Evolution of Facial Plastic Surgery Global Surgery Outreach in the Context of International Conflict and the COVID-19 Pandemic.

Bilateral hypoplastic facial arteries terminating as submental arteries were identified on computed tomography angiography, accompanied by rare compensatory vascular patterns. The right maxillary artery exhibited a triangular fenestration between the maxillary tuberosity and inferior orbital fissure, from which an aberrant buccal artery arose and descended to supply the inferior lip. The left side demonstrated a common buccoalveolar trunk bifurcating into the inferior alveolar artery and an aberrant buccal artery with a previously unreported transmandibular trajectory, entering at the lingula and exiting through a retromolar foramen before continuing tortuously to vascularize the cheek and lower lip. These anatomical variants present significant surgical hazards during regional anesthesia procedures targeting the maxillary tuberosity, pterygomandibular space, and mandibular lingula, as well as during facial reconstructive surgery. Comprehensive preoperative angiographic evaluation is essential when facial artery hypoplasia is encountered to identify compensatory networks and prevent inadvertent vascular injury.

BackgroundRhinoplasty is acknowledged as one of the most commonly conducted facial plastic surgical procedures worldwide. Periorbital ecchymosis and edema pose considerable postoperative complications that influence patient satisfaction and recovery duration.ObjectivesThis study aimed to examine the impact of local tranexamic acid (TXA) infiltration on periorbital ecchymosis and edema in patients undergoing rhinoplasty.MethodsA randomized, triple-blind, controlled trial was conducted involving 80 patients scheduled for primary open septorhinoplasty at our university hospital between 2021 and 2022. Participants were randomly allocated to receive either local infiltration consisting of TXA (1 mg/mL) combined with lidocaine and epinephrine (n = 40) or a control solution containing identical components, except TXA (n = 40). Periorbital ecchymosis and edema were evaluated at 24 h and 1 week postoperatively, utilizing a standardized scale.ResultsNo significant differences were observed between the TXA and control groups regarding periorbital edema at 24 h (P = .965) and 1 week (P = 1.000) postoperatively. Additionally, periorbital ecchymosis showed no substantial difference between the groups at 24 h (P = .597) or 1 week (P = .063). Intraoperative bleeding was marginally reduced in the TXA group (39.38 ± 23.699 vs 43.13 ± 26.435 mL), although this difference did not achieve statistical significance (P = .506).ConclusionsThe local infiltration of TXA did not lead to a statistically significant reduction in periorbital edema, ecchymosis, or intraoperative bleeding among rhinoplasty patients compared with a placebo. These findings suggest that local infiltration may not provide the same benefits in rhinoplasty procedures as those documented with systemic administration routes.Level of Evidence: 2 (Therapeutic)

Understanding the anatomy of the medial canthal tendon (MCT) is essential for accurate facial reconstruction and orbital surgery. This study analyzed the morphometry and anatomical position of the MCT in 109 orbits from 55 Thiel-embalmed Scottish cadavers (27 males, 28 females; mean age at time of death 84.79 years). Measurements included bone-to-tendon, soft tissue, and bone-to-bone distances, with transverse lines established using a ruler at the superior and inferior orbital margins. Vertical distances from these lines to the MCT were recorded, alongside MCT length, width, and orbital height and width. A previously undocumented decussation pattern was observed in 7% of cadavers, in which the superior and inferior bands of the MCT crossed over the frontal process of the maxilla. The remaining specimens exhibited a single-band configuration. Statistically significant sex-based differences were found in four of seven parameters: the distance between the inferior orbital margin and MCT (p < 0.001), orbital height (p < 0.01), orbital width (p < 0.01), and frontonasal suture to MCT distance (p < 0.02). MCT length and width showed no sex differences. These findings establish the dacryon as a reliable landmark for MCT positioning and highlight the importance of population-specific anatomical data in surgical and forensic applications. This study offers novel insights into MCT morphology within a Scottish population, reinforcing the relevance of precise morphometric data for clinical accuracy.

BackgroundCaudal septal deviation is a challenging condition that affects nasal function and aesthetics.ObjectivesThe aim of the study was to evaluate surgical practices for caudal septoplasty among otolaryngologists in Saudi Arabia and compare them with international approaches.MethodsA cross-sectional electronic survey was distributed to otolaryngologists across academic, governmental, and private healthcare institutions in Saudi Arabia. A parallel systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines using PubMed, Web of Science, and Scopus. Eligible studies published between 1954 and 2024 described techniques addressing caudal septal deviation with reported outcomes. The study protocol was prospectively registered before the study's start in PROSPERO (CRD42024621207).ResultsSixty otolaryngologists completed the survey. The most commonly used techniques were swinging door (76.6%), cartilage reshaping (51.7%), and suturing (48.3%). Only 16.7% had facial plastic surgery training. In the systematic review, 559 records were identified with 53 studies meeting the inclusion criteria involving 3564 patients, splinting or grafting (47.2%), and cartilage reshaping (30.2%) predominated. Patient-reported outcome measures (PROMs) were used in 66% of studies, primarily the Nasal Obstruction Symptom Evaluation scale, with scores improving from 70.2 to 16.1 postoperatively.ConclusionsOtolaryngologists in Saudi Arabia predominantly employ conservative caudal septoplasty techniques, with limited adoption of extracorporeal approaches and PROMs. These findings contrast with broader international practices and highlight the need for enhanced subspecialty training and standardized outcome evaluations.Level of Evidence: 5 (Therapeutic)

Autonomous sensory meridian response (ASMR) videos simulating medical encounters have gained popularity on social media. This study aimed to assess the thematic focus and clinical representation of otorhinolaryngology-themed ASMR videos using a novel expert-based scoring system and to examine their relationship with viewer engagement. Fifty-six YouTube ASMR videos were analyzed and categorized by subspecialty, procedures, and engagement metrics. A clinical representation score (CRS) was developed to assess the degree of clinical representation, and inter-rater reliability for the total score was evaluated using an intraclass correlation coefficient (ICC). Viewer interaction was measured using video view rate (VVR) and daily engagement rate (DER). Pearson correlation and ANOVA were used (p < 0.05). Otologic content predominated (96.4%), with otoscopy (89.3%) and earwax removal (53.6%) most common. Rhinologic (33.9%) and head and neck (41.1%) content were underrepresented. Endoscopic or surgical procedures appeared only once each (1.8%). No video addressed facial plastic surgery. Most videos showed moderate (58.7%) or low (28.3%) clinical representation; only one (2.2%) achieved high CRS. A significant inverse correlation was found between CRS and both VVR (r = -0.38, p < 0.01) and DER (r = -0.56, p < 0.001). This first cross-sectional content analysis of otorhinolaryngology-themed ASMR videos reveals a dominance of otologic content with limited clinical accuracy or scope. The inverse association between CRS and viewer engagement suggests that the most popular videos may offer the least clinical realism. Although not educational in intent, their widespread reach raises important concerns about shaping public expectations of otolaryngologic care. N/A.

We read with great interest the article by Levin et al. , "Nasal Septal Perforation Reconstruction with Polydioxanone Plate: A Systematic Review," published in Facial Plastic Surgery. The review comprehensively summarized the literature on the use of polydioxanone (PDS) plates in nasal septal perforation repair and highlighted promising results with high closure rates and minimal complications. However, we would like to respectfully draw attention to one of the included studies, which may not directly pertain to septal perforation repair. The cited paper by Menger DJ, Tabink IC, and Trenité GJ (Arch Otolaryngol Head Neck Surg. 2008;134(8):842-847) describes nasal septal reconstruction following abscess formation in children, using autologous cartilage grafts mounted on a PDS plate. This study focused on septal integrity restoration after abscess-related cartilage loss rather than closure of a preexisting septal perforation. Moreover, while other studies in the review included perforations smaller than 10 mm, this particular paper was noted as involving perforations of 15 mm or greater. A careful review of the original article, however, reveals that the mentioned 15 mm refers not to the diameter of a septal perforation but to the size of the cartilaginous defect resulting from infection. Therefore, the inclusion of this reference in a systematic review specifically addressing nasal septal perforation reconstruction may not be fully appropriate. While the use of PDS plates in various nasal reconstructive settings is certainly valuable, distinguishing between septal reconstruction after abscess and true perforation repair is essential for accurate synthesis of the literature and interpretation of outcomes. We commend the authors for their thorough review and valuable contribution to the field. We hope this clarification will assist in refining the evidence base and support future research on the optimal use of PDS plates in nasal septal surgery.

This study aims to evaluate and compare the responses of two large language model (LLM) AI chatbots, ChatGPT and Gemini, against those provided by expert surgeons during consultations for revision rhinoplasty. Given the emotional complexities and relatively low satisfaction rates in revision cases, assessing AI's effectiveness in providing empathetic and accurate information is essential. A set of fifteen hypothetical questions reflecting patient concerns were presented to ChatGPT, Gemini, and two expert surgeons. Four academic otolaryngologists rated the responses based on empathy, precision, perfectness, and communication skills using a 5-point Likert scale. The ratings were analyzed using one-way ANOVA and Bonferroni tests to determine statistical significance. ChatGPT achieved the highest mean scores across all categories, outperforming both expert surgeons significantly in empathy, precision, perfectness, and communication skills (p<0.01). Gemini also outperformed the expert surgeons in these categories. Notably, ChatGPT excelled in perfectness compared to Gemini, while expert surgeon1 demonstrated superior precision. Evaluators showed consistent ratings in precision, perfectness, and communication skills, but significant differences were found in empathy (p<0.01). ChatGPT and Gemini showed remarkable performance in consultation for revision rhinoplasty. However, there are known weak points in LLM chatbots; they can play an under-controlled role in facial plastic surgery and the healthcare system. 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 .

Rhinoseptoplasty addresses both nasal deformities and functional issues. Effective postoperative care is essential for optimal recovery, as complications such as swelling, bruising, and pain can adversely affect healing and patient satisfaction. Proper postoperative care emphasizes the significance of comprehensive management strategies.A systematic literature review was performed utilizing the PubMed and Cochrane databases to identify articles published between 2014 and 2024 that specifically addressed postoperative care following rhinoplasty. Of 191 articles, 22 met the preestablished inclusion criteria. We assessed the quality of evidence according to the Oxford Centre for Evidence-Based Medicine's Levels of Evidence.Seven key studies were analyzed, exploring a range of postoperative care interventions, including administering corticosteroids, elevating the head during and after the procedure, using alternative therapeutic approaches, and applying cooling techniques.Postsurgical recovery after rhinoplasty involves managing pain, swelling, and bruising, among other complications. Educating patients about expected outcomes and the healing process helps alleviate their anxiety and uncertainty. Corticosteroids have proven effective in controlling swelling and bruising. Antibiotics are generally not recommended. Silicone septal splints provide support, particularly when stabilization of an injured mucous membrane or septal cartilage is required; however, nasal packing is not recommended. Adhesive strips can help reduce edema in the dorsal and supratip areas. Positioning patients in a 20° reverse Trendelenburg position during surgery, followed by maintaining the head elevated at a 90° angle postoperatively, has significantly reduced edema and ecchymosis. Using a cannula for drainage and cooling techniques has been shown to reduce postoperative morbidity effectively.Rhinoplasty is a common facial plastic surgery, yet there is no consensus on optimal postoperative care. Key strategies include silicone splints, subperiosteal drainage, nasal taping, cooling, corticosteroids, and intra- and postoperative head elevation. However, further systematic trials are necessary to refine these strategies and improve patient outcomes.

This study proposes a fully automatic segmentation of the fibula bone from CT images for application in pre-operative planning of reconstructive surgery. The objective is to make use of new developments in the image segmentation field to optimize and reduce the costs of patient-specific surgery planning. Two different approaches are proposed to perform the fibula bone segmentation, both based on a two-step segmentation method using a 3D-UNet architecture. To account for the symmetry of the left and right fibula bones, input images of the right fibula are mirrored to the left side. The accuracy of the trained models is measured using common evaluation metrics, together with specific metrics focused on facial reconstructive surgery. Both of the described approaches achieve high-accuracy results. For the best-trained model, an average Dice score of 0.95 and Average Surface Distances below 0.31 mm is measured on the test set in the region of interest for the surgery. Both approaches are robust segmentation techniques and permit data pre-processing for further application in the context of preoperative surgical planning of procedures for facial reconstruction with bony transplants.

Rhinoplasty is one of the most commonly performed facial plastic surgeries worldwide. Despite its frequency, there is significant heterogeneity in perioperative management, particularly regarding the choice of anesthesia-local, local with sedation, or general-and the postoperative use of nasal packing. A clear, evidence-based consensus on safety and outcomes is lacking. To systematically review the literature comparing anesthesia techniques used in rhinoplasty and their associated complication rates, and to assess the indications, benefits, risks, and duration of nasal packing postoperatively. The aim is to identify whether current evidence supports standardized safety protocols or guidelines. A systematic search of PubMed and Scopus databases was conducted for studies published from January 2000 to May 2025. Inclusion criteria were clinical studies reporting outcomes of rhinoplasty under local, sedation, or general anesthesia, and studies comparing the use vs. nonuse of nasal packing post-surgery. Outcomes evaluated included intraoperative and postoperative complications, patient-reported discomfort, and mean duration of nasal pack placement. Forty-three studies were included. General anesthesia remains the most frequently used method (72%), with local anesthesia with sedation favored in selected secondary or minor procedures. Complication rates were not significantly different across anesthesia modalities, although general anesthesia had a slightly higher incidence of nausea and vomiting (12%) compared to sedation (7%) and local (4%). Regarding nasal packing, the literature shows a progressive trend toward minimal or no packing, citing lower patient discomfort, quicker recovery, and no increase in postoperative bleeding. The average duration of packing ranged from 24 to 72hours. Current literature supports the safe use of all anesthesia modalities in rhinoplasty when appropriately selected. Nasal packing appears increasingly avoidable in routine cases, without compromising safety. However, a lack of unified guidelines persists. The development of evidence-based perioperative protocols could standardize care and reduce variability in clinical practice. It should also be underlined that certain packing materials, such as carboxymethylcellulose-based absorbable sponges or silicone splints, can in fact reduce the risk of synechiae formation by maintaining separation of mucosal surfaces during healing. Thus, the blanket statement that packing is a source of synechiae must be nuanced: The material, duration, and indication are critical determinants. 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 .

Rhinoplasty is one of the most frequently requested aesthetic procedures. However, a subset of patients presents with complex psychological profiles that can adversely impact surgical outcomes. Early psychological assessment is crucial to optimizing patient safety and satisfaction.This narrative review aims to explore the role of integrated psychological assessment within multidisciplinary facial plastic surgery services. It hypothesizes that early psychological input improves patient selection, manages expectations, and reduces revision rates.Narrative review.We conducted a structured narrative review of PubMed/MEDLINE, PsycINFO, Embase, and Scopus (from inception to June 2025), supplemented by clinical experience from a high-volume United Kingdom rhinoplasty center. Search terms included rhinoplasty, psychology, BDD, screening, and multidisciplinary care. Eligible sources comprised peer-reviewed studies, reviews, and guidelines on psychological assessment or outcomes in aesthetic rhinoplasty.Integrated psychological assessment can identify patients at risk of dissatisfaction, enhance patient selection, reduce revision surgeries, and improve overall outcomes.Multidisciplinary collaboration between surgeons and psychologists improves rhinoplasty outcomes, enhances patient safety, and supports the ethical principle of nonmaleficence.

Modern facial plastic surgery operates at the intersection of anatomy, psychology, and cultural ideals of beauty. Among the most enduring yet unspoken aesthetic drivers are intellectual beauty-the radiance of inner vitality-and eternal beauty-the timeless idealized image of youth and harmony. To examine the conceptual and clinical relevance of intellectual and eternal beauty in aesthetic surgery, and propose a practical framework for integrating these ideals into surgical judgment and patient communication. Literary and philosophical sources (Percy Bysshe Shelley's "Hymn to Intellectual Beauty" and W.B. Yeats's "To the Rose upon the Rood of Time") were examined alongside clinical reasoning drawn from contemporary aesthetic practice. These were synthesized into a conceptual model highlighting their relevance to surgical strategy and patient satisfaction. Intellectual beauty reflects identity, expression, and inner vitality. Eternal beauty represents a timeless ideal, often linked to youth and cultural archetypes. In surgical practice, intellectual beauty is revealed or preserved, whereas eternal beauty is approximated but never fully attained. Balancing these 2 ideals can prevent overcorrection, maintain patient identity, and align aesthetic outcomes with psychological well-being. Intellectual and eternal beauty provide a philosophical lens for understanding patient motivations and guiding surgical decision-making. Recognizing their interplay can enrich aesthetic judgment and promote more natural, dignified, and satisfying outcomes.

Background/AimThe optimal extent of neck dissection (ND) in oral squamous cell carcinoma (OSCC) is controversial, particularly regarding levels IV and V in cases with metastases in levels I-III. This study evaluated the probability of metastases in levels IV-V when levels I-III are pN+ in cN0 necks and analyzes prognostic factors influencing their occurrence.Patients and MethodsA retrospective study was performed at the Department of Oral, Maxillofacial and Facial Plastic Surgery, Ludwigshafen Hospital, Germany, including 61 patients with primary OSCC treated surgically including ND. Patients underwent either supraomohyoid ND (SOND) of levels I-III with secondary extension to IV-V or modified radical ND (MRND) of levels I-V. Statistical analysis assessed the correlation between metastases in levels IV-V and extracapsular spread (ECS), number of positive lymph nodes, T-classification, bone infiltration, grading, lymphovascular invasion, vascular invasion, and perineural invasion.ResultsAmong the 61 patients with metastases in levels I-III, 6 patients (9.8%) had metastases in levels IV-V. A significant correlation (p=0.042) indicated that pN+ in levels I-III is associated with >5% risk of level IV-V metastases. The presence of more than one metastasis in levels I-III significantly (p=0.027) predicted level IV-V involvement. A pN status of >pN2b significantly (p=0.002) increased the prevalence of metastases in levels IV-V. ECS showed a trend toward increased IV-V involvement, though not statistically significant (p=0.078).ConclusionThe risk of level IV-V metastases in patients with pN+ in levels I-III exceeds 5% in cN0 necks. The number of affected nodes and pN classification were the strongest predictors. These findings support selective extension of ND beyond level III in specific patients and emphasize individualized treatment strategies.

Facelift surgery offers aesthetic results that nonsurgical methods cannot achieve. As an elective procedure, facelift surgery requires patients to have a clear understanding of potential postoperative complications and appropriate postoperative care. Nevertheless, timely access to medical care can be challenging in remote areas. Integrating advanced artificial intelligence (AI) tools such as ChatGPT-4 and Gemini into postoperative care may help bridge this gap by offering continuous patient education and support. This study aimed to evaluate the utility of ChatGPT-4 and Gemini in addressing common patient concerns and education following facelift surgery. The five most frequently asked postoperative facelift questions were submitted to ChatGPT-4 and Gemini. Responses were assessed by five expert facial plastic surgeons based on four criteria: accuracy, clarity, relevance, and response time. Both AI models demonstrated strong overall performance. ChatGPT-4 and Gemini each achieved an average accuracy of 88%, closely aligning with current medical guidelines. Clarity ratings were 80% for ChatGPT-4 and 92% for Gemini, indicating generally understandable responses. Relevance scores were high, with ChatGPT-4 at 100% and Gemini at 96%, effectively addressing patient concerns. Both models provided instant responses, earning 100% in response time. ChatGPT-4 and Gemini show promise as supportive tools in postoperative facelift care. They delivered responses that were accurate, clear, relevant, and timely. While not a replacement for medical professionals, both AI models can serve as valuable adjuncts to patient education, particularly where access to care is limited. These findings highlight AI's emerging role in enhancing postoperative care in facial plastic surgery. 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 .

Background and Objectives: Quantifying nasal proportions is central to facial plastic and reconstructive surgery, yet manual measurements are time-consuming and variable. We sought to develop a simple, reproducible deep learning pipeline that localizes the nose in a single frontal photograph and automatically computes the two-dimensional, photograph-derived apparent nasal index (aNI)-width/height × 100-enabling classification into five standard anthropometric categories. Materials and Methods: From CelebA we curated 29,998 high-quality near-frontal images (training 20,998; validation 5999; test 3001). Nose masks were manually annotated with the VGG Image Annotator and rasterized to binary masks. Ground-truth aNI was computed from the mask's axis-aligned bounding box. A lightweight one-class YOLOv8n detector was trained to localize the nose; predicted aNI was computed from the detected bounding box. Performance was assessed on the held-out test set using detection coverage and mAP, agreement metrics between detector- and mask-based aNI (MAE, RMSE, R2; Bland-Altman), and five-class classification metrics (accuracy, macro-F1). Results: The detector returned at least one accepted nose box in 3000/3001 test images (99.97% coverage). Agreement with ground truth was strong: MAE 3.04 nasal index units (95% CI 2.95-3.14), RMSE 4.05, and R2 0.819. Bland-Altman analysis showed a small negative bias (-0.40, 95% CI -0.54 to -0.26) with limits of agreement -8.30 to 7.50 (95% CIs -8.54 to -8.05 and 7.25 to 7.74). After excluding out-of-range cases (<40.0), five-class classification on n = 2976 images achieved macro-F1 0.705 (95% CI 0.608-0.772) and 80.7% accuracy; errors were predominantly adjacent-class swaps, consistent with the small aNI error. Additional analyses confirmed strong ordinal agreement (weighted κ = 0.71 linear, 0.78 quadratic; Spearman ρ = 0.76) and near-perfect adjacent-class accuracy (0.999); performance remained stable when thresholds were shifted ±2 NI units and across sex and age subgroups. Conclusions: A compact detector can deliver near-universal nose localization and accurate automatic estimation of the nasal index from a single photograph, enabling reliable five-class categorization without manual measurements. The approach is fast, reproducible, and promising as a calibrated decision-support adjunct for surgical planning, outcomes tracking, and large-scale morphometric research.

Standardized photography is foundational in facial plastic surgery (FPS) for accurate documentation of outcomes. The increased use of smartphones and social media introduces challenges such as variable lighting, filters, and digital manipulation that can distort results.To examine current FPS photography standards and propose updated guidelines that address the influence of digital platforms. We hypothesize that modern adaptations are required to ensure accuracy and patient trust.Perspective on FPS photography standards in the age of social media.We reviewed published recommendations, historical practices, and recent studies on perioperative FPS photography, including the impact of smartphone technology and social media on standardization.Findings highlight that smartphone photography and social media images often introduce bias through inconsistent angles, lighting, and digital enhancements.Revised photographic guidelines that integrate digital-era considerations are necessary to maintain accuracy, transparency, and ethical standards in FPS.

Disclosure: F.P. Salvador-Badilles: None. M.B. Cating-Cabral: None. B.I. Cabral: None.Acromegaly is a condition caused by overproduction of growth hormone (GH). Characteristics include facial changes, acral enlargement, and metabolic dysfunction. This manifests gradually with ∼10 years of unrecognized clinical activity. Diagnosis can be difficult when the typical features are altered when acromegaly goes undiagnosed and the patient resorts to cosmetic surgery to correct these changes. This case presents the difficulty in diagnosing a GH secreting pituitary adenoma in the setting of multiple facial reconstructive surgeries. We report a 54-year-old female, hypertensive, who initially consulted for work up of hypercalcemia and recurrent nephrolithiasis. She was diagnosed with primary hyperparathyroidism due to a parathyroid adenoma with a concomitant multinodular goiter, then underwent subtotal thyroidectomy and parathyroidectomy. Histopathology confirmed findings of parathyroid adenoma, and incidentally, papillary microcarcinoma. Post surgery, calcium levels normalized. On follow-up after a year, she reported galactorrhea. Further review of past medical history and comprehensive review of systems revealed that for many years, she had been noticing that rings no longer fit, increased shoe size, and diagnosis of bilateral carpal tunnel syndrome. Additionally, she reported that she started to undergo multiple facial reconstructive surgeries, including 2 blepharoplasties and 3 rhinoplasties because of changes in her appearance. Despite these procedures, her nose continued to increase in size which prompted further work up. Prolactin was 82.69 ng/mL, IGF-1 was 854 ng/mL and GH was 9.97 ng/mL and remained elevated with documented hyperglycemia with oral glucose load. Cranial MRI showed a 1.7 x 1.0 x 1.0 cm mass extending to the right cavernous sinus, encasing the right internal carotid artery, and sphenoid sinus. A transsphenoidal excision of the pituitary tumor was done and histopathology showed a pituitary adenoma. Immunohistochemistry was positive for GH and prolactin. Her facial features were observed to have softened following the surgery. 6 months post excision, IGF-1 decreased to 419 ng/mL, GH decreased to 1.23 ng/mL , and prolactin decreased to 21.3 ng/mL. 4 years later, GH was 1.57 ng/mL, prolactin was 36.47 ng/mL, and repeat cranial MRI showed no tumor recurrence. The case depicts the challenge in diagnosing GH secreting pituitary adenoma in a patient with a history of multiple facial surgeries which masked the typical features of acromegaly. This emphasizes the importance of thorough clinical evaluation, complete history, and comprehensive review of systems in identifying subtle manifestations of this disorder. Immediate diagnosis and management are crucial to prevent long term effects associated with growth hormone excess.Presentation: Monday, July 14, 2025

We reviewed the prospects of Artificial Intelligence (AI) and its usage in facial plastic surgery. Literature search was performed using PubMed, Medline, Google and Google Scholar search engines between 2000 and 2025 years. AI is poised to impact the threefold missions of patient care, education and research. It plays a role in aiding clinician decision-making, serving as virtual conversational agents for patient engagement, and forecasting surgical outcomes. Primary areas of AI exploration in the medical field include machine learning (ML), neural networks (NN) and natural language processing (NLP). ML models have demonstrated the ability to detect facial features such as larger nasofrontal and nasolabial angles, correlating with increased attractiveness post-cosmetic rhinoplasty. Efficient resource allocation can be achieved through ML models guiding the analysis of post-operative free flap viability in facial skin cancer reconstruction. During online patient consultations, AI virtual assistants (AIVA) utilising NLP comprehend human speech intent, responding through dialogue. Unsupervised ML in facial analysis software is currently employed for correctly diagnosing rare diseases by recognising dysmorphic craniofacial features in two-dimensional photographs. AI also finds application in assessing post-operative outcomes, as well as in surgical training and research. The use of AI in healthcare is on the rise, contributing to advancements in pre-operative assessments, predicting prognoses, managing patients and monitoring postoperative progress. Surgeons are encouraged to explore collaboration with data scientists to shape the evolution of AI, aiming to enhance surgical efficiency, improve patient outcomes and potentially alleviate the workload associated with repetitive administrative duties.

Social Capital and Facial Plastic Surgery.