Facial Plastic Research Articles

Otoplasty and Ear Reconstruction Complications.

Prominauris, often known as prominent ears, is one of the most frequent congenital deformities of the head and neck. Therefore, otoplasty has gained significant popularity and is now one of the most performed procedures in the field of facial plastic surgery.Reconstructing and correcting ear abnormalities remains a challenging procedure in facial plastic and reconstructive surgery. These deformities, whether congenital or acquired, have a substantial influence on patients' lives and inflict psychological harm. Addressing the deformity and tissue loss will improve the overall quality of life.Throughout history, various surgical techniques have been reported for treating external ear abnormalities. While most of these surgeries are considered safe, a comprehensive preoperative evaluation and understanding of the different techniques and risks can minimize potential complications.

Effect of facial fillers on post-rhinoplasty oedema- a hypothesis based on literature review.

In the quest of achieving younger and media driven facial aesthetics, the use of fillers in the face has recently expanded exponentially. Therefore, it is inevitable that every facial plastic surgeon (FPS) will be facing patients with facial fillers. A consequence of fillers is a sub-optimal/altered lymphatic drainage, which has a direct impact on post-operative oedema following facial surgery including rhinoplasty. In the senior author's experience (AD), it was observed that patients with facial fillers had persistent oedema post-rhinoplasty. This research hypothesizes that prolonged post-rhinoplasty oedema may be related to fillers and aims to gather evidence from the literature to support this hypothesis. It also investigates whether fillers compromise lymphatic drainage. A narrative review was performed on selective articles based on fillers and post-rhinoplasty oedema. Then, it is methodologically analyzed to look for a standard theory and categorize it throughout the discussion. Theoretically, with inherent characteristics of hydrophilic nature, hardness, volume and back-flow phenomena, fillers can lead to prolonged oedema. Additionally, they can either directly block or indirectly exert pressure on the lymphatic pathways and hinder drainage. This research findings support the hypothesis that facial fillers can impact post-operative facial oedema. Future research is required to objectively measure the effect of fillers on facial lymphatic drainage. Facial plastic surgeon (FPS), Hyaluronic acid (HA), submandibular (SM), Lymph nodes (LN), ultrasonography (US). Hyaluronic acid fillers, dermal oedema, prolonged post-filler oedema, recurrent oedema, persistent oedema, facial oedema, face lymphatics. 'Conflict of Interest: 'none declared'. No commercial interest or financial support.

Insights Into Minimally Invasive Aesthetic Procedures- Defining Demographic Factors and Impact of the Treatment on Self Perception: A Propensity Matched Cross Sectional Study

Abstract Background The lion´s share of the research on facial aesthetic procedures focuses on visual results and patient satisfaction. Objectives To characterize treated and untreated potential patients and the identification of determinants that influence the decision making as well as the impact of such treatments on patients’ self-perception. Methods A cross-sectional propensity-score-matched study on minimally invasive aesthetic procedures was performed through a survey comprising elements regarding demographics, conduct towards minimally invasive facial plastic interventions as well as psychological well-being and social self-esteem domains of the validated Face-Q module. Results Complete data was collected from 598 participants. Among those, 88% (n=529) were female and 12% (n=69) were male. Forty-six percent (n=277) of the participants were below the age of 30, and 39% (n=233) percent were between 30 and 45 years of age. Of the 598 participants, 22% (n=134) participants had undergone a minimally invasive aesthetic procedure of botulinum toxin and/or hyaluronic acid injection and 78% (n=464) participants had never received any aesthetical treatment. Female gender, 30-45 years of age, self-employment and an income over 75000€ were significant predictors of undergoing minimally invasive aesthetic procedures. Among treated participants, the overall Face-Q score as well as the scores for the social-esteem and the psychological well-being domains improved significantly with the aesthetic treatment. Conclusions This study highlights the major role of healthcare providers in better informing patients and the positive impact of facial aesthetic treatments on patients’ appearance as well as on psychological wellbeing and self-esteem.

Utility of Generative Artificial Intelligence for Patient Care Counseling for Mandibular Fractures.

To determine the readability and accuracy of information regarding mandible fractures generated by Chat Generative Pre-trained Transformer (ChatGPT) versions 3.5 and 4o. Patients are increasingly turning to generative artificial intelligence to answer medical queries. To date, the accuracy and readability of responses regarding mandible fractures have not been assessed. Twenty patient questions regarding mandible fractures were developed by querying AlsoAsked (https://alsoasked.com), SearchResponse (https://searchresponse.io), and Answer the Public (https://answerthepublic.com/). Questions were posed to ChatGPT 3.5 and 4o. Readability was assessed by calculating the Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, number of sentences, and percentage of complex words. Accuracy was assessed by a board-certified facial plastic and reconstructive otolaryngologist using a 5-point Likert Scale. No significant differences were observed between the two versions for readability or accuracy. Readability was above recommended levels for patient education materials. Accuracy was low, and a majority of responses were deemed inappropriate for patient use with multiple inaccuracies and/or missing information. ChatGPT produced responses written at a high level inappropriate for the average patient, in addition to containing several inaccurate statements. Patients and clinicians should be aware of the limitations of generative artificial intelligence when seeking medical information regarding mandible fractures.

Applications of Artificial Intelligence in Facial Plastic and Reconstructive Surgery: A Narrative Review.

Importance: Artificial intelligence (AI) has made invaluable contributions to the technologic advancements across many fields. It is transforming health care and may have a role in improving patient outcomes in facial plastic and reconstructive surgery (FPRS). Observations: In recent years, new automated approaches to simulating and analyzing outcomes using AI have emerged. Advances in rhinoplasty, facelifts, orthognathic surgery, facial reanimation, and preoperative consultation are currently being developed in FPRS. Conclusions and Relevance: Applications of AI have been applied to assist facial plastic surgeons in the preoperative stage, intraoperative planning process, and objective assessment of postoperative outcomes. The application of AI provides avenues to improve postoperative outcomes, while also optimizing patient care.

Exploring the Ability of ChatGPT to Act as a Research Aid in Otolaryngology

AbstractRecently artificial intelligence (AI) platforms have developed at a rapid pace. To date no studies have explored AI platform ChatGPT’s ability to serve as an aid in research in the field of otolaryngology. The objective of our study is to evaluate the ability of ChatGPT to generate unique research ideas relevant to Otolaryngology. ChatGPT was tasked to generate novel research project ideas. Seven categories for all otolaryngology subspecialties were created: general otolaryngology, facial plastics and reconstructive surgery, rhinology and skull base surgery, pediatrics, head and neck oncology, laryngology, and otology/neurotology. Within each of the subspecialties, ChatGPT was prompted to provide research ideas for two specific research topics in order to gauge ChatGPT’s ability to explore specific domains. Ten prompts were entered for general otolaryngology, and five prompts were entered for each subspecialty and subspecialty topic. ChatGPT was subsequently prompted with the same query to generate systematic review ideas for each category. Ideas were deemed novel if there were no similar systematic reviews retrieved during the literature review on PubMed, Scopus, or Web of Science. Ideas were graded for Clinical Relevance on a scale of 0 to 5, 5 being considered highly relevant/would contribute greatly to patient care and 0 being considered not relevant/not beneficial to patient care. Two reviewers graded each response. Out of 100 systematic review ideas generated by ChatGPT, we found that the artificial intelligence platform was incapable of creating unique systematic review research ideas. However, the ideas that it did generate were largely feasible and clinically relevant. Future studies should investigate the ability of ChatGPT to generate research inquiries with non-systematic review methodologies and in more specific otolaryngology topics.

From Filters to Scalpels-Understanding Perceptions of Facial Asymmetry: An AAFPRS Survey.

Facial asymmetries can significantly affect patient satisfaction post-surgery. Social media can impact a patient's perception of their asymmetries. To gather insights into the practices, perceptions, and approaches concerning facial asymmetry among facial plastic surgeons. The aim of this study was to understand the impact of social media on perceptions of facial asymmetry. This is an American Academy of Facial Plastic and Reconstructive Surgeons (AAFPRS) survey consisting of 46 questions that sought to understand facial plastic surgeons' perceptions of facial asymmetry, their consultation process, their patients' perspectives on their own facial asymmetries, and patient satisfaction. The survey was distributed to 1,269 members of AAFPRS across community hospitals, private practices, and academic hospitals. Sixty-seven members completed the survey. The survey revealed that 31% (21) of surgeons face challenges in managing patient expectations regarding facial asymmetry. In addition, 12% (8) of surgeons felt that patients did not initially recognize their own asymmetries. Eighty-seven percent (58) of surgeons emphasize the natural occurrence of asymmetry during consultations to set realistic expectations. This study emphasizes the need for thorough patient education during initial consultations to align expectations with achievable outcomes. Surgeons should explain the natural occurrence of asymmetry clearly and use digital imaging to show patients realistic previews of surgical results.

Split Dorsal Nasal Flap: A Modification to Expand Its Utilization.

Nasal reconstruction presents the facial plastic surgeon with a complex problem given its functional and aesthetic importance. The dorsal nasal flap is a composite rotational flap of the glabella and nasal dorsum that can be used for nasal dorsum and tip defects of medium to large sizes. Given its composite nature, this flap can be split into its constituent parts-the epidermis and dermis and the subcutaneous tissue and superficial musculoaponeurotic system-without flap loss. This case series describes this technique and various potential applications within nasal reconstruction.

Outcome of isolated and combined direct feminization laryngochondroplasty: Our first 20 cases

This retrospective study describes the surgical outcomes of our first 20 transgender women to undergo feminization thyroid laryngochondroplasty (FLC) by a direct transvestibular FLC (DTV-FLC) approach from December 2019 to October 2023. The medical records of all patients were retrieved and reviewed. Data on the operative, postoperative, and follow-up courses, complications, and functional and cosmetic outcomes were retrieved. The cosmetic results were evaluated by four independent facial plastic surgeons. Thirteen patients underwent DTV-FLC combined with genioplasty or genioplasty with mandibular angle reduction and seven underwent isolated DTV-FLC. DTV-FLC was feasible in all planned cases. Complications (skin flap perforation, thyroid cartilage fracture, mental hypoesthesia, hematoma, dehiscence of the vestibular incision, vestibular scar adhesions, and anemia) were minor and resolved spontaneously. The preoperative grade of thyroid cartilage protrusion was 1.9 ± 0.9 on a scale from 1 to 3. The postoperative cosmetic results of 18 patients were judged as having improved (a score of 2.1 ± 0.8 on a scale from −1 to 3). Eighteen patients were satisfied with the cosmetic result, one was dissatisfied (the revision surgery patient), and one was lost to follow-up. In conclusion, DTV-FTLC is a valid surgical approach for FLC, yielding high patient satisfaction and good cosmetic results.

Non-surgical (liquid) rhinoplasty

Non-surgical (liquid) rhinoplasty (LR) is a common and expanding cosmetic procedure. The use and safety of in-office injectables, as well as surgeon comfort, has led to substantial growth with the procedure. Knowledge of nasal structural and vascular anatomy, injectable filler properties and in situ behavior, and procedural technique are all required for the application of non-surgical rhinoplasty. There is consensus regarding common indications for the procedure, including dorsal augmentation, correction of post-surgical deformities, and improvement of nasal tip symmetry. However, there is substantial variability in filler usage, technique, and patient selection. As with surgical rhinoplasty, the risk of patient dissatisfaction with LR remains high. It is of utmost importance to consider the rise of non-surgeon providers performing these procedures. A thorough understanding of the risks, benefits, and proper patient selection are key for any facial plastic surgeon utilizing LR.

Differences in Patient Secure Message Volume Among Otolaryngologists: A Retrospective Cohort Study.

To identify differences in inbox and secure message burden among otolaryngologists based on demographics and subspecialty over 4 years. Inbox data were queried from January 2019 until December 2022. Otolaryngologists were categorized into cohorts by area of practice and gender. All inbox tasks, secure messages, and clinical encounters were collected and compared by gender, practice type, and years in practice. Means were compared using t-tests and chi-squared tests. Of the 128 physicians, 45.7% were comprehensive otolaryngologists and 61.3% were male. The most common subspecialties were facial plastics (15.6%), oncology (8.6%), and otology (7.8%). Otolaryngologists had an average of 143.5 inbox tasks per month, with 97.2 (67.7%) of them being secure messages, resulting in an average of 1.14 inbox tasks and 0.80 secure messages per clinical encounter. The ratio of secure messages per clinical encounter was consistent across all specialties except oncology (1.10, P = .003). Otology (0.86, P = .032) and facial plastics (0.95, P = .028) had significantly lower ratios of inbox tasks to clinical encounters when compared to their colleagues, while oncology had a higher ratio (1.70, P < .001). No significant differences in inbox burden were observed between genders, years in practice, or languages spoken. Secure messages steadily increased over the study period. Inbox burden for otolaryngologists primarily stems from patient secure messages and varies across subspecialties. Considerations should be made to the inbox burden of head and neck oncologists. The implementation of support systems for inbox management could improve the imbalance between clinical and non-clinical responsibilities in otolaryngology. Level III, Retrospective Cohort Study.

The Evolution of My Extended SMAS-Biplanar Deep Plane Facelift to a Composite Tissue Deep Plane Face and Neck Lift: Similarities and Differences.

In this article, Dr. Stephen Perkins, a seasoned facial plastic surgeon, presents his refined techniques in facelift surgery developed over four decades of practice. His evolution from traditional methods to the current composite tissue deep plane facelift is elucidated. His composite tissue deep plane facelift involves meticulous dissection and repositioning of the superficial musculoaponeurotic system (SMAS) and platysma in the deep plane, as well as incorporating his innovative "Perkins' Kelly clamp anterior platysmaplasty." This technique, refined through years of experience, aims for natural, enduring results, crucially addressing patient concerns such as jowling and neck laxity. Long-term analysis reveals the advantages of Dr. Perkins' technique, particularly in achieving sustained cervicomental angle improvement for over a decade postoperatively. This article underscores the importance of understanding deep plane facelift techniques, distinguishing between different approaches, and tailoring surgical interventions to individual patient characteristics. Dr. Perkins' comprehensive approach, incorporating advancements in surgical technique and meticulous patient care protocols, exemplifies the goal of achieving natural, long-lasting facial rejuvenation.

Analgesic considerations in facial plastic and reconstructive surgery: a review

Analgesic considerations in facial plastic and reconstructive surgery: a review

Impact of COVID-19 on facial plastic surgery volumes: A large database analysis of pre- and post-pandemic trends.

During the COVID-19 pandemic, elective surgeries faced cancelations due to quarantine measures. The objective of this study was to assess facial plastic and reconstructive surgery (FPRS) volume before, during, and after the height of the pandemic on a national scale. The TriNetX Research Network identified 68,101,098 individuals aged 18+ with healthcare interactions from 2017 to 2022. Rates of common FPRS surgeries and procedures were compared during March-August of each year, aligning with the pandemic lockdown. Compared to immediately before the pandemic in 2019, the 2020 pandemic peak saw an overall surgical volume reduction of -36.8%, with specific surgeries decreasing significantly: rhinoplasty (-28.6%), septoplasty (-34.0%), rhytidectomy (-54.9%), blepharoplasty (-40.7%), brow lift (-43.8%), ectropion/entropion repair (-35.6%), repair of blepharoptosis (-45.6%), correction of lagophthalmos (-29.9%), correction of lid retraction (-36.8%), and lipectomy (-41.8%) (p < .001). The procedural volume also decreased by 28.6%, encompassing reductions in various procedures: botulinum toxin A (-18.7%), facial filler (-40.7%), dermabrasion (-62.3%), chemical peel (-36.6%), and intralesional injection (-33.3%) (p < .001). In contrast to 2020, 2021 witnessed an increase of +75.0% in total surgical and +61.3% procedural volume: rhinoplasty (+81.0%), septoplasty (+74.7%), rhytidectomy (+143.4%), blepharoplasty (+81.7%), brow lift (+64.5%), ectropion/entropion repair (+55.2%), repair of blepharoptosis (+62.7%), correction of lagophthalmos (+39.0%), correction of lid retraction (+73.0%), lipectomy (+121.2%), botulinum toxin A (+52.4%), filler (+59.6%), dermabrasion (+91.8%), chemical peel (+78.8%), and intralesional injection (+67.3%) (p < .001). In 2022, rates of total surgeries (+8.5%) and procedures (+12.8%) surpassed pre-pandemic levels from 2019 (p < .001). FPRS experienced significant pandemic-induced decreases, followed by a notable recovery in subsequent years, with certain surgeries and procedures surpassing pre-pandemic levels. 4.

Artificial intelligence in maxillofacial and facial plastic and reconstructive surgery.

To provide a current review of artificial intelligence and its subtypes in maxillofacial and facial plastic surgery including a discussion of implications and ethical concerns. Artificial intelligence has gained popularity in recent years due to technological advancements. The current literature has begun to explore the use of artificial intelligence in various medical fields, but there is limited contribution to maxillofacial and facial plastic surgery due to the wide variance in anatomical facial features as well as subjective influences. In this review article, we found artificial intelligence's roles, so far, are to automatically update patient records, produce 3D models for preoperative planning, perform cephalometric analyses, and provide diagnostic evaluation of oropharyngeal malignancies. Artificial intelligence has solidified a role in maxillofacial and facial plastic surgery within the past few years. As high-quality databases expand with more patients, the role for artificial intelligence to assist in more complicated and unique cases becomes apparent. Despite its potential, ethical questions have been raised that should be noted as artificial intelligence continues to thrive. These questions include concerns such as compromise of the physician-patient relationship and healthcare justice.

Health Disparities Research in Facial Plastic and Reconstructive Surgery: A Scoping Review.

Health disparities contribute significantly to disease, health outcomes, and access to care. Little is known about the state of health disparities in facial plastic and reconstructive surgery (FPRS). This scoping review aims to synthesize the existing disparities research in FPRS and guide future disparities-related efforts. PubMed, Embase, Web of Science. We conducted a scoping review in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Our search included all years through March 03, 2023. All peer-reviewed primary literature of any design related to disparities in FPRS was eligible for inclusion. Of the 12283 unique abstracts identified, 215 studies underwent full-text review, and 108 remained for final review. The most frequently examined topics were cleft lip and palate (40.7%), facial trauma (29.6%), and gender affirmation (9.3%). There was limited coverage of other areas. Consideration of race/ethnicity (68.5%), socioeconomic status (65.7%), and gender/sex (40.7%) were most common. Social capital (0%), religion, occupation, and features of relationships were least discussed (0.01% each). The majority of studies were published after 2018 (59.2%) and were of nonprospective designs (95.4%). Most studies focused on disparity detection (80.6%) and few focused on understanding (13.9%) or reducing disparities (5.6%). This study captures the existing literature on health disparities in FPRS. Studies are concentrated in a few areas of FPRS and are primarily in the detecting phase of public health research. Our review highlights several gaps and opportunities for future disparities-related focus.

Artificial Intelligence in Facial Plastic Surgery

Using Artificial Intelligence Facial Plastic surgery is a new important tool that has been implemented recently into helping surgeons, we focused in two aspect of AI uses in facial plastics which is in the use of early detection of skin lesions and the use of it in the aspect of cosmetic facial plastic surgery by developing an algorithm that determines attractive facial features most closely related to post-operative target variables

Characterizing the Rhinoplasty Outcomes Most Important to Patients, Surgeons, and the General Population.

Understanding rhinoplasty characteristics important to patients, physicians, and society is essential for evaluating outcomes and designing optimal treatment plans. The authors aimed to elucidate specific rhinoplasty-related outcomes that are most important to patients, surgeons, and the general population. A cross-sectional survey comprising 11 rhinoplasty-specific characteristics, was distributed to patients, facial plastic surgeons, and the general population. Adult patients presenting for rhinoplasty consideration or follow-up after undergoing rhinoplasty were recruited. Characteristics rankings were compared between the 3 respondent groups using Spearman's rank correlation coefficient (ρ). Responses from 150 surgeons, 111 patients, and 102 lay individuals from the general population were included for analysis. When ranking rhinoplasty-specific characteristics in order of importance, patients and the general population ranked "ability to breathe through nose while awake" first and "overall appearance of nose" as second. Surgeons ranked "overall appearance of nose" first and "ability to breathe through nose while awake" second. There were strong correlations between patients' and surgeons' rankings (Spearman's ρ=0.836, P =0.002), between patients' and the general population's rankings (Spearman's ρ=0.773, P =0.007), and between surgeons' and the general population's rankings (Spearman's ρ=0.782, P =0.006). Our results highlight a significant correlation between characteristics of the "ideal" nose as determined by patients, surgeons, and the general population.

Perceptions and Understanding of Transgender Patient Care: A Survey of Practicing Facial Plastic Surgeons.

Transgender individuals face significant health disparities including deficiencies in physician education, knowledge, and comfort with care. The objective of this study was to determine the perceptions, practice patterns, and familiarity of facial plastic surgeons with transgender health care. An anonymous questionnaire was sent to facial plastic surgeons within the American Academy of Facial Plastic and Reconstructive Surgery list-serve. Primary datapoints included participant characteristics, transgender-related experience, and educational goals. Of the 66 facial plastic surgeons surveyed, 49% had treated 1 to 10 transgender patients during their career, and 70% were actively treating at least 1 transgender patient. The number of patients treated and surgeries performed was significantly associated with self-perceived competence, comfort counseling on gender-affirming surgeries, discussing gender identity, asking preferred pronouns, and a desire to learn more about transgender care. Most participants (61%) obtained transgender care training through real-world experience, with only 18% receiving formal training in residency or fellowship. In total, 50% of respondents believe transgender care training among facial plastic surgeons is inadequate and 60% support its incorporation into residency/fellowship curricula. Increased awareness is needed to address the disparities experienced by transgender patients. Many facial plastic surgeons desire to learn more and support incorporating transgender care into training. Understanding the current state of transgender care can assist the facial plastic community in promoting education that strengthens physicians' ability to deliver competent care that addresses the inequities faced by this diverse group.

Women in Facial Plastic and Reconstructive Surgery: The State of the Academy and Why It Matters.

Facial plastic and reconstructive surgery has historically been a male-dominated field. It is critical to assess the current state of female representation within our Society to better gauge how we reflect the changing needs of our community and our patients. Although we have made headway in fostering a community ripe for progress, we must continue to create and promote equal opportunities, dissuade microaggressions, address burnout, and capitalize on the innate strengths of our female constituents. With the data presented in this study, we hope to further illuminate the benefits of women engagement in our Academy while recommending sustainable actions to create a culture of allyship.