Facial Plastic Surgery Research Articles

Current Practices and Trends in Midface Rejuvenation.

Cosmetic approaches to midface aging are complex and vary in their treatment methodology. The nature of cosmetic surgery limits clinical trial data, forcing surgeons to rely on small studies and professional preferences when choosing an approach. Our study aimed to quantitatively assess national trends in midface rejuvenation practices. We conducted a cross-sectional study consisting of a survey administered through the American Academy of Facial Plastic and Reconstructive Surgery and the American Society of Plastic Surgeons listservs. To evaluate trends, techniques were grouped into 2 categories: minimally invasive (injectable fillers, fat transfer, fat repositioning) or invasive (deep plane facelift, subperiosteal lift, malar/cheek alloplastic implant, bone grafting/bone advancement). Two hundred thirty-two survey responses were received. Of the total respondents, 46.52% were certified by the American Board of Facial Plastic and Reconstructive Surgery, and 48.26% were certified by the American Board of Plastic Surgery. Minimally invasive techniques were far more preferred (66.67%) over invasive (33.33%) techniques, with injectable fillers as the most common technique (34.88%), followed by fat transfer (20.93%). Deep plane facelift was preferred over subperiosteal lift (18.60% vs 7.91%, respectively). Surgeons board certified by the American Board of Facial Plastic and Reconstructive Surgery were more inclined to perform invasive techniques over those board certified by the American Board of Plastic Surgery (P = 0.0427). This study quantitatively assessed national trends in cosmetic approaches to midface aging. Our data suggest that trends among surgeons across the United States have shifted toward favoring minimally invasive techniques over more invasive approaches.

43. Trends in Craniofacial Fellowship Career Outcomes: A Call for Expanding Professional Opportunities in Craniofacial Surgery

Background: Limited available pediatric plastic surgery positions fail to accommodate the increasing number of craniofacial fellows trained annually. However, many adult indications have increased the demand for craniofacial expertise. Given new opportunities available to craniofacial surgeons, the authors aim to evaluate career prospects for recent craniofacial graduates and explore additional career opportunities. Methods: Upon approval from the American Society of Craniofacial Surgeons (ASCFS), an anonymous online survey invitation was sent to craniofacial fellows who graduated from 2016 to 2021. Respondents were queried regarding their craniofacial fellowship and subsequent career prospects. Results: A total of 124 eligible participants were identified, of which 30 (24.2%) responded. Craniomaxillofacial case distribution at respondents’ current practices varied, with 42.3% reporting a 50-75% craniofacial case load and 38.5% reporting less than 25%. Craniofacial trauma reconstruction was performed most at current positions (92.3%), followed by general reconstruction (92.3%) and breast surgery (69.2%); least commonly performed was facial feminization (23.1%). Most respondents desired an increased craniomaxillofacial case load (65.4%). 26.9% were unable to secure their current position prior to fellowship completion, and 80.0% cited limited craniofacial job availability. Recommendations to improve fellowship comprehensiveness and increase candidate competitiveness included increased facial feminization, facial aesthetic, and microsurgical experience. Conclusion: To adapt to trends in craniomaxillofacial surgery, ASCFS should encourage developing fellowships that increase exposure to gender-affirming, adult craniofacial reconstruction, orthognathic, and skeletal facial aesthetic surgery. Expanding training beyond congenital deformities can provide additional employment opportunities while maintaining excellence and innovation in facial plastic surgery.

Editorial introductions.

Editorial introductions.

American Academy of Facial Plastic and Reconstructive Surgery Face-to-Face Ukraine Volunteer Surgical Team.

American Academy of Facial Plastic and Reconstructive Surgery Face-to-Face Ukraine Volunteer Surgical Team.

The Posterior Belly of Digastric Muscle as the Landmark in Facial Nerve Anastomosis Surgery: Anatomical Study and Case Illustration

To establish a new method for fast exposure of the facial nerve and hypoglossal nerve during facial nerve anastomosis surgery. Dissection of 12 formalin-fixed cadaveric specimens was performed to explore the positional relationship between the posterior belly of digastric muscle (PBD) and the facial nerve and hypoglossal nerve. We retrospectively reviewed patients who underwent facial nerve reconstruction surgery between 2015 and 2020 at Xuanwu Hospital, Capital Medical University, and the optimized surgical strategy based on the PBD was proposed. The trunk of the hypoglossal nerve runs across the external carotid artery after giving off the descendens hypoglossi located within the 1-cm scope deep to the junction of the tendon and belly of the PBD. The mean depth difference between the hypoglossal nerve and the junction of the tendon and belly of the PBD was 5.48 ± 2.24 mm (range, 1.88-9.27 mm). The stylomastoid foramen segment of the facial nerve was revealed after the parotid gland was dissected within the angle between the anterior margin of the mastoid tip and the inferior margin of the cartilage of the external acoustic meatus. The facial nerve and hypoglossal nerve can be rapidly identified using the PBD as an anatomical landmark. The end-to-end facial-descendens hypoglossi anastomosis is a reliable facial nerve reconstruction method for patients whose facial nerve was damaged during operation.

Evaluation of edge detection algorithm of frontal image of facial contour in plastic surgery

With the improvement of medical levels and the continuous improvement of people’s living standards, the demand for beauty by the general public is increasing. The plastic surgery industry has also developed by leaps and bounds. People’s dissatisfaction with their own facial appearance, facial injuries and some other reasons have prompted people to carry out facial reconstruction, and facial plastic surgery has developed rapidly. However, in the current facial plastic surgery, the edge detection effect on the contour image is general. In order to improve the edge detection effect of facial contour lines in medical images, this paper proposed a facial contour line generation algorithm. First, the detection effects of four operators were compared. After comparing the effects, the Sobel operator was used as the input data to generate an edge detection algorithm. Then, the grayscale features of the tissue in the image and the symmetry of the image were used to perform bidirectional contour tracking on the detected image to extract facial contour lines. In addition, for facial contour features, the midpoint method can be used to generate auxiliary contours. The algorithm was verified by a set of facial CT (Computed Tomography) images in the experiment. The results showed that the new generation algorithm accelerated the edge detection speed, had good denoising performance, and enhanced the edge detection effect by about 12.05% compared with the traditional edge detection algorithm. The validity and practicability of facial edge detection were verified, and it provided a theoretical basis for further realizing the design of a facial contour digital image processing system.

Evaluation of Mobile and Digital Single-Lens Reflex Photography for Facial Surgical Analysis.

High-quality perioperative photography is imperative to good surgical planning in facial reconstructive and aesthetic surgery. We explore the utility of an add-on smartphone telephoto lens to avoid the distortions noted in prior studies using smartphone cameras. Standard perioperative photographs of the same subject were taken with three distinct cameras using a dual-ring light setup. The three camera setups iPhone 11 alone, iPhone 11 with the 58 Moment telephoto lens attachment, and a D3300 Nikon DSLR APS-C sensor camera with a 60 mm NIKKOR F2.8G ED macro lens were compared using a 47-question online survey consisting of demographic and image-specific questions sent to plastic surgeons. Forty-nine facial plastic surgeons completed the survey. The iPhone 11 alone was identified as having the lowest quality for central/peripheral distortion (83%), columella/caudal septum/alar anatomy (58.3%), and skin quality (38.3%). With the addition of the telephoto lens, the ability to assess all categories was significantly improved. 53.1% (n= 26) of respondents found the iPhone 11 + 58 mm telephoto lens setup to be the most useful for perioperative surgical planning. Smartphone photography with the addition of a telephoto lens can offer a comparable option to the DSLR with regard to photo quality and detail. A telephoto add-on lens is an effective solution to overcome the central distortion seen in images taken by the iPhone for perioperative photography. This photo quality was found to be comparable to that of traditional DSLR cameras in our survey study. 3 Laryngoscope, 133:2590-2596, 2023.

Evolution and Trends of Facial Plastic Surgery and Facial Aesthetic Procedures in India: From Awakening to Revival.

Abstract Facial aesthetic surgery is an emerging branch worldwide. India, a torchbearer country in facial plastic surgery, has seen tremendous growth in medical technology, resources, and clientele over the past century. This study aims to study past practices and current trends in facial plastic surgery and aesthetic procedures in India by individually addressing commonly performed nonsurgical procedures (Botox, Kybella [Allergan, Irvine, CA], fillers, threads, micro-focused ultrasound, and nonsurgical hair restoration), and surgical procedures (rhinoplasty, blepharoplasty, hair transplant, and facelift). It also aims to further elaborate on the scope of facial aesthetics and make recommendations on prospects in the field. A structured scoping review and a subsequent evidence-based synthesis were done following an extensive literature search on various databases such as PubMed (National Institutes of Health, Bethesda, MD), LILACS (Latin American and Caribbean Center on Health Sciences Information, São Paulo, Brazil), MEDLINE (National Library of Medicine, Bethesda, MD), EMBASE (Elsevier, Amsterdam, the Netherlands), and Cochrane (Wiley, Hoboken, NJ). The initial search yielded 703 articles, out of which 20 were found to be relevant to the present study and discussed. It was found that there is an upward trend in the growth of facial plastic surgery in India, and a gradual shift in patient attitude toward nonsurgical aesthetic procedures was seen. This article affirms the growth of facial aesthetic surgery in India by highlighting the recent development and trends in the practices of surgeons. It also addresses the shortcomings in the current administration and makes recommendations to fill the existing loopholes in plastic surgery. Level of Evidence: 5

Three-Dimensional Photography and Computer Modeling as a Reconstructive Surgical Training Tool.

Reconstructive surgery operations are often complex, staged, and have a steep learning curve. As a vocational training requiring thorough three-dimensional (3D) understanding of reconstructive techniques, the use of 3D photography and computer modeling can accelerate this learning for surgical trainees. The authors illustrate the benefits of introducing a streamlined reconstructive pathway that integrates 3D photography and computer modeling, to create a learning database for use by trainees and patients alike, to improve learning and comprehension. A computer database of 3D photographs and associated computer models was developed for 35 patients undergoing reconstructive facial surgery at the Royal Free Hospital, London, UK. This was used as a training and teaching tool for 20 surgical trainees, with an MCQ questionnaire assessing knowledge and a Likert scale questionnaire assessing satisfaction with the understanding of core reconstructive techniques, given before and after teaching sessions. Data were analyzed using the Mann-Whitney U test for trainee knowledge and Wilcoxon rank sum test for trainee satisfaction. Trainee (n = 20) knowledge showed a statistically significant improvement, P < .01, as did trainee satisfaction, P < .05, after a teaching session using 3D photography and computer models for facial reconstruction. Three-dimensional photography and computer modeling are useful teaching and training tools for reconstructive facial surgery. The authors advocate the implementation of an integrated pathway for patients with facial defects to include 3D photography and computer modeling wherever possible, to develop internal databases for training trainees as well as patients. This algorithm can be extrapolated to other aspects of reconstructive surgery.

Patient-Reported Outcome Measures in a Facial Reconstruction Case Series Following the Implementation of an Integrated Craniofacial Multidisciplinary Team Clinic, Three-Dimensional Photography, and Computer Modeling.

Facial reconstruction surgery is often a complex and staged process, leading to lengthy reconstructive journeys for patients. The integration of a clinical pathway can give patients a clearer understanding of what to expect at each stage of their reconstructive journey. The authors demonstrate how the incorporation of multidisciplinary team clinics, three-dimensional (3D) photography, and 3D modeling into an integrated pathway can streamline the process for patients undergoing facial reconstructive surgeries and aid their understanding of their surgeries. A novel clinical pathway was developed for patients undergoing facial reconstructive surgery at a tertiary reconstructive unit in London. A case series was collated of 35 patients who had been through the integrated pathway. Patient-reported outcome measures (PROMs) were assessed using FACE-Q scales, Global Aesthetic Improvement Scale, Self-Perception of Age score, and Ordinal Rank change in facial aesthetic appearance, determined subjectively and objectively. Statistical analysis was performed to calculate mean averages for each scale and PROM. High patient satisfaction with overall facial appearance, aging appearance, and the decision-making process was demonstrated. The average perceived improvement in age-related facial appearance was -7.7 years postreconstruction compared with prereconstruction. The Ordinal Rank improvement on facial aesthetic appearance showed considerable improvement, both subjectively and objectively. The authors advocate the implementation of an integrated clinical pathway for facial reconstruction, with positive impacts observed in terms of patient satisfaction and objective assessments of facial appearance. Similar principles can be extrapolated to other aspects of reconstructive surgery.

Lower Eyelid Blepharoplasty With Volume Preservation Using the Skin Flap.

Abstract Lower blepharoplasty is one of the most commonly performed facial plastic surgeries and can be approached through many different techniques to improve perceived aging and fatigue due to prominent eyelid fat pads, deep tear troughs, loose eyelid skin, and global periorbital deflation. The technique discussed herein is a personal approach to lower eyelid rejuvenation surgery by the senior author, focusing on volume preservation with conservative resection and transposition of lower eyelid fat pads, muscle preservation, and microfat grafting. The authors discuss a series of 80 patients with case examples and a technique video. Level of Evidence: 5

The perforator flap of ipsilateral nasolabial sulcus used to repair the defect after the eradication of nasal vestibular squamous cell carcinoma

Objective: To investigate the feasibility of only surgical resection for nasal vestibular squamous cell carcinoma and the efficacy of perforator flap of ipsilateral nasolabial sulcus in repairing postoperative defects. Methods: The clinical data of 8 cases with squamous cell carcinoma of the nasal vestibule who admitted to Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University were analyzed, including 6 males and 2 females, aged from 38 to 75 years. The tumor of the nasal vestibule was eradicated in time after making definite diagnosis of lesions, then the perforators flap of the ipsilateral nasolabial sulcus was used for repairment, without performing further chemotherapy or radiotherapy after surgery. The tumor recurrence, facial appearance, nostril form, donor area scar, nasal ventilation function, and cutaneous sensation were evaluated after surgery. Descriptive analysis was used in this research. Results: There were 2 cases of stage T1 and 6 cases of stage T2 in 8 cases. After 32 to 45 months of following-up, no recurrence accurred and all the flaps survived well. However, there was about 2 mm necrosis of the transplanted flap in the lateral foot of the alar in one case, which was healed well by carrying out wound care after 10 d. And the dark color flap was occurred in another case, showing the flap's backflow trouble, yet it was improved with addressing timely during 5 d postoperation. Pincusion-like deformity of the transplanted flap occurred in 4 cases (50%), which subsided gradually after 6 months. The morphology of the anterior nostril was altered in 4 cases (50%), but there was no ventilation trouble and no need for addressment in any case. The postoperative facial appearance was rated as excellentor good with hidden scar in the donor site, and the sensation of the transplanted flaps was indistinct from the surrounding tissue after 3 months. Conclusions: Surgical resection of nasal vestibular squamous cell carcinoma with tumor stage T1-2 is a feasible treatment. And it is the one of the best reconstructive methods of the perforator flap of the ipsilateral nasolabial sulcus to repair the deformities after the surgery.

Trends of rhinoplasty research in the last decade with bibliometric analysis.

As rhinoplasty (RP) with different requirements is becoming more and more popular in the latest decade, this study aims to quantitatively and qualitatively explore the trends in RP research, depict research hotspots, and point out the future direction with a bibliometric analysis. All RP literature studies in the last decade (from 2012 to 2021) were retrieved from the Web of Science Core database. Annual output, institutions, authors, journals, and most-cited literature studies were analyzed by bibliometric tools, including CiteSpace, bibliometric online platform, bibliometrix R language kit, BICOMB, and gCLUTO. A total of 2,590 RP research studies dated between 2012 and 2021 were included according to our criterion. As for the country, the United States, Turkey, and Korea maintained the top three in RP research. As for the institutions, the University of California, Irvine, Stanford University, and University of Ulsan ranked top three in RP research publications based on article counts. Professor Rhorich RJ, Most SP, and Jang YJ were the most contributed authors according to article counts and citation number. The top journals were The Plastic and Reconstructive Surgery, JAMA Facial Plastic Surgery, and Aesthetic Surgery Journal. The 10 most-cited literature studies were also listed explicitly in this study. Finally, biclustering analysis on the most frequent keywords were conducted which helped us to identify seven hotspot clusters in RP research. We comprehensively summarized the publication information of RP literature studies in the past decade, highlighted the current status and trends over time, and provide guidance for in-depth research direction on RP for the future.

3D Facial Plastic Surgery Simulation: Based on the Structured Light

The 3D quantitative analysis of facial morphology is of importance in plastic surgery (PS), which could help surgeons design appropriate procedures before conducting the surgery. We propose a system to simulate and guide the shaping effect analysis, which could produce a similar but more harmonious face simulation. To this end, first, the depth camera based on structured light coding is employed for facial 3D data acquisition, from which the point cloud data of multiple facial perspectives could be obtained. Next, the cascade regression tree algorithm is used to extract the esthetic key points of the face model and to calculate the facial features composed of the key points, such as the nose, chin, and eyes. Quantitative facial esthetic indexes are offered to doctors to simulate PS. Afterward, we exploit a face mesh metamorphosis based on finite elements. We design several morphing operators, including augmentation, cutting, and lacerating. Finally, the regional deformation is detected, and the operation effect is quantitatively evaluated by registering the 3D scanning model before and after the operation. The test of our proposed system and the simulation of PS operations find that the measurement error of facial geometric features is 0.458 mm, and the area is 0.65 mm2. The ratings of the simulation outcomes provided by panels of PS prove that the system is effective. The manipulated 3D faces are deemed more beautiful compared to the original faces respecting the beauty canons such as facial symmetry and the golden ratio. The proposed algorithm could generate realistic visual effects of PS simulation. It could thus assist the preoperative planning of facial PS.

Interest of Oral and Maxillofacial Surgeons Towards Specialised Training in Facial Aesthetic and Plastic Surgery in India - An Evaluative Study.

The Dental Council of India has included facial plastic surgery in the scope of practice of Oral and Maxillofacial Surgeons (OMFSs) in India. However, the knowledge and interests of these specialists towards facial plastic surgery are unexplored. A descriptive cross-sectional study consisting of a structured questionnaire tool with six domains and 46 questions was circulated amongst registered OMFSs in India. The study consisted of 950 participants. The data obtained from this questionnaire were coded and entered into Statistical Package for Social Sciences (SPSS) and a descriptive analysis was conducted. The study yielded that only 33% of the participants were completely aware of facial fillers and 30.5% were aware of Botox procedure. However, there was complete awareness of blepharoplasty in 42%, cheiloplasty/palatoplasty in 65.8%, laser facial resurfacing in 23.7% and facial rejuvenation in 23.5% of the participants. It was found that a high number of OMFSs felt that their exposure to plastic surgery during their post-graduation years was not sufficient.

Awake video laryngoscopy aided intubation as an alternative to awake fiberoptic intubation in a patient with difficult airway.

Dear Editor, We are reporting the airway management of a 75-year-old male patient diagnosed with recurrent basal cell carcinoma (BCC) nose who had undergone multiple resections and facial reconstructive surgeries. He was posted for excision of recurrent BCC. On examination, his mouth had a fish-mouth appearance with restricted opening of approximately 4 cm. He had no nose, was edentulous with restricted tongue protrusion, and had a Mallampati score of 4. The patient had no other comorbidities and the investigations were within normal limits. After 6 h of fasting, the patient was taken up for surgery. The anesthetic plan was awake intubation followed by induction of general anesthesia (GA) and controlled ventilation. Fiberoptic bronchoscope (FOB) was unavailable and mask ventilation was seemingly impossible due to deformed facial contours. So, we planned to perform an initial awake check laryngoscopy under topical anesthesia. Following intravenous glycopyrrolate 0.2 mg, topicalization of oral cavity was done with 10% lignocaine spray. Then awake check laryngoscopy was performed with C MAC videolaryngoscope using D blade and we were able to visualize the glottic opening. Transtracheal block was given with 4 mL of 4% lignocaine, and then, under videolaryngoscopic visualization, a soft gum elastic bougie was introduced into the trachea. A 7.0mm internal diameter flexometallic endotracheal tube (ETT) was then railroaded over the bougie [Figure 1]. After observing regular end-tidal carbon dioxide waveforms, the patient was induced with propofol, paralyzed with vecuronium, and ETT was fixed at 21 cm at the left angle of the mouth. Fentanyl was used as an analgesic and anesthesia was maintained with isoflurane in an air–oxygen mixture. The intraoperative period was uneventful and the patient was extubated when fully awake after reversing neuromuscular blockade.Figure 1: Patient after intubationThough awake fiberoptic intubation (AFOI) is considered the gold standard for securing the airway in difficult airway patients, it may not be available always. Awake check laryngoscopy is helpful to plan mode of induction and intubation in difficult airway patients. Induction of GA in such patients is considered safe only if glottis could be visualized during check laryngoscopy. If FOB was available, oral AFOI would have been the ideal technique for our patient. Securing airway in patients with anticipated difficult airway in the absence of FOB could be accomplished by use of intubating laryngeal mask airway[1]or I gel,[2,3]a few among the many techniques described. We preferred intubation over supraglottic airway devices as they are bulkier than ETT and in the presence of reduced mouth opening, it would have further limited the surgical access for excision of the tumor at the mouth. Recent research has shown that videolaryngoscopes provide similar success rates and faster intubation times when compared with FOB-aided intubations in awake patients having difficult airways.[4,5]Optimal topicalization of the oral cavity, oropharynx, and the structures near the glottis as well as proper counseling of the patient are important for a successful outcome of this technique. We conclude that awake videolaryngoscopy followed by the introduction of soft gum elastic bougie into the trachea and railroading ETT over it is a safe alternative to AFOI during unavailability of FOB, provided the patient has adequate mouth opening. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Trends in otolaryngology-head and neck surgery procedural volumes during the COVID-19 pandemic

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The COVID-19 pandemic significantly impacted procedural volumes across all surgical specialties. This study aims to assess trends two years after the start of the pandemic and analyze the current surgical volume in Otolaryngology-Head and Neck Surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The COVID-19 TriNetX database, consisting of 67 health care organizations (HCOs) was utilized to collect de-identified data patients that underwent otolaryngologic surgical procedures from February 1, 2018 to January 31, 2022. The pre-pandemic (2018 to 2019) and post-pandemic (2020 to 2021) periods were analyzed and compared for surgical volumes by season, surgical subspecialty, and procedure type. Student's t-test was utilized to test for statistical significance of trends between seasonal averages pre- and post-pandemic. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 2,005,796 otolaryngology surgical procedures from 45 HCOs were included. When comparing the average monthly post-pandemic (2020 and 2021) volumes to their pre-pandemic (2018 and 2019) seasonal counterparts, there were statistically significant decreases in the averages of all seasons. Post-pandemic seasonal volumes assessed by individual years depicted a significant decline in the total otolaryngology surgical volumes in all seasons, with the steepest reduction from Winter 2019 to Spring 2020.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Specialties that experienced significant reductions in volume without sufficient evidence of rebounding trends include paediatric otolaryngology and otology, while general/rhinology/endoscopy, laryngology, head and neck surgery, and facial plastics and reconstructive surgery are trending towards pre-pandemic baselines.&lt;/p&gt;

Utilization of Virtual Consultations in Facial Plastic Surgery during the COVID-19 Pandemic.

The coronavirus disease 2019 pandemic affected many aspects of medical practice, particularly surgical fields. The American College of Surgery initially recommended the cancellation of all elective procedures. As a result, virtual consultations (VCs; a form of telemedicine), became widely used in the field of facial plastic and reconstructive surgery. With more facial plastic and reconstructive surgeons (FPRS) conducting both in-person and virtual visits, it is imperative to understand how VCs are utilized in practice. An electronic, anonymous survey was distributed to 1,282 electronic mail addresses in the 2018 American Academy of Facial Plastic and Reconstructive Surgery directory. The survey collected responses on various topics including demographic information and past, current, and future use of VCs. The survey yielded 84 responses. Most surgeons (66.7%) were 11+ years out of fellowship. There was a significant increase in the percentage of VCs scheduled after the pandemic than before (p = 0.03). FPRS most frequently responded that VCs should always be followed by an in-person visit (48.6%). A majority of FPRS (66.2%) believe that VCs have improved the delivery of health care in at least some cases. Almost all FPRS (86.5%) plan on using VCs after the pandemic. Since the pandemic, VCs are more frequently used by surgeons and are mostly utilized as an initial patient visit. A majority of FPRS believe that VCs have improved health care in at least some cases, and plan on using VCs after the pandemic.

Artificial intelligence for objectively measuring years regained after facial rejuvenation surgery

BackgroundFew objective measures are available for assessing the success of facial rejuvenation after face lift surgery. Convolutional neural networks (CNNs) may be used for this type of measurement. The purpose of this investigation is to use artificial intelligence (AI) via CNNs to objectively classify patient photos by age before and after aesthetic surgery. Uniquely, men and patients undergoing deep plane face lifts were included. MethodsA CNN (FaceX) was used for facial age recognition and age estimation. Patient photos were analyzed preoperatively, and at three (PO1) and 12 months (PO2) postoperatively. The study population included male and female patients who underwent facial rejuvenation at our institution from 2017 to 2021. Patient photos were collected with the same camera, distance, and lighting. Results226 patients were analyzed with a mean true age of 62.2 (SD 6.7) years. The AI estimated the mean preoperative age to be 64.7 (SD 10.4) years. The AI was 96.0 % accurate. Across all subjects, a 3.5-year, 5 % reduction in age (p ≤ 0.001) was attributed at PO1, and a 1.7 year, 3 % age reduction (p = 0.034) at PO2. No single ancillary procedure or technique conferred more benefit than others. The 15 males had a 2.0 year, 4 % age reduction (p = 0.06) at PO1. ConclusionAI can be used to objectively measure the success of facelift surgery and compare outcomes among rhytidectomy techniques. Additionally, multiple, different approaches were effective with no single approach being superior. As AI continues to rapidly advance, more accurate models may be developed for multiple applications in facial plastic surgery.

Minimally Invasive Otoplasty.

Minimally invasive otoplasty (MIO) is an elegant and well-proven technique for correcting protruding ears as the most frequent form of first-degree auricular dysplasia. It is well suited for the majority of patients with prominauris who regularly present to a facial plastic surgery practice. Although there are several variations of the MIO, all MIO techniques differ from traditional otoplasty techniques in that they avoid a large retroauricular skin incision and excision. This distinction considerably diminishes the risk of hypertrophic scars and keloids. The best elements of traditional otoplastic techniques can be utilized with much smaller incisions, respectively, even without incisions at all and with new surgical instruments to achieve an effective and precise surgical result. The MIO technique described herein enables all steps of cartilage work through the small retroauricular skin incision that Kaye already suggested in the very first publications of a closed otoplasty technique 1967.