Facial Plastic Surgery Research Articles

Editorial introductions.

Editorial introductions.

Advances in Virtual Surgical Planning and Three-Dimensional Printing in Facial Reconstruction and Aesthetic Surgery.

We are excited to co-edit this issue of Seminars in Plastic Surgery on Advances in Virtual Surgical Planning and Three-Dimensional Printing in Facial Reconstruction and Aesthetic Surgery.

Samir Mardini, MD, and Basel Sharaf, MD, DDS, FACS.

I want to thank Drs. Samir Mardini and Basel Sharaf for sharing the responsibility as guest editors for this issue of Seminars in Plastic Surgery on “Advances in Virtual Surgical Planning and Three-Dimensional Printing in Facial Reconstruction and Aesthetic Surgery” and the invited authors for sharing their experience.

Use of platelet-rich fibrin a backbone in facial plastic surgery and wound healing: A review of literature

Platelet aggregates has been used in surgery for many years. The primary goal of these ‘Autologous Preparation’ was to aggregate platelets and their growth factors and to convey it to a surgical site, to improve healing only. The latest research work shows that the PRF also can be used for Protection of Graft, neo-angiogenesis, vascularization locally and release of various growth factors apart from healing. Platelet rich fibrin (PRF) is considered as the new generation of platelet concentrate. “Choukroun’s PRF” or Leucocyte PRF (L-PRF) is the new development, which was first developed by Choukroun’s et al. in 2001 as an ‘Autologous biomaterial.’ A systematic literature search was performed to identify relevant articles that describes the use of PRF, through PubMed and Scopus databases. The focus of this article is to explore the role of PRF in esthetic facial surgery.

Preparation and Optimization of an Ultraflexible Liposomal Gel for Lidocaine Transdermal Delivery.

The pain caused by lidocaine injections into the face prior to facial plastic surgeries intended to remove growths or tumorous lesions has been reported by many patients to be the worst part of these procedures. However, the lidocaine gels and creams currently on the market do not deliver an equal or better local anesthetic effect to replace these injections. To develop an alternative to the painful local anesthetic injection, we prepared ultraflexible liposomes using soy phosphatidylcholine, lidocaine, and different amounts of sodium cholate, a surfactant. The prepared ultraflexible liposomes (UFLs) were examined for particle size, zeta potential, cytotoxicity, and in vitro release. By using a carbomer as a gelling agent, the prepared UFL lidocaine gels were evaluated for their penetration ability in a Franz diffusion cell, using Strat-M membranes. The formulation achieving the highest amount of penetrated lidocaine was chosen for further pH, viscosity, and stability tests. The local anesthetic efficacy of the formulation was investigated by an in vivo tail-flick test in rats. Our findings suggested that this topical gel formulated with ultraflexible liposomal lidocaine has enhanced skin permeation ability, as well as an improved local analgesic effect from the lidocaine.

Long-Term Evaluation of the Lip and Nose in Bilateral Complete Cleft Lip Patients following Lip Adhesion and Secondary Nose Correction.

Background Surgical correction of bilateral cleft lip deformities remains one of the most challenging areas in facial plastic surgery. Many surgical techniques and conservative devices have been offered for the early management of bilateral cleft lip in infants. The purpose of this study was to evaluate the effect of lip adhesion on the lip and nose of patients with bilateral cleft lip. Methods A retrospective review of 13 patients with bilateral cleft lip was performed and compared with age-matched noncleft children. Patients underwent lip adhesion at a mean age of 2.8 months, and cheiloplasty at 6.6 months of age using a modification the Mulliken method. Secondary rhinoplasty was performed at the age of 6 in 13 patients. The surgical results were analyzed using photographic records obtained at the age of 1 and 7 years. Twelve length measurements and one angle measurement were obtained. Results All measurements were not statistically different from those of the noncleft age-matched control group at the age of 1. At 7 years of age, upper lip height and vermilion mucosal height were shorter ( p < 0.05) than in the control group. Nasal tip protrusion and the nasolabial angle were greater ( p < 0.05) than in the control group. Conclusion Lip adhesion followed by secondary rhinoplasty resulted in an acceptable lip and nasal appearance. Although nasoalveolar molding is now widely used, lip adhesion can be an appropriate alternative if an orthodontist is not available due to geographical or economic constraints.

New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2021.

ObjectiveTo evaluate new medical devices and drugs pertinent to otolaryngology–head and neck surgery that were approved by the Food and Drug Administration (FDA) in 2021.Data SourcesPublicly available FDA device and drug approvals from ENT (ear, nose, and throat), anesthesia, neurosurgery, plastic surgery, and general surgery FDA committees.Review MethodsFDA device and therapeutic approvals were identified and reviewed by members of the American Academy of Otolaryngology–Head and Neck Surgery’s Medical Devices and Drugs Committee. Two independent reviewers assessed the relevance of devices and drugs to otolaryngologists. Medical devices and drugs were then allocated to their respective subspecialty fields for critical review based on available scientific literature.ConclusionsThe Medical Devices and Drugs Committee reviewed 1153 devices and 52 novel drugs that received FDA approval in 2021 (67 ENT, 106 anesthesia, 618 general surgery and plastic surgery, 362 neurosurgery). Twenty-three devices and 1 therapeutic agent relevant to otolaryngology were included in the state of the art review. Advances spanned all subspecialties, including over-the-counter hearing aid options in otology, expanding treatment options for rhinitis in rhinology, innovative laser-safe endotracheal tubes in laryngology, novel facial rejuvenation and implant technology in facial plastic surgery, and advances in noninvasive and surgical treatment options for obstructive sleep apnea.Implications for PracticeFDA approvals for new technology and pharmaceuticals present new opportunities across subspecialties in otolaryngology. Clinicians’ nuanced understanding of the safety, advantages, and limitations of these innovations ensures ongoing progress in patient care.

Congenital Midline Cervical Cleft: A Rare Window to the Neck.

Facial Plastic Surgery & Aesthetic MedicineVol. 25, No. 2 ObservationsCongenital Midline Cervical Cleft: A Rare Window to the NeckDavid A. Shaye, Hirwa Nteyumwete, Aimee Kamaliza, Theophile Muhawenimana, Josiane Umutoni, Isaie Ncogoza, and Victor NyabyendaDavid A. Shaye*Address correspondence to: David A. Shaye, MD, MPH, FACS, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA. E-mail Address: david_shaye@meei.harvard.eduhttps://orcid.org/0000-0002-7786-7812Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.College of Medicine & Health Sciences, University Teaching Hospital Kigali, University of Rwanda, Kigali, Rwanda.Search for more papers by this author, Hirwa NteyumweteCollege of Medicine & Health Sciences, University Teaching Hospital Kigali, University of Rwanda, Kigali, Rwanda.Search for more papers by this author, Aimee KamalizaCollege of Medicine & Health Sciences, University Teaching Hospital Kigali, University of Rwanda, Kigali, Rwanda.Search for more papers by this author, Theophile MuhawenimanaCollege of Medicine & Health Sciences, University Teaching Hospital Kigali, University of Rwanda, Kigali, Rwanda.Search for more papers by this author, Josiane UmutoniCollege of Medicine & Health Sciences, University Teaching Hospital Kigali, University of Rwanda, Kigali, Rwanda.Search for more papers by this author, Isaie NcogozaCollege of Medicine & Health Sciences, University Teaching Hospital Kigali, University of Rwanda, Kigali, Rwanda.Search for more papers by this author, and Victor NyabyendaCollege of Medicine & Health Sciences, University Teaching Hospital Kigali, University of Rwanda, Kigali, Rwanda.Search for more papers by this authorPublished Online:3 Mar 2023https://doi.org/10.1089/fpsam.2022.0101AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Congenital Midline Cervical Cleft: A Rare Window to the Neck." Facial Plastic Surgery & Aesthetic Medicine, 25(2), pp. 184–185FiguresReferencesRelatedDetails Volume 25Issue 2Apr 2023 InformationCopyright 2023, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:David A. Shaye, Hirwa Nteyumwete, Aimee Kamaliza, Theophile Muhawenimana, Josiane Umutoni, Isaie Ncogoza, and Victor Nyabyenda.Congenital Midline Cervical Cleft: A Rare Window to the Neck.Facial Plastic Surgery & Aesthetic Medicine.Apr 2023.184-185.http://doi.org/10.1089/fpsam.2022.0101Published in Volume: 25 Issue 2: March 3, 2023Online Ahead of Print:June 29, 2022PDF download

Reconstruction of the Nose After Unilateral Cheilouranoplasty.

Congenital clefts of the maxillofacial area still remain of current interest in reconstructive facial surgery. While their frequency grows up, the issues of effective surgical primary and secondary interventions are not completely solved yet. The article presents the main problems associated with the elimination of the deformations and our modifications of methods for their correction. The study was conducted based on the Centre [2] and the University [1], Russian Federation. The project was carried out within the framework of the state assignment of the Ministry of Science and Higher Education of the Russian Federation, mnemocode 0669-2020-0008. The research is based on the results of complex treatment of 112 patients with unilateral clefts of the upper lip and palate from the age of 5 to 34 years, 68 patients of them also carried out secondary surgeries. The methods of performing rhinocheiloplasty by moving a “sliding” flap, of eliminating a ctenoid plica appearing after primary surgeries are presented, described, explained, and substantiated in the article. The proposed methods gave a good or satisfactory result in 92.8% of the operated patients, which allows them to be considered effective for eliminating congenital and postoperative nasal deformities in patients with facial clefts. : The surgical methods of eliminating congenital and postoperative deformities of the nose in patients with facial clefts should be modified in accordance with the nature of the most frequently arising shortcomings of the surgical stages of correction.

Randomized trial of the effect of video training on residents’ surgical skills in facial skin reconstructive surgery: A SQUIRE study

ObjectivesThe purpose of this study was to evaluate the impact of facial skin reconstruction training videos for head and neck and maxillofacial surgery residents. Material and methodsThis randomized trial, conducted in France, involved residents in head and neck and maxillofacial surgery. A website was created containing facial skin reconstruction training videos. Selected residents performed facial skin flap dissections in the Paris School of Surgery. They were randomized into two groups, one receiving a standard course before the dissection, and the other a standard course plus a video of the flap (“no-video” and “video” groups). Each resident performed 4 facial flaps and was graded (blindly) during dissection. The main study endpoint was intergroup difference in grading score (out of 15). The article was written up following the SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in EDUcation) criteria. ResultsEighteen residents were included. For the main endpoint, scores were significantly higher in the “video” than the “no-video” group (6 [IQR, 4: 9] vs. 10 [9: 12]; P<0.001). In addition, as secondary endpoint, “no-video” group residents requested more assistance (3 [2: 4] vs. 1 [1: 2] P<0.001). Power was lacking for any subgroup analysis according to year of residency or to the 4 flaps. ConclusionVideos improved surgical residents’ performance during dissections. However, these results would be difficult to transpose to real clinical conditions. They need validating in a larger study evaluating performance in real-life procedures.

Commentary on: "The Tinel Sign and Myelinated Axons in the Cross-Face Nerve Graft: Predictors of Smile Reanimation Outcome for Free Gracilis Muscle Transfer?" by Greene et al.

Facial Plastic Surgery & Aesthetic MedicineVol. 24, No. 4 Invited CommentaryCommentary on: “The Tinel Sign and Myelinated Axons in the Cross-Face Nerve Graft: Predictors of Smile Reanimation Outcome for Free Gracilis Muscle Transfer?” by Greene et alBabak Azizzadeh and Adrian E. HouseBabak Azizzadeh*Address correspondence to: Babak Azizzadeh, MD, Center for Advanced Facial Plastic Surgery, 9401 Wilshire Boulevard, Suite #650, Beverly Hills, CA 90212, USA. E-mail Address: drazizzadeh@gmail.comhttps://orcid.org/0000-0002-5607-1022Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA.Search for more papers by this author and Adrian E. HouseCenter for Advanced Facial Plastic Surgery, Beverly Hills, California, USA.Search for more papers by this authorPublished Online:29 Jul 2022https://doi.org/10.1089/fpsam.2022.0027AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Commentary on: “The Tinel Sign and Myelinated Axons in the Cross-Face Nerve Graft: Predictors of Smile Reanimation Outcome for Free Gracilis Muscle Transfer?” by Greene et al." Facial Plastic Surgery & Aesthetic Medicine, 24(4), pp. 260–261FiguresReferencesRelatedDetails Volume 24Issue 4Aug 2022 Information© 2022, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Babak Azizzadeh and Adrian E. House.Commentary on: “The Tinel Sign and Myelinated Axons in the Cross-Face Nerve Graft: Predictors of Smile Reanimation Outcome for Free Gracilis Muscle Transfer?” by Greene et al.Facial Plastic Surgery & Aesthetic Medicine.Aug 2022.260-261.http://doi.org/10.1089/fpsam.2022.0027Published in Volume: 24 Issue 4: July 29, 2022Online Ahead of Print:June 3, 2022PDF download

Comparison of off-the-shelf β-tricalcium phosphate implants with novel resorbable 3D printed implants in mandible ramus of pigs.

Facial reconstructive surgery has already implemented the use of 3D printed Patient Specific Implants derived from CAD/CAM-based technologies as an alternative to preformed bone graft substitutes. 3D-printed patient-specific implants derived from CAD/CAM-based technologies are used in facial reconstructive surgery as an alternative to preformed bone graft substitutes. However, to minimize the invasiveness and long-term adverse effects of surgical interventions, the implant needs to exhibit exact fitting, porosity, density, and volume and be made from resorbable materials that allow ingrowth and formation of new bone tissue. Therefore, we present this pilot study using 3D-printed implants consisting of pure β-TCP, produced using a novel technique that assures these properties. Eight pigs received 3D-printed truncated porous cone bone implants paired with either an off-the-shelve a chronOS (DePuy Synthes chronOS Vivify Preforms) preformed block (n=4) or a no-implant void (n=4) in a surgically created defect on each side of the angle of the mandible. After 6months, CT data showed that all 3D-printed implants performed as well as did the off-the-shelve implants, with predicted osteointegration medially and laterally and with minimal gapping between the implants and native bone. The CT findings were confirmed by histological analysis that revealed that the 3D-printed implants together with the off-the-shelve implants were almost complete resorbed. Much of the resorbed volume had been replaced by vascularized compact bone, and fusion between newly formed bone and native bone was observed in all implants, further indicating that the 3D-printed implants and off-the-shelve implants performed equally well. Only soft tissue developed in the void control sites. Further studies are needed to confirm these initial findings.

Research on 3D face measurement for facial virtual plastic surgery

Calculating the key data of human face through three-dimensional face model can help doctors predict the surgical results before plastic surgery, guide the formulation of surgical plan and reduce the surgical risk. In this paper, 3D face measurement technology is studied, and the area of plastic area is calculated by slice method. A large number of experimental tests show that the average errors of facial geometric feature measurement, area measurement are 0.458mm and 0.65mm2 respectively. The rating of simulation results provided by plastic surgeons shows that facial measurement technology can effectively improve the success rate of plastic surgery. Compared with the original face, the edited 3D face is more attractive in respecting the following beauty standards: “three courts and five eyes”, golden section, etc.

Iatrogenic seeding of cholesteatoma in rare planes

&lt;p class="abstract"&gt;A cholesteatoma is a cystic lesion of keratinizing stratified squamous epithelium commonly found in the middle ear space. Acquired cholesteatomas are often caused by seeding of squamous epithelium into the middle ear space during surgery. We present a 29-year-old male who had a left tympanomastoidectomy and then staged second look with ossicular chain reconstruction for cholesteatoma 6 years prior to presenting with a left pre and post-auricular mass measuring 8.2×2.9×6 cm. He underwent combined surgical excision with facial plastic surgery and neuro-otology. He was found to have cholesteatoma extending from a defect in the mastoid cavity into the pre-auricular and post-auricular soft tissue. This was felt to be recurrent disease seeded from his initial surgery. To our knowledge, we present the largest iatrogenic cholesteatoma reported in the literature. It had explosive growth in a relatively short time period with extension into an unusual location due to presumed iatrogenic causes. Our case highlights the potential to seed cholesteatoma in previously disease-free areas when performing cholesteatoma surgery. It also demonstrates the aggressive nature of pediatric cholesteatomas, and is in line with the literature in that regard. The case enforces the extreme care that needs to be taken when performing cholesteatoma surgery to ensure that disease is not introduced in areas of the head and neck. It also stresses the importance of close, long term follow up for pediatric cholesteatoma given the potential for aggressive reoccurrence and growth.&lt;/p&gt;

Increasing Levels of Evidence in Rhinoplasty: Stepping Up Our Role as Leaders in the Specialty.

Increasing Levels of Evidence in Rhinoplasty: Stepping Up Our Role as Leaders in the Specialty.

Comparison of two surgical techniques (HOO vs. BSSO) for mandibular osteotomies in orthognathic surgery—a 10-year retrospective study

PurposeTo retrospectively compare the high-angled sagittal split osteotomy (HOO) and the bilateral sagittal split osteotomy (BSSO) for the correction of skeletal dysgnathias regarding intra- and postoperative complications.MethodsThe electronic medical records of all patients treated with an orthognathic surgery at the Department for Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Germany, between the years 2009 and 2019 were retrospectively reviewed.ResultsTwo hundred ninety-one patients were included. The overall complication rates were 19.78% (BSSO) compared to 12.5% (HOO) (p = 0.14). Significant differences were found regarding the operation time (HOO < BSSO, p = 0.02), material failure (HOO > BSSO, p = 0.04), and early recurrence requiring revision surgery (HOO < BSSO, p = 0.002). The use of a ramus plate significantly reduced the risk of plate failure (2.8% < 13.6%, p = 0.05). More bad splits (p = 0.08) and early sensory disorders (p = 0.07) occurred in the BSSO group.ConclusionThe HOO presents a possible alternative to the BSSO since newly developed osteosynthesis material significantly reduces the risk of material failure. The BSSO is accompanied by higher risks of developing complications like a bad split and sensory disorders but, however, remains the standard for large anterior–posterior transpositions of the mandible.

Application of Ultrasonic Piezoelectric Technology for Rhinoplasty.

Application of Ultrasonic Piezoelectric Technology for Rhinoplasty.

Nasal Ulceration in Trigeminal Trophic Syndrome.

Facial Plastic Surgery & Aesthetic MedicineVol. 24, No. 6 ObservationNasal Ulceration in Trigeminal Trophic SyndromeTerrence K. Pleasant, Andrew Benvenuto, and Jeffrey S. MoyerTerrence K. PleasantDepartment of Otolaryngology- Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.Search for more papers by this author, Andrew Benvenuto*Address correspondence to: Andrew Benvenuto, BS, University of Michigan Medical School, 1500 E Medical Center Drive, TC 1904, Ann Arbor, MI 48109-0624, USA, E-mail Address: abenvenu@med.umich.eduhttps://orcid.org/0000-0003-4663-2938University of Michigan Medical School, Ann Arbor, Michigan, USA.Search for more papers by this author, and Jeffrey S. Moyerhttps://orcid.org/0000-0002-0435-9200Department of Otolaryngology- Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.Search for more papers by this authorPublished Online:8 Nov 2022https://doi.org/10.1089/fpsam.2021.0417AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 24Issue 6Dec 2022 InformationCopyright 2022, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Terrence K. Pleasant, Andrew Benvenuto, and Jeffrey S. Moyer.Nasal Ulceration in Trigeminal Trophic Syndrome.Facial Plastic Surgery & Aesthetic Medicine.Dec 2022.506-508.http://doi.org/10.1089/fpsam.2021.0417Published in Volume: 24 Issue 6: November 8, 2022Online Ahead of Print:May 12, 2022PDF download

Fresh Frozen Rib Cartilage Grafts in Revision Rhinoplasty: A 9-Year Experience.

Revision rhinoplasty is undoubtedly one of the most challenging procedures in facial plastic surgery. The complexity is compounded when there is a paucity of native septal cartilage to perform the required framework reconstruction. Harvest of autologous costal cartilage can result in increased operative times and possible secondary-site complications such as contour irregularity, poor scarring, and even pneumothorax. A retrospective review was conducted of the senior author's (R.J.R.) patients from 2011 to 2020 who underwent primary or revision rhinoplasty. Inclusion criteria consisted of patients with fresh frozen off-the-shelf cartilage used in revision rhinoplasty only with a minimum of 6 months' follow-up. Outcomes for evaluation were warping, resorption, displacement, and infection. The authors identified 226 patients who underwent open rhinoplasty with the use of fresh frozen rib cartilage grafts and met inclusion criteria. The mean follow-up period was 12.18 months (range, 6 months to 8 years). The majority of patients had undergone one prior rhinoplasty procedure (54 percent); however, 4 percent of patients had undergone four or more prior procedures on their nose. The overall infection rate was 2.7 percent ( n = 6), with the majority successfully managed with antibiotics alone (2.3 percent). The results in revision rhinoplasty are significantly enhanced with the creation of a stable nasal framework using off-the-shelf, easily accessible, specifically tailored fresh frozen cadaveric rib grafts. The long-term outcomes and complication rate in this 9-year retrospective study demonstrates the safety of fresh frozen rib graft in comparison to autologous or irradiated rib graft. Therapeutic, IV.

Pandemics and facial plastics and reconstructive surgery

The purpose of this article is to review the impact of COVID-19 on the specialty of Facial Plastic and Reconstructive Surgery. Initially, COVID-19 caused significant disruption to facial plastic surgeon practices and patient care with cancellation of surgery and clinical practice. As medical practices resumed, facial plastic surgeons were resilient and adaptive. Reliance on technology helped to meet the needs of patients. There was a surge of facial plastic surgery interest and procedures as the pandemic wore on with recovery of many physician practices. COVID-19 created numerous challenges for facial plastic and reconstructive surgeons but also many opportunities. The facial plastic surgery community and the American Academy of Facial Plastic and Reconstructive Surgery worked together to achieve best outcomes.