Background: Facial surgeries require meticulous planning and outcome assessments, where facial analysis plays a critical role. This study introduces a new approach by utilizing three-dimensional (3D) imaging techniques, which are known for their ability to measure facial areas and volumes accurately. The purpose of this study is to introduce and evaluate a free web-based software application designed to take area and volume measurements on 3D models of patient faces. Methods: This study employed the online facial analysis software to conduct ten measurements on 3D models of subjects, including five measurements of area and five measurements of volume. These measurements were then compared with those obtained from the established 3D modeling software called Blender (version 3.2) using the Bland–Altman plot. To ensure accuracy, the intra-rater and inter-rater reliabilities of the web-based software were evaluated using the Intraclass Correlation Coefficient (ICC) method. Additionally, statistical assumptions such as normality and homoscedasticity were rigorously verified before analysis. Results: This study found that the web-based facial analysis software showed high agreement with the 3D software Blender within 95% confidence limits. Moreover, the online application demonstrated excellent intra-rater and inter-rater reliability in most analyses, as indicated by the ICC test. Conclusion: The findings suggest that the free online 3D software is reliable for facial analysis, particularly in measuring areas and volumes. This indicates its potential utility in enhancing surgical planning and evaluation in facial surgeries. This study underscores the software’s capability to improve surgical outcomes by integrating precise area and volume measurements into facial surgery planning and assessment processes.

Clients' Facial Expressions of Self-Compassion, Self-Criticism, and Self-Protection in Emotion-Focused Therapy Videos.

Clients' facial expressions allow psychotherapists to gather more information about clients' emotional processing. This study aims to examine and investigate the facial Action Units (AUs) of self-compassion, self-criticism, and self-protection within real Emotion-Focused Therapy (EFT) sessions. For this purpose, we used the facial analysis software iMotions. Twelve video sessions were selected for the analysis based on specific criteria. For self-compassion, the following AUs were significant: AUs 4 (brow furrow), 15 (lip corner depressor), and the AU12_smile (lip corner puller). For self-criticism, iMotions identified the AUs 2 (outer brow raise), AU1 (inner brow raise), AU7 (lid tighten), AU12_smirk (unilateral lip corner puller), and AU43 (eye closure). Self-protection was combined using the occurrence of AUs 1 and 4 and AU12_smirk. Moreover, the findings support the significance of discerning self-compassion and self-protection as two different concepts.

Masseteric-to-facial nerve transfer for treatment of pediatric facial paralysis: An initial report

ObjectivesThe indications and outcomes of masseteric-to-facial nerve transfer in pediatric patients with short-term facial paralysis is incompletely understood as compared to its use in adult patients. This report aims to retrospectively quantify outcomes with both clinician-based measurements and objective facial analysis software. MethodsRetrospective case series at a single institution. The Sunnybrook Facial Grading System was used for clinician-based measurements and Emotrics software for objective measurements. ResultsFour pediatric patients underwent masseteric-to-facial nerve transfers from 2016 to 2018. The mean patient age at the time of surgery was 4.5 years (range = 2–7) and the mean time from paralysis onset to surgical intervention was 12.9 months (range = 10.0–16.2). The mean follow-up was 18.3 months (range = 14.5–23.6). With regards to the Sunnybrook resting nasolabial fold symmetry, 3 of the 4 patients improved from 2 (absent nasolabial fold) to 1 (less pronounced nasolabial fold). Per the Emotrics analysis, the pre- and post-operative mean absolute differences for commissure excursion between the normal functioning and paralyzed sides were 11.8 mm and 6.7 mm, respectively (p = 0.04). ConclusionThe masseteric-to-facial nerve transfer technique leads to an objective improvement in dynamic smile function in select pediatric patients.

Facial Analysis Software Helps Screen for Parkinson's Disease

Facial Analysis Software Helps Screen for Parkinson's Disease

The face of future: Face expressions during future thinking.

Future thinking, which is the ability to project oneself forward in time to pre-experience an event, is intimately associated with emotions. We investigated whether emotional future thinking can activate emotional facial expressions. We invited 43 participants to imagine future scenarios, cued by the words "happy," "sad," and "city." Future thinking was video recorded and analysed with a facial analysis software to classify whether facial expressions (i.e., happy, sad, angry, surprised, scared, disgusted, and neutral facial expression) of participants were neutral or emotional. Analysis demonstrated higher levels of happy facial expressions during future thinking cued by the word "happy" than "sad" or "city." In contrast, higher levels of sad facial expressions were observed during future thinking cued by the word "sad" than "happy" or "city." Higher levels of neutral facial expressions were observed during future thinking cued by the word "city" than "happy" or "sad." In the three conditions, the neutral facial expressions were high compared with happy and sad facial expressions. Together, emotional future thinking, at least for future scenarios cued by "happy" and "sad," seems to trigger the corresponding facial expression. Our study provides an original physiological window into the subjective emotional experience during future thinking.

A simple computerised technique for estimating resting lip position and symmetry

The angle between the commisure–commisure and the endocantus–commisure lines (CCE angle) is approximately equal to the contralateral angle. A computerised technique for assessing the gross symmetry and position of the lips by comparing left- and right-sided CCE angles was developed. This study established (1) the repeatability of computerized CCE angle measurement; (2) mean CCE angle magnitudes in healthy controls and suggest a “normal” reference range. Two authors independently measured CCE angles on frontal repose facial photographs of 104 volunteers on three separate occasions using facial analysis software. Twenty right-sided hemifaces with the largest CCE differences were then mirrored in the sagittal plane to produce symmetrical photographs. Measurements were repeated by a single author. There was high agreement of angle measurements between authors (inter-rater ICC of 0.89) and within each authors’ repeated measurements (intra-raters ICCs of 0.85 and 0.77). Differences in the mean right and left-sided CCE angles in controls were small but statistically significant (82.4° and 81.7°, respectively, mean absolute difference 2.2 ± 1.7°, p < 0.05). The mean absolute differences had a skewed distribution. The 2.5th and 97.5th centiles were therefore set as limits of the range of asymmetries which could be regarded as “normal” (95% reference range, or 95% reference interval): 0.2°–6.2°. Measurements of opposing CCE angles in symmetrical mirrored images were similar (82.4° versus 82.3°, mean absolute difference 0.6°, p > 0.05). In conclusion, computerised CCE angle measurement is highly repeatable and may be a useful tool with which to assess gross resting lip symmetry.

A Novel Use of Artificial Intelligence to Examine Diversity and Hospital Performance

BackgroundThe US population is becoming more racially and ethnically diverse. Research suggests that cultural diversity within organizations can increase team potency and performance, yet this theory has not been explored in the field of surgery. Furthermore, when surveyed, patients express a desire for their care provider to mirror their own race and ethnicity. In the present study, we hypothesize that there is a positive correlation between a high ranking by the US News and World Report for gastroenterology and gastrointestinal (GI) surgery and greater racial, ethnic, and gender diversity among the physicians and surgeons. MethodsWe used the 2019 US News and World Report rankings for best hospitals by specialty to categorize gastroenterology and GI surgery departments into 2 groups: 1-50 and 51-100. Hospital websites of these top 100 were viewed to determine if racial diversity and inclusion were highlighted in the hospitals' core values or mission statements. To determine the rates of diversity within departments, Betaface (Betaface.com) facial analysis software was used to analyze photos taken from the hospitals’ websites. This software was able to determine the race, ethnicity, and gender of the care providers. We examined the racial and ethnic makeup of the populations served by these hospitals to see if the gastroenterologists and surgeons adequately represented the state population. We then ran the independent samples t-test to determine if there was a difference in rankings of more diverse departments. ResultsHospitals with gastroenterology and GI surgery departments in the top 50 were more likely to mention diversity on their websites compared with hospitals that ranked from 51-100 (76% versus 56%; P = 0.035). The top 50 hospitals had a statistically significant higher percentage of underrepresented minority GI physicians and surgeons (7.01% versus 4.04%; P < 0.001). In the 31 states where these hospitals were located, there were more African Americans (13% versus 3%; P < 0.001) and Hispanics (12% versus 2%; P < 0.001), while there were fewer Asians (4% versus 21%; P < 0.001) in the population compared with the faculty. ConclusionsWe used artificial intelligence software to determine the degree of racial and ethnic diversity in gastroenterology and GI surgery departments across the county. Higher ranking hospitals had a greater degree of diversity of their faculty and were more likely to emphasize diversity in their mission statements. Hospitals stress the importance of having a culturally diverse staff, yet their care providers may not adequately reflect the populations they serve. Further work is needed to prospectively track diversity rates over time and correlate these changes with measurable outcomes.

Can Facial Pose and Expression Be Separated with Weak Perspective Camera?

Separating facial pose and expression within images requires a camera model for 3D-to-2D mapping. The weak perspective (WP) camera has been the most popular choice; it is the default, if not the only option, in state-of-the-art facial analysis methods and software. WP camera is justified by the supposition that its errors are negligible when the subjects are relatively far from the camera, yet this claim has never been tested despite nearly 20 years of research. This paper critically examines the suitability of WP camera for separating facial pose and expression. First, we theoretically show that WP causes pose-expression ambiguity, as it leads to estimation of spurious expressions. Next, we experimentally quantify the magnitude of spurious expressions. Finally, we test whether spurious expressions have detrimental effects on a common facial analysis application, namely Action Unit (AU) detection. Contrary to conventional wisdom, we find that severe pose-expression ambiguity exists even when subjects are not close to the camera, leading to large false positive rates in AU detection. We also demonstrate that the magnitude and characteristics of spurious expressions depend on the point distribution model used to model the expressions. Our results suggest that common assumptions about WP need to be revisited in facial expression modeling, and that facial analysis software should encourage and facilitate the use of the true camera model whenever possible.

Automated recognition of spontaneous facial expression in individuals with autism spectrum disorder: parsing response variability

BackgroundReduction or differences in facial expression are a core diagnostic feature of autism spectrum disorder (ASD), yet evidence regarding the extent of this discrepancy is limited and inconsistent. Use of automated facial expression detection technology enables accurate and efficient tracking of facial expressions that has potential to identify individual response differences.MethodsChildren and adults with ASD (N = 124) and typically developing (TD, N = 41) were shown short clips of “funny videos.” Using automated facial analysis software, we investigated differences between ASD and TD groups and within the ASD group in evidence of facial action unit (AU) activation related to the expression of positive facial expression, in particular, a smile.ResultsIndividuals with ASD on average showed less evidence of facial AUs (AU12, AU6) relating to positive facial expression, compared to the TD group (p < .05, r = − 0.17). Using Gaussian mixture model for clustering, we identified two distinct distributions within the ASD group, which were then compared to the TD group. One subgroup (n = 35), termed “over-responsive,” expressed more intense positive facial expressions in response to the videos than the TD group (p < .001, r = 0.31). The second subgroup (n = 89), (“under-responsive”), displayed fewer, less intense positive facial expressions in response to videos than the TD group (p < .001; r = − 0.36). The over-responsive subgroup differed from the under-responsive subgroup in age and caregiver-reported impulsivity (p < .05, r = 0.21). Reduced expression in the under-responsive, but not the over-responsive group, was related to caregiver-reported social withdrawal (p < .01, r = − 0.3).LimitationsThis exploratory study does not account for multiple comparisons, and future work will have to ascertain the strength and reproducibility of all results. Reduced displays of positive facial expressions do not mean individuals with ASD do not experience positive emotions.ConclusionsIndividuals with ASD differed from the TD group in their facial expressions of positive emotion in response to “funny videos.” Identification of subgroups based on response may help in parsing heterogeneity in ASD and enable targeting of treatment based on subtypes.Trial registrationClinicalTrials.gov, NCT02299700. Registration date: November 24, 2014

Masseteric-zygomatic nerve transfer for the management of eye closure-smile excursion synkinesis.

The purpose of this study is to illustrate the efficacy of masseteric-to-zygomatic nerve transfer to address eye closure-smile excursion synkinesis after facial nerve paralysis. Synkinesis after facial nerve paralysis represents a wide range of facial movement disability. One manifestation is involuntary smiling with eye closure and a concomitant reduction of oral commissure movement with attempted smile ("frozen smile") - arising as a result of aberrant fibers populating the zygomatic branch-muscle complex. This is a particularly difficult area to treat with conservative management. We propose a single-stage procedure to sever the dysfunctional zygomatic nerve and perform a masseteric-zygomatic nerve coaptation to recover a voluntary smile. We present a case series of eight patients with eye closure/smile excursion synkinesis who underwent single-stage masseteric-zygomatic nerve transfer by a single surgeon. The surgical technique and indications for surgery were reviewed. Patients underwent facial movement analysis using Emotrics. We analyzed the pre- and post- surgical photographic images of 8 patients with synkinesis (7 female, 1 male). Masseteric-facial nerve transfer was performed from 18months to 22years after the initial facial paralysis. Eyelid and brow positioning were more symmetric after surgery, with discrepancy between affected and unaffected side decreasing from 2.1 to 1.0mm (p<.05) and 1.74 to 1.29mm (p<.05), respectively. Symmetry of smile excursion postoperatively was also improved with commissure excursion discrepancy decreasing from 8.8 to 3.78mm (p<.05). Discrepancy in the smile angle when comparing affected to unaffected side improved postoperatively from 10.3 to 5.2 degrees (p<.05). Improvement in oral commissure height was noted, but not statistically significant. The masseteric-zygomatic nerve transfer is a useful technique for the treatment of eye closure/smile excursion synkinesis after failure of chemodenervation and/or physical therapy.

The Selfie View: Perioperative Photography in the Digital Age.

The aesthetics of social media have become increasingly important to cosmetic surgery patients in recent years; however, aesthetic treatments have not kept pace with the desires of modern patients. The current study investigates the most common angles employed by various user cohorts when posting a selfie on social media platforms and proposes that aesthetic surgeons consider utilizing a selfie angle alongside standard pre- and postoperative photographic views. Full face photographs published on the social media platform Instagram™ with the tag #selfie were divided into three cohorts: female models/influencers, amateur females, and amateur males. Each cohort contained 100 photographs. The photographs were analyzed using cloud-based facial analysis software for facial pan, roll, and tilt relative to the camera. One hundred photographs from each cohort were analyzed and demonstrated that amateur females (AF) take photographs from higher angles than amateur males (AM) or model females (MF). Roll-off-midline was significantly greater for AF and MF as compared to AM. The MF group had significantly a greater pan-off-midline as compared to AF and AM, while AF had significantly a greater pan-off-midline than AM. Common photography practices employed within selfie photographs utilize angles not captured in standard perioperative photographs. This study supports the implementation of a selfie photograph into the standard set of pre- and postoperative photographs taken by aesthetic surgeons to evaluate the effects of interventions in the context of selfie photography. The angle employed can vary depending upon the demographic profile of the patient. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Investigating Bias in Facial Analysis Systems: A Systematic Review

Recent studies have demonstrated that most commercial facial analysis systems are biased against certain categories of race, ethnicity, culture, age and gender. The bias can be traced in some cases to the algorithms used and in other cases to insufficient training of algorithms, while in still other cases bias can be traced to insufficient databases. To date, no comprehensive literature review exists which systematically investigates bias and discrimination in the currently available facial analysis software. To address the gap, this study conducts a systematic literature review (SLR) in which the context of facial analysis system bias is investigated in detail. The review, involving 24 studies, additionally aims to identify (a) facial analysis databases that were created to alleviate bias, (b) the full range of bias in facial analysis software and (c) algorithms and techniques implemented to mitigate bias in facial analysis.

Automated vs. manual pain coding and heart rate estimations based on videos of older adults with and without dementia.

IntroductionTechnological advances have allowed for the estimation of physiological indicators from video data. FaceReader™ is an automated facial analysis software that has been used widely in studies of facial expressions of emotion and was recently updated to allow for the estimation of heart rate (HR) using remote photoplethysmography (rPPG). We investigated FaceReader™-based heart rate and pain expression estimations in older adults in relation to manual coding by experts.MethodsUsing a video dataset of older adult patients with and without dementia, we assessed the relationship between FaceReader’s™ HR estimations against a well-established Video Magnification (VM) algorithm during baseline and pain conditions. Furthermore, we examined the correspondence between the Facial Action Coding System (FACS)-based pain scores obtained through FaceReader™ and manual coding.ResultsFaceReader’s™ HR estimations were correlated with VM algorithm in baseline and pain conditions. Non-verbal FaceReader™ pain scores and manual coding were also highly correlated despite discrepancies between the FaceReader™ and manual coding in the absolute value of scores based on pain-related facial action coding of the events preceding and following the pain response.ConclusionsCompared to expert manual FACS coding and optimized VM algorithm, FaceReader™ showed good results in estimating HR values and non-verbal pain scores.

Integrating Artificial and Human Intelligence: A Partnership for Responsible Innovation in Biomedical Engineering and Medicine.

Historically, the term "artificial intelligence" dates to 1956 when it was first used in a conference at Dartmouth College in the US. Since then, the development of artificial intelligence has in part been shaped by the field of neuroscience. By understanding the human brain, scientists have attempted to build new intelligent machines capable of performing complex tasks akin to humans. Indeed, future research into artificial intelligence will continue to benefit from the study of the human brain. While the development of artificial intelligence algorithms has been fast paced, the actual use of most artificial intelligence (AI) algorithms in biomedical engineering and clinical practice is still markedly below its conceivably broader potentials. This is partly because for any algorithm to be incorporated into existing workflows it has to stand the test of scientific validation, clinical and personal utility, application context, and is equitable as well. In this context, there is much to be gained by combining AI and human intelligence (HI). Harnessing Big Data, computing power and storage capacities, and addressing societal issues emergent from algorithm applications, demand deploying HI in tandem with AI. Very few countries, even economically developed states, lack adequate and critical governance frames to best understand and steer the AI innovation trajectories in health care. Drug discovery and translational pharmaceutical research stand to gain from AI technology provided they are also informed by HI. In this expert review, we analyze the ways in which AI applications are likely to traverse the continuum of life from birth to death, and encompassing not only humans but also all animal, plant, and other living organisms that are increasingly touched by AI. Examples of AI applications include digital health, diagnosis of diseases in newborns, remote monitoring of health by smart devices, real-time Big Data analytics for prompt diagnosis of heart attacks, and facial analysis software with consequences on civil liberties. While we underscore the need for integration of AI and HI, we note that AI technology does not have to replace medical specialists or scientists and rather, is in need of such expert HI. Altogether, AI and HI offer synergy for responsible innovation and veritable prospects for improving health care from prevention to diagnosis to therapeutics while unintended consequences of automation emergent from AI and algorithms should be borne in mind on scientific cultures, work force, and society at large.

The face of memory: experiential avoidance and facial expressions during the retrieval of autobiographical memories

ABSTRACTExperiential avoidance refers to attempts to control or suppress unwanted thoughts, feelings and emotions. We investigated whether experiential avoidance is associated with fewer facial expressions during autobiographical retrieval (i.e. retrieval of memory for personal information). We invited participants to retrieve autobiographical memories, and recall was analysed by a facial analysis software that detects and classifies emotional expressions. Participants were divided into high vs. low experiential avoidance. Analysis showed fewer emotional facial expressions in participants with high experiential avoidance than in those with low experiential avoidance during autobiographical retrieval. This low emotional expression can be regarded as an attempt by individuals with high experiential avoidance to avoid communicating the emotional load to others. This low emotional expression can be also regarded as an attempt by individuals with high experiential avoidance to control or suppress the internal events that contribute to the appearance or persistence of unwanted emotional states during retrieval.

Positive facial expressions during retrieval of self-defining memories.

In this study, we investigated, for the first time, facial expressions during the retrieval of Self-defining memories (i.e., those vivid and emotionally intense memories of enduring concerns or unresolved conflicts). Participants self-rated the emotional valence of their Self-defining memories and autobiographical retrieval was analyzed with a facial analysis software. This software (Facereader) synthesizes the facial expression information (i.e., cheek, lips, muscles, eyebrow muscles) to describe and categorize facial expressions (i.e., neutral, happy, sad, surprised, angry, scared, and disgusted facial expressions). We found that participants showed more emotional than neutral facial expressions during the retrieval of Self-defining memories. We also found that participants showed more positive than negative facial expressions during the retrieval of Self-defining memories. Interestingly, participants attributed positive valence to the retrieved memories. These findings are the first to demonstrate the consistency between facial expressions and the emotional subjective experience of Self-defining memories. These findings provide valuable physiological information about the emotional experience of the past.

More emotional facial expressions during episodic than during semantic autobiographical retrieval.

There is a substantial body of research on the relationship between emotion and autobiographical memory. Using facial analysis software, our study addressed this relationship by investigating basic emotional facial expressions that may be detected during autobiographical recall. Participants were asked to retrieve 3 autobiographical memories, each of which was triggered by one of the following cue words: happy, sad, and city. The autobiographical recall was analyzed by a software for facial analysis that detects and classifies basic emotional expressions. Analyses showed that emotional cues triggered the corresponding basic facial expressions (i.e., happy facial expression for memories cued by happy). Furthermore, we dissociated episodic and semantic retrieval, observing more emotional facial expressions during episodic than during semantic retrieval, regardless of the emotional valence of cues. Our study provides insight into facial expressions that are associated with emotional autobiographical memory. It also highlights an ecological tool to reveal physiological changes that are associated with emotion and memory.

The role of botulinum toxin a in the establishment of symmetry in pediatric paralysis of the lower lip.

Botulinum toxin A has been described as an effective adjunct treatment for achieving symmetry in adults with facial paralysis. Few investigators have described the use of botulinum toxin A in pediatric patients with facial paralysis. To present our preliminary experience with botulinum toxin A in pediatric patients presenting with asymmetry of the lower lip. We performed a retrospective medical record review of all pediatric patients (age range, 4-17 years; mean [SD] age, 11.2 [4.7] years) with facial paralysis who were treated with botulinum toxin A injections from January 1, 2004, through December 31, 2012. Patients presented for treatment at The Hospital for Sick Children, Toronto, Ontario, Canada, or the Massachusetts Eye and Ear Infirmary, Boston. Using facial analysis software, we measured lower lip asymmetry in the patients' photographs before and after treatment, at rest, and in a dynamic state. We performed analysis of variance to assess for improvement in symmetry. We identified 18 patients with the following 3 primary indications for treatment: focal lip asymmetry (n = 11), extensive hemifacial asymmetry (n = 5), and focal synkinesis (n = 2). We found no complications related to botulinum toxin A treatment. The mean (SD) dynamic deviation before the injection was 3.5 (1.7) mm, whereas the mean dynamic deviation after the injection was 1.5 (0.8) mm. The mean (SD) deviation correction was evaluated at 61% (6%) and was statistically significant (P = .04). Botulinum toxin A injection is a safe procedure for improving localized asymmetry in pediatric patients with facial paralysis. Preliminary results indicate that botulinum toxin A may be an effective treatment for lower lip asymmetry in children and adolescents. 4.