Lower Face Research Articles

An assessment of urban park accessibility using multi‐source data in Hefei, China: A social equity perspective

AbstractUrban parks are vital to enhance human well‐being and encourage sustainable urban development. However, the supply–demand match between the layout of urban parks and various social groups needs to be addressed. Therefore, this study quantitatively evaluates urban park accessibility using house‐level data from the social equity perspective in Hefei, China. A real‐time navigation route measurement based on the Amap application programming interface was taken advantage of to calculate green space travel time costs‐accessibility, and a combination of the Gaussian‐based two‐step floating catchment area method and measurement model to analyze supply–demand accessibility. On the other hand, housing price was used to indicate dwellers' socioeconomic status. The Gini coefficient, Lorenz curve, and bivariate correlation were adopted to explore the inequality of green space accessibility among residential communities. The results reveal a spatial inequality of green space between communities in the central portion of the Hefei and those in peri‐urban areas. We further found a spatial mismatch between green space resources and population distribution. At the same time, there is a significant correlation between green space accessibility and housing prices, which means the disadvantaged urban strata with low economic income face a supply shortage, while wealthier communities benefit more from green space accessibility. Hence, based on the evaluation results, the author proposes feasible optimization strategies for constructing urban parks in Hefei and can inform policy decisions regarding future park construction.

Parametric Analysis Of Wave-Induced Forces And Overtopping On Composite Vertical Breakwaters With Retreated Crown Wall

Composite vertical breakwaters are monolithic structures often used to protect port basins, especially in deep-water conditions. At present, the design of these structures is mainly based on Goda's formulae (Goda, 2010) or on the probabilistic design tools (PROVERBS) proposed by Oumeraci et al. (2001), while their hydraulic performance in terms of overtopping can be predicted by using the tools described in the EurOtop Manual (EurOtop Manual, 2018). Due to the size of these structures, the optimization and the improvement of the hydraulic performances (e.g. reduction of wave loads, wave overtopping, etc.) of these breakwaters can lead to significant economic saving. Typically, designers try to make small geometric changes without modifying the main geometrical dimensions of these structures. One of these technical solutions consists in placing the cast-in-situ concrete crown wall at a retreated position with respect to the front caisson face. It is assumed that the retreat of the crown wall, for geometric reasons, induces a time lag between the loads acting on the lower front external seawall face and on the crown wall of the caisson; furthermore, this could introduce a change in the pulsating nature of the loads, introducing also turbulent dissipations, consequently reducing the reflection coefficient and modifying the wave overtopping. To the best authors’ knowledge, in the literature there is a lack of guidelines to consider the effects of crown wall retreat in terms of wave actions and hydraulic performance of the structure. Recently, Romano & Bellotti (2023), based on physical model tests, provided a first experimental insight on the increase/reduction of the wave loads acting on deep water vertical breakwaters with retreated crown wall.

Combined Genioplasty and External Oblique Line Grafting: An Innovative Method to Improve Lower Facial Contour.

Microgenia and the accompanying plump cheeks or hamster-like facial contour are all unattractive appearances among the Asian. Genioplasty with autogenous bone grafting is one of the effective ways to improve microgenia, in which a suitable donor area with less additional damage, lower infection rate, and more excellent effect is crucial. Patients who had undergone genioplasty and autogenous external oblique line grafting (G-EOL) were followed up. The operation-related complications, preoperative, and long-term follow-up 3-dimensional spiral computed tomography (3D-CT) were collected and analyzed. Eight female patients who had received G-EOL and received 1 to 3 years of follow-up were included in this study. There were no short-term or long-term complications. CT data of bone of 8 patients and CT data of soft tissue of 6 patients at the preoperative and long term were compared. Through comparing CT data, the width at the level of the intersection of EOL and mandibular body, and the protrusion of the bony chin had improved significantly; the P values were all <0.001. Through measuring the soft tissue and analyzing the data, the ratio of lower and middle facial width, and the distance from the lower lip to Ricketts' line were all improved, with the P values 0.042 and 0.001, respectively. For patients with microgenia and hamster-like facial contour, the combination of genioplasty and autogenous external oblique line grafting is innovative and effective in improving both the front and side contour of the lower face simultaneously, with excellent stability, bone healing, and low complication rates.

Ultrasonographic Study of the Submandibular Gland for Botulinum Neurotoxin Injection.

Hypertrophied submandibular glands provide a bulky contour to the lower face. Botulinum neurotoxin injection methods are commonly used for facial contouring; however, no studies have suggested injection points because of the lack of delicate anatomical information on the submandibular gland. The aim of this study was to determine the optimal injection site for botulinum neurotoxin injections in the submandibular gland. Anatomical considerations when injecting botulinum neurotoxin into the submandibular gland were determined using ultrasonography. The thickness of the submandibular gland, its depth from the skin surface, and the location of the vascular bundle were observed bilaterally in 42 participants. Two cadavers were dissected to measure the location of the submandibular gland corresponding to the ultrasonographic observation. The thickest part of the submandibular gland measured 11.12 ± 2.46 in width with a depth of 4.63 ± 0.76. At the point where it crosses the line of the lateral canthus, it measured 5.53 ± 1.83 in width and 8.73 ± 1.64 in depth. The authors suggest optimal injection sites based on external anatomical landmarks. These guidelines aim to maximize the effects of botulinum neurotoxin therapy by minimizing its deleterious effects, which can be useful in clinical settings.

Quenching of Disk-Shaped Components in Aqueous Polymer Solutions

Abstract In addition to various advantages over oil quenching, quenching in aqueous polymer solutions can also have disadvantages. Under certain conditions, “explosive” phenomena can occur when quenching steel components in such solutions, leading to pressure waves and vibrations in the quenching tank, which can even destroy the weld seams of the tank in the long term. After these processes were analyzed in the past when quenching cylindrical shafts, the processes occurring with horizontally charged disks have now been investigated. The main difference between these two geometries lies in the size of the lower disk end face, which significantly impedes the outflow of evaporated portions of the aqueous polymer solutions and thus has a pronounced influence on the cooling behavior of disk-shaped components. The investigations to be presented here were carried out in a laboratory quenching tank. The type and concentration of the polymer, the flow type and the diameter of the inner bore of the disks were varied. Temperature and conductivity were measured and audio and video recordings were made to characterize the resulting cooling processes. Selected quenching variants are presented in detail in the article. Furthermore, key figures for characterizing the various cooling variants are compared and discussed.

Accuracy and repeatability of fetal facial measurements in 3D ultrasound: A longitudinal study

ObjectiveFetal face measurements in prenatal ultrasound can aid in identifying craniofacial abnormalities in the developing fetus. However, the accuracy and reliability of ultrasound measurements can be affected by factors such as fetal position, image quality, and the sonographer's expertise. This study assesses the accuracy and reliability of fetal facial measurements in prenatal ultrasound. Additionally, the temporal evolution of measurements is studied, comparing prenatal and postnatal measurements. MethodsThree different experts located up to 23 facial landmarks in 49 prenatal 3D ultrasound scans from normal Caucasian fetuses at weeks 20, 26, and 35 of gestation. Intra- and inter-observer variability was obtained. Postnatal facial measurements were also obtained at 15 days and 1 month postpartum. ResultsMost facial landmarks exhibited low errors, with overall intra- and inter-observer errors of 1.01 mm and 1.60 mm, respectively. Landmarks on the nose were found to be the most reliable, while the most challenging ones were those located on the ears and eyes. Overall, scans obtained at 26 weeks of gestation presented the best trade-off between observer variability and landmark visibility. The temporal evolution of the measurements revealed that the lower face area had the highest rate of growth throughout the latest stages of pregnancy. ConclusionsCraniofacial landmarks can be evaluated using 3D fetal ultrasound, especially those located on the nose, mouth, and chin. Despite its limitations, this study provides valuable insights into prenatal and postnatal biometric changes over time, which could aid in developing predictive models for postnatal measurements based on prenatal data.

How face mask wearing affects the sense of self: breathing as a case of disrupted bodily self-consciousness

ABSTRACT This pioneer study focuses on the feedback effect that the face mask has on its wearer’s sense of Self (i.e. bodily Self-consciousness) caused by its multisensorial components and affordances which are taken into account from a first-person perspective approach. On the grounds of enactivism and Material Engagement Theory, we run qualitative semi-structured interviews recruiting 48 participants: 24 people had no experience using lower face coverings before COVID-19 pandemic (February 2020) and 24 people were hospital workers with such prior experience. Results show that face mask wearing dramatically updates bodily Self-consciousness retroacting on breathing experience, with differences between the two groups. This is consistent with evidence showing that breathing is “transparent” unless bodily, environmental, and/or emotional changes arouse a situated awareness of it. We conclude that the face mask performs a retroactive effect, which we explained as due to a “material performative agency” that significantly modifies the standard balance between the transparency and the opacity of our bodily Self-consciousness.

DGAT2 Plays a Crucial Role to Control ESRRA-PROX1 Transcriptional Network to Maintain Hepatic Mitochondrial Sustainability.

Diacylglycerol O-acyltransferase 2 (DGAT2) synthesizes triacylglycerol (TG) from diacylglycerol; therefore, DGAT2 is considered as a therapeutic target for steatosis. However, the consequence of inhibiting DGAT2 is not fully investigated due to side effects including lethality and lipotoxicity. In this article, we observed the role of DGAT2 in hepatocarcinoma. The role of DGAT2 is analyzed via loss-of-function assay. DGAT2 knockdown (KD) and inhibitor treatment on HepG2 cell line was analyzed. Cumulative analysis of cell metabolism with bioinformatic data were assessed, and further compared with different cohorts of liver cancer patients and non-alcoholic fatty liver disease (NAFLD) patients to elucidate how DGAT2 is regulating cancer metabolism. Mitochondrial function is suppressed in DGAT2 KD HepG2 cell along with the decreased lipid droplets. In the aspect of the cancer, DGAT2 KD upregulates cell proliferation. Analyzing transcriptome of NAFLD and hepatocellular carcinoma (HCC) patients highlights negatively correlating expression patterns of 73 lipid-associated genes including DGAT2. Cancer patients with the lower DGAT2 expression face lower survival rate. DGAT2 KD cell and patients' transcriptome show downregulation in estrogen- related receptor alpha (ESRRA) via integrated system for motif activity response analysis (ISMARA), with increased dimerization with corepressor prospero homeobox 1 (PROX1). DGAT2 sustains the stability of mitochondria in hepatoma via suppressing ESRRA-PROX1 transcriptional network and hinders HCC from shifting towards glycolytic metabolism, which lowers cell proliferation.

Does old-age security promote rural residents' consumption? A decomposition based on contribution and replacement rates

Vulnerable groups have low income and face borrowing constraints. What is the effect of pension security on lifelong consumption? Since 2011, China has been piloting old-age security among rural residents, which provides opportunities to study this issue. We numerically simulate the impact of old-age security on rural residents' consumption based on the overlapping generations framework and empirically test the findings. The empirical results show that pension security increases per capita expenditure during the working and retirement periods by 2.04% and 0.91%, respectively. The current excessively high average payment rate (exceeding the numerical simulation threshold of 0.1) has a negative moderating effect on the two consumption periods. The replacement rate, which primarily exhibiting a wealth effect, positively moderates consumption in both periods. Our research has theoretical and practical implications for optimizing social security and promoting welfare among low-income groups.

Selenate reduction mediated by underpotentially deposited Cu on the low index faces of Au in aqueous perchloric acid

Underpotential deposited Cu on the low index faces of single crystal Au electrodes has been found to promote the reduction of selenate, SeO42−(aq),in 0.1 M HClO4 solutions, a behavior analogous to that reported earlier in our laboratory for polycrystalline Au (Strobl et al. J. Electrochem. Soc.2016,163 (13), H1066). Sequential potential step-linear scan voltammetry data collected for Au(111) film electrodes in solutions containing Cu2+(aq) in the μM range afforded evidence that the onset for the electrocatalytic activity occurs for Cu(UPD) coverages, θCu ≈ 0.18, the same value at which complementary microgravimetric data displayed a clear increase in mass. On this basis, a reaction mechanism has been proposed involving the initial reversible formation of an adsorbed adduct, we denote as Cu|SeO42−(ads), followed by a first order irreversible reduction to yield a yet to be identified species, which we denote as Cu|Se(ads), as the rate determining step. Support for this reaction scheme was obtained from numerical solutions of the coupled differential equations that govern the time evolution of Cu|SeO4−(ads) and Cu|Se(ads), yielding best agreement with the experimental data for values of the equilibrium constant for adduct formation and the adduct reduction rate constant of 2.5 × 106 cm3 mol−1, and 9.1 × 10−3 s−1, respectively. This unique electrocatalytic effect has been attributed to a shift in the potential of zero charge of the bare Au substrates induced by Cu(UPD), which promotes the adsorption of HSeO4−(aq) at potentials more negative than those found for the bare substrates, allowing access to overpotentials high enough for its activation and further reduction to ensue.

Ethnic variation in lower face anthropometry on facial computed tomography scans for patients seeking facial feminization surgery

BackgroundFacial feminization surgery (FFS) is the most common form of facial gender-affirming surgery. One of the current knowledge gaps is the understanding of racial group differences in baseline craniofacial norms for transgender and nonbinary patients. MethodsAll patients who sought consultation for FFS with a completed craniofacial computed tomographic (CT) scan at a single institution between the years of 2018 to 2023 were included. Patients with previous facial surgeries were excluded. Chart reviews were conducted for patient characteristics, including race, age, hormone therapy duration, and prior gender-affirming surgeries. Racial categorizations included White, Latinx, African American, or Asian. Patients with other or multiracial identity were excluded. Measurements of the lower face were derived from preoperative facial CT scans. Comparative analyses were performed on all measurements between racial groups. Results204 patients were included with an average age of 32.0±10.2 years and a median hormone duration of 2.0 years. Notable racial group differences were: 1. Zygomatic width was largest in Asian patients (13.5±0.6cm) compared to all other racial groups (p=0.03), 2. Nasolabial angle was smallest in African American patients (82.5±13.1 degrees, p<0.001), 3. Lower face height was largest in African American patients (6.9±0.7cm, p<0.001) and 4. Lateral mandibular flare was largest in African American patients (0.4±0.1cm) and smallest in Latinx patients (0.2±0.1cm, p<0.001). ConclusionsSpecific target areas of FFS should be carefully considered to account for possible baseline ethnic differences. Relative facial proportions may also be a more salient surgical planning tool for TGNB patients rather than absolute measurements alone.

Bioelectrical activity in temporalis and masseter muscles across different gnathic types

Relevance. Discrepancies in the bioelectrical activity of the masseter muscle were observed through surface electromyography analysis. Despite the availability of scientific literature on the morphological and anatomical variances in the mastication muscles and subcutaneous adipose tissue across different gnathic types, these differences are often overlooked in the interpretation of surface electromyography absolute values.Materials and methods. A clinical evaluation, including the measurement of craniofacial parameters and an electromyography study of the right and left temporalis (RTA and LTA) and masseter muscles (RM and LM), was conducted on 73 individuals aged 21 to 24. Subjects were categorized based on upper and lower face gnathic type indices into three groups of 10: Group 1 (brachyfacial type), Group 2 (mesofacial type), and Group 3 (dolichofacial type). The study compared the surface electromyography-derived IMPACT index and average amplitude values of the muscles across groups, alongside analyzing the correlation between electromyographic values and gnathic type indices (GPDu.f./t-t and GPDl.f./ko-ko), with statistically significant differences noted at p ≤ 0.017.Results. Differences in RM and LM parameters, and the IMPACT index during the "Maximal Voluntary Gnathic Clenching of the Jaws" (MVC) test were statistically significant among the groups. An increase in both the IMPACT index and average masseter muscle values was noted in dolichofacial subjects. Significant variations in LM values during the MVC test were observed between dolichofacial and mesofacial subjects. In the MVC test, groups 1 and 3 demonstrated a moderately strong positive correlation between the IMPACT index and GPDu.f./t-t and GPDl.f./ko-ko, while a strong positive correlation was identified between the RM parameter and GPDu.f./t-t and GPDl.f./ko-ko.Conclusion. In the MVC test, the RM and LM parameters, as well as the average IMPACT index, were notably higher in dolichofacial subjects compared to other groups. A direct correlation between the mean right masseter bioelectrical activity and the average IMPACT index with the upper and lower facial gnathic indices was observed in brachyfacial and dolichofacial subjects in the MVC test.

Longitudinal assessment of blepharospasm severity in patients with long disease duration

IntroductionBlepharospasm (BSP) represents one of the most common idiopathic adult-onset dystonia. A few longitudinal observations indicated progression and worsening of BSP severity within 16 years of onset. Information is lacking about the trend of BSP severity in the later stages of the disease. MethodsThe study comprised 15 women and 3 men that underwent a standardized video protocol at two time points: 14 ± 9 years after BSP onset and 11 ± 2 years later. BSP severity was rated by the Blepharospasm Severity Rating Scale (BSRS). Two independent observers reviewed 36 videos in a pseudo-randomized order, yielding satisfactory agreement. ResultsMean total severity score was 7.6 ± 3.9 years at baseline, 6.4 ± 2.5 at the last examination (p = 0.14). The last video examination showed a stable BSRS score in 14/18 patients, while the score of 4 patients decreased by two points or more, due to disappearance (n.3) or reduction (n.1) of prolonged spasms with complete rim closure. Over the long term, the BoNT dosage increased in those who improved, but remained stable in the other patients. On follow-up examination, dystonia spread to the lower face or neck in two new patients. No significant correlations emerged between disease duration and BSP severity. The presence of sensory trick significantly correlated with disease duration but not with BSP severity. DiscussionThis study provides novel information on the long-term prognosis in patients with idiopathic BSP, showing that severity of BSP may not worsen in the later stages of the disease.

Anthropometric Analysis of the Faces of Chinese Women in Leadership Roles.

The aim of this study was to investigate the appearance of the faces of Chinese women in leadership positions through an anthropometric analysis of Women of China from 1949 to 2022. Photographs of cover women of Women of China were gathered and a total of 380 frontal and 101 lateral photographs were collected. The photographs were divided into 3 time phases: phase I (1949-1978): from the launch of Women of China magazine, up until the time of reform and opening; phase II (1978-2010): from the time of reform and opening until when Google China was blocked; and phase III (2010-2022): to the present. The horizontal corneal diameter (11.52mm) was set as the reference value for the frontal face. The anthropometric results showed the width of the face, midface, and lower face decreased over time. The women at phase I had larger and round faces, smaller and narrower eyes, wider noses, and thicker lips; relatively masculine and hard-working woman image, as the occupations of women were mainly described as workers, farmers, and civil servants. Phase II showed smaller but still round faces, relatively wide-set round eyes, narrower noses, and smaller lips than in phase I; neutral features as skilled workers, engineers, entrepreneurs, civil servants, and researchers. Phase III showed oval faces, almond eyes, narrower noses, smaller full lips, and wider chins, reflecting a process of feminization; working in entertainment, sports, and science. The data from this study might serve as the recommended aesthetic proportions when performing plastic surgical procedures for talented woman.

Does Upper Incisors Procline following Rapid Maxillary Expansion Facemask Therapy?

Background: The present study is intended to evaluate the changes in upper incisor angulation, skeletal and dental parameters, soft-tissue and airway dimensions following rapid palatal expansion and maxillary protraction. Materials and Methods: Twenty class III subjects (mean age 11.3 years) were given bonded rapid maxillary expansion (RME) and facemask (FM) for 6 months. Pre- and posttreatment cephalogram were compared and dental, skeletal, soft-tissue, and airway changes were quantified. Results: The mean increase in SNA was 1.85° (P &lt; 0.001) while SNB decreased by 1.85° (P &lt; 0.001). Upper and lower face height increased (UFH 1.1 mm, P &lt; 0.05; LFH 2.92 mm, P &lt; 0.001). Upper lip moved forward (E line U/lip 1.27 mm, P &lt; 0.001; S line U/lip 1.3 mm, P &lt; 0.01). 1-SN decreased by 4.35° and 1-NA decreased by 4.50° with P &lt; 0.01. Overjet improved by 3.07 mm (P &lt; 0.001). Conclusion: RME and FM therapy resulted in maxillary forward movement; mandible rotated downward and backward; UFH and LFH increased. The upper lip exhibited forward movement, resulting in a less concave profile. Upper incisor retroclined and there was increase in overjet and no changes in airway dimensions. The upper incisors following RME and FM does not always procline; it is decided by the interaction of four factors – mesial dental movement, rotation of maxillary/occlusal plane, amount of expansion with RME (expansion effect), and reverse twin block if incorporated with FM.

Semiology and Neurophysiology of Clonic Seizures: A Report of 39 Patients.

Clonic seizures are currently defined as repetitive and rhythmic myoclonic contractions of a specific body part, producing twitching movements at a frequency of 0.2-5 Hz. There are few studies in the literature that have reported a detailed analysis of the semiology, neurophysiology, and lateralizing value of clonic seizures. In this article, we aim to report our findings from a retrospective review of 39 patients. We identified 39 patients (48 seizures) from our center who had been admitted with clonic seizures between 2016 and 2022. We performed a retrospective review of their video-EEG recordings for semiology and ictal EEG findings. Seventeen patients also had simultaneous surface-EMG (sEMG) electrodes placed on affected body parts, which were analyzed as well. The most common initial affected body parts were face, arm, and hand. In most of the cases, seizures propagated from lower face to upper face and distal hand to proximal arm. The most common seizure-onset zone was the perirolandic region, and the most common EEG seizure pattern was paroxysmal rhythmic monomorphic activity. The lateralizing value for EEG seizure onset to contralateral hemisphere in unilateral clonic seizures (n = 39) was 100%. All seizures recorded with sEMG electrodes demonstrated synchronous brief tetanic contractions of agonists and antagonists, alternating with synchronous silent periods. Arrhythmic clonic seizures were associated with periodic epileptiform discharges on the EEG, whereas rhythmic clonic seizures were associated with paroxysmal rhythmic monomorphic activity. Overall, the most common etiology was cerebrovascular injuries, followed by tumors. Clonic seizures are characterized by synchronized brief tetanic contractions of agonist and antagonistic muscles alternating with synchronized silent periods, giving rise to the visible twitching. The most common seizure onset zone is in the perirolandic region, which is consistent with the symptomatogenic zone being in the primary motor area. The lateralizing value of unilateral clonic seizures for seizure onset in the contralateral hemisphere is 100%.

Teleworkability and its heterogeneity in labor market shock

The rapid development of information and communication technologies has brought about a marked change in work patterns, with teleworking emerging as a vital and complementary form of employment. The COVID-19 outbreak in 2020 led to widespread social isolation, accelerating the adoption of teleworking. Following Dingel and Neiman (2020), we construct a teleworkability index for over 4539 employees and analyze the dynamic changes in their working status in China. Our findings suggest that business and technical workers are more likely to work remotely than essential labor workers. Highly educated female workers who live in the southeast of China show the advantage of working from home. Further regression estimation indicates that, throughout 2020, workers with a higher teleworkability index can better cope with adverse shocks from the pandemic with higher return-to-work rates and higher productivity. In contrast, those with a lower teleworkability index face challenges in job retention and suffer from higher unemployment rates and severe income losses. In addition, the teleworkability index is positively associated with mental health status. This study highlights the most vulnerable segment in the labor market, those with low teleworkability, should be well targeted by the social security system.

Double Chin Concerns afterEn Bloc Mandibular U-ShapedOsteotomy: Submental-Cervical Soft Tissue Changes and Anterior Belly of Digastric Muscle Assessment.

To assess submental-cervical soft tissue changes afteren bloc mandibularU-shapedosteotomy and examine alterations in the anterior belly of digastric muscle (ABDM). A retrospective study analyzed 20 patients who underwent en bloc mandibularU-shaped osteotomy from 2018 to 2023. Preoperative (Tp) and long-term follow-up (Tf) CT data were collected for analysis, measuring mandibular volume, soft tissue thickness at menton (Mes) and cervicale (C), and ABDM parameters (length, cross-sectional area (CSA), volume, distance from centroid point to the mandibular margin). Correlation analyses were performed to investigate the connection between soft tissue thicknesschanges, ABDM changes, and mandibular osteotomy volume. Long-term follow-up revealed a significant increase in soft tissue thickness at the Mes and C points after U-shaped mandibular osteotomy, especially at the C point. The adaptive length of ABDM decreased, CSA increased, and volume decreased, but the ABDM centroid point shifted downward relative to the mandibular margin, indicating drooping protrusion. The increment of soft tissue thicknesswas moderately positively correlated with the amount of osteotomy, and the decrement of ABDMlength and volume were slightly positively correlated with the amount of osteotomy. The degree of soft tissue relaxation afterU-shaped osteotomy is related to the extent of osteotomy. Notably, the protrusion of ABDM relative to the mandibular margin affects submental-cervical contour aesthetics. Prior to U-shaped osteotomy, it is crucial to assess the soft tissue condition of the patient's lower face, and the individualized design of the osteotomy volume should be carried out cautiously and safely. 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 .

Ambulatory facial feminization surgery: a comparative analysis of outcomes and complications

BackgroundTo date, there are no studies investigating the safety and outcomes of facial feminization surgery (FFS) as an outpatient procedure. This is the first study of its kind analyzing the outcomes of ambulatory FFS based on a comparison of complications, post-operative emergency department or urgent care (ED/UC) visits, and readmissions between patients who underwent FFS with admission versus same-day surgery. MethodsA retrospective analysis was conducted on all patients who underwent FFS in a single integrated healthcare system. Patient charts were reviewed for operative details, complications, post-operative ED/UC visits, readmission, and demographic factors. Major outcomes including complications, readmissions, and ED/UC visits were compared between groups with same-day discharge and post-operative hospital admission. ResultsOf 242 patients included in the study, ED/UC visits were comparable between patients discharged same-day (18.2%) and patients admitted post-operatively (21.6%, p = 0.52). Logistic regression showed no significant difference in the composite outcomes of minor complications, major complications, and readmissions (15.6% for ambulatory versus 19.3% for admission, p = 0.46). Temporary nerve palsy, infection, and hematoma were the most common post-operative complications. However, covariates of a lower face procedure and operative time were shown to have significant differences in the composite complication outcome (p = 0.04 and p = 0.045, respectively). ConclusionAmbulatory FFS is a safe practice with no associated increase in adverse outcomes including complications, ED/UC visits, and readmission when compared to post-operative admission. Adoption of same-day FFS should be considered by high-volume gender health centers to potentially benefit from increased scheduling flexibility and efficiency, increased access to care, and lower healthcare costs.

Supraclavicular Artery Flap for Head and Neck Reconstruction

Reconstruction of various defects following head and neck surgery is crucial for restoring both function and aesthetics. Over the years, various flap techniques have been developed to meet these demands. The supraclavicular artery flap is a versatile option readily accessible within the same surgical field during head and neck surgery. Its similarity in texture, color, and contour to the facial region makes it particularly useful for reconstructing defects in the neck and lower face. Additionally, its thin and pliable nature, coupled with a moderate volume, renders it suitable for a wide range of applications, including intraoral defects, pharyngeal defects, and contour refinement in facial surgery. In this paper, we present a method for reconstructing defects in the head and neck region using the supraclavicular artery flap, and discuss its utility, advantages, and limitations.