Facial Plastic Surgery & Aesthetic Medicine

While selective neurectomy has emerged as a surgical adjunct for patients with facial synkinesis to eliminate aberrantly regenerated axons, postoperative outcomes have been mixed.

To understand how a zonal denervation approach to selective neurectomy targeting a broader elimination of unwanted neural elements can affect periocular and perioral movements among patients with facial synkinesis.

We retrospectively assessed patients who underwent zonal denervation from July 2023 through August 2024. Pre- and postoperative photographs were analyzed in a blinded fashion using Emotrics and eFACE; postoperative changes were compared within patients using Wilcoxon matched-pairs signed rank tests.

We included 20 zonal denervation patients who were primarily female (90%) with median age of 51 years (interquartile range 42–63) and most often developed initial facial paralysis due to viral etiology (45%). These patients experienced significant improvement in median oral commissure excursion from 2.50 mm to 5.88 mm (p < 0.001) at median 12-month follow-up (interquartile range 9–14 months). Median interlabial distance difference decreased from 5.23 mm to 2.64 mm (p = 0.002), while median palpebral fissure width difference decreased from 2.98 mm to 1.01 mm (p = 0.003). eFACE outcomes mirrored Emotrics improvements. Six patients (30%) developed transient oral incompetence resolving in less than 6 months in all cases.

Zonal denervation is an effective technique to improve periocular and perioral synkinesis.

Transcutaneous lower blepharoplasty has been associated with scleral show and lid malposition.

To evaluate postoperative eyelid position (marginal reflex distance, canthal tilt), complication rates, and patient satisfaction, as measured by standardized photographic analysis and patient-reported outcomes.

A retrospective review of 78 patients undergoing transcutaneous lower eyelid blepharoplasty with orbicularis suspension between 2022 and 2024 was conducted. Minimum follow-up was 12 months. Clinical photographs were assessed using PicPick software (version 7.2.8), and follow-up data were analyzed for aesthetic outcomes, complications, and satisfaction.

Of 78 patients (62% female, mean age = 47.5 years), the mean follow-up was 14.2 months (range = 12–25). Comorbidities included hypertension (18%) and diabetes (9%). Postoperative eyelid malposition (29.5%) and scleral show (28.2%) were unchanged from preoperative values. No cases of frank ectropion occurred, and one revision surgery (1.3%) was required. Negative preoperative canthal tilt was significantly associated with scleral show (p < 0.001). Overall, 98.7% of patients reported satisfaction.

Transcutaneous lower blepharoplasty with orbicularis suspension maintains eyelid position and contour, with low complication rates and high patient satisfaction.

Literature regarding the longevity of deep plane facelifts is limited.

To measure the time duration between initial deep plane facelifts and revision facelifts among patients treated in a single-surgeons practice over a 30-year period.

Chart review from a surgeon’s 30-year experience performing revision facelifts. Patient demographics and motivation, timing for primary/revision facelifts, and adjunctive procedures were collected. Patients were stratified into groups ≤53 and >53 based on statistical assessment. t-Tests were used.

A total of 93 revision facelifts on patients who underwent deep plane lifts were included. Seventy-seven patients had a second facelift, 14 had a third, and 2 had a fourth. Sex (female 73/77, 94.8%; male 4/77, 5.2%), age at time of first facelift (mean = 53.5 ± 6.85), second facelift (mean = 64.5 ± 6.5). Adjunctive procedures: Upper/lower blepharoplasty (18.18%, 7.8%), brow lift (15.5%), and rhinoplasty (7.8%). The mean interval between the primary deep plane facelift and the secondary lift was 10.9 years ± 5.1 Patients who underwent primary facelift surgery at ≤53 years of age returned for revision facelift after 12.4 years ± 5.6; patients >53 returned 9.3 years later ± 3.9 (p = 0.004).

Patients returning for revision surgery following deep plane facelifts do so after an average of 10.9 years. Patients who are younger at the time of their initial facelift may have greater longevity.

Artificial intelligence (AI) is increasingly applied to assess facial reanimation outcomes. However, its clinical utility and evidence have not been systematically reviewed.

This study aims to critically appraise studies evaluating AI-based tools used for outcome assessment in patients undergoing facial reanimation.

This PROSPERO-registered review involved a search of five major databases. We included adult patients with facial palsy of any etiology undergoing static or dynamic facial reanimation procedures, whereby AI tools (e.g., algorithms, simulations) were used in objective and/or subjective outcomes. A qualitative analysis was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.

Fourteen studies comprising 560 participants were included. The main tools include eight studies using Emotrics to assess structural and symmetry outcomes, demonstrating significant postoperative improvements in oral commissure excursion and symmetry. Five studies using FaceReader demonstrated its strength in capturing socio-emotional dimensions of reanimation and strong correlations with Emotrics and other clinician-rated tools. Two studies showed the utility of Affdex in quantifying the affective dimension of reanimation outcomes.

By combining precise symmetry analysis with emotional quantification, AI has strong potential to enhance objective and multidimensional assessments of functional and psychosocial outcomes following facial reanimation. Factors affecting its applicability include large heterogeneity and limited validation data.

Facial appearance influences social perception, with laypersons focusing on the central facial triangle; nasal differences may alter gaze patterns, but few studies have quantified this using eye-tracking.

To evaluate how layperson gaze patterns shift in response to different nasal variations as measured by eye-tracking.

In this prospective cohort study, facial images with 30 nasal differences were created using Photoshop to represent a range of phenotypes, such as dorsal hump, crooked nose, and pinched tip, alongside controls. Gaze data were captured via eye-tracking, and linear mixed-effects modeling assessed differences in time spent viewing defined areas of interest, adjusting for participant and image variables.

A total of 119 participants (53.8% female) were enrolled. The median age was 40 years, and 82% identified as Caucasian. Among the 30 nasal alterations, only the saddle nose resulted in significantly increased gaze time compared to controls (mean increase: 0.89 s; p < 0.001). Participant age, sex, and gender of the face in the image did not significantly influence gaze behavior.

In this study, only the saddle nose attracted greater visual attention from lay observers compared with other nasal variants.

Comparative evidence regarding the effectiveness of adjuvant intralesional triamcinolone versus radiotherapy for auricular keloids remains limited.

To compare adjuvant triamcinolone injection and radiotherapy in preventing recurrence after auricular keloid excision as measured by regrowth of keloid tissue with a minimum follow-up of 6 months.

A systematic review and meta-analysis of PubMed, Embase, Cochrane Library, and Scopus identified studies of auricular keloids treated with excision plus adjuvant radiotherapy or triamcinolone. Non-English articles, case series with fewer than 10 patients, and combined treatments were excluded. Risk of bias was assessed using Cochrane Risk of Bias 2.0 and the Newcastle-Ottawa Scale, and pooled recurrence rates were calculated with random-effects models.

Forty-five studies (1,885 lesions) were analyzed. Overall recurrence was comparable (triamcinolone: 12% [95% CI: 0.06–0.18] vs. radiotherapy: 13% [0.06–0.21]; p = 0.83). Triamcinolone recurrence varied by follow-up (≤1 year: 36% [0.24–0.49] vs. >3 years: 20% [0.11–0.33]; p < 0.001), while radiotherapy remained stable. Subgroup analyses showed no significant differences for injection timing or radiation dose.

In this study, the findings suggest that radiotherapy provides durable and superior effectiveness per treatment, whereas triamcinolone requires 4–6 monthly injections and shows progressive loss of long-term effectiveness. Individualized treatment selection that prioritizes long-term stability and treatment frequency is recommended.

Facial nerve injury can result in a spectrum of clinical presentations from complete facial paralysis (CFP) to facial synkinesis. Willingness to pay (WTP) and quality-adjusted life years are established metrics used to assess the societal value of treatments.

To quantify the perceived value of surgery for CFP and synkinesis amongst casual observers, as measured by WTP and quality of life indices.

Casual observers were shown standardized videos of faces with complete paralysis, synkinesis, and nonparalyzed controls (eight videos each). Observers were asked to imagine having each condition and to rate their quality of life and WTP for surgical repair.

A total of 557 observers were included (mean age 36.5 years, 59% female). Both complete paralysis and synkinesis were associated with reduced quality-adjusted life year indices (0.9 [95% confidence interval [CI] 0.87–0.93]) for synkinesis; 0.86 (95% CI: 0.83–0.89) for complete paralysis, p = 0.0011). The mean WTP was $22,791 for complete flaccid paralysis and $15,718 for synkinesis repair and increased with income. WTP per quality-adjusted-life year gained was $6,844 for complete paralysis and $6,604 for synkinesis (p > 0.05).

Observers perceived surgical repair of CFP and synkinesis as highly valuable and within common cost-effectiveness thresholds.