Facial Plastic Surgery & Aesthetic Medicine

Head and neck free flap survival relies on adequate tissue perfusion from the external carotid artery (ECA), and vessel length is inversely proportional to blood flow rate.

Investigate whether distance from the ECA (as a proxy for pedicle vessel length) predicts flap survival or complications.

Retrospective review of free flaps performed at three academic centers from 9/2006 to 8/2021. Flaps were categorized by distance from the ECA: orbit and above (zone 1), maxilla to parotid (zone 2), and mandible and below (zone 3). Secondary analysis assessed flap outcomes stratified by average historical pedicle length.

A total of 2,369 flaps were identified in zones 1 (n = 109), 2 (n = 1878), and 3 (n = 382). Rates of flap failure (4.9%) and perioperative complications (36.3%) did not differ by zone or pedicle length. Zone 3 flaps, most commonly located in the larynx and hypopharynx, had significantly higher rates of fistula and infection. Conversely, 30-day readmission rates were significantly lower in patients with zone 2 flaps (p < 0.001). Rates of all other complications did not differ significantly between zones.

Proximity to mucosal anatomic sites was a more powerful predictor of free flap viability than pedicle length or ECA proximity.

It is difficult to predict functional and aesthetic results and provide patient satisfaction after rhinoplasty.

To investigate the effect of nasal obstruction, body appreciation, and acceptance of cosmetic surgery (ACS) in predicting patient satisfaction postrhinoplasty.

We prospectively included 97 consecutive participants who underwent rhinoplasty. We recorded age, gender, marital status, education, and body mass index (BMI), and nasal obstruction symptom evaluation (NOSE) scale, body appreciation scale-2 (BAS-2), acceptance of cosmetic surgery scale (ACSS), and rhinoplasty outcome evaluation (ROE) scale were determined preoperatively and at the 3-month postoperative follow-up.

The preoperative and postoperative NOSE, BAS-2, ACSS, and ROE scores differed significantly. The mean ROE score improved from 36.8 preoperatively to 82.1 postoperatively. The ROEpostop score was not correlated significantly with age, BMI, ACSSpreop, BAS-2postop, or ACCSpostop. The BAS-2preop scores were correlated significantly with ACCSpreop and ACSSpostop scores. The NOSEpreop and BAS-2preop scores were significant predictors of the ROEpostop scores in the regression analysis.

Preoperative nasal obstruction and body appreciation, but not ACS, are factors that might affect patient satisfaction after rhinoplasty.

Nasal septal perforations (NSPs) are notoriously difficult to fix and closure can paradoxically lead to worsening of symptoms, prompting numerous techniques for repair including temporoparietal fascia (TPF)–polydioxanone (PDS) plate interposition grafting.

To compare rates of NSP closure with TPF–PDS interposition grafting among a variety of institutions with diverse environmental influences and patient-specific factors.

Retrospective review of patients undergoing TPF–PDS interposition grafting at seven different U.S. institutions over 5 years. Outcomes include closure rate, self-reported symptom improvement, change in Nasal Obstruction Symptomatic Evaluation (NOSE) score, and postoperative complications.

Sixty-two patients (39 female) with a mean age of 41.5 years were included. Most common perforation location was anterior (53%), and average size was 1.70 cm². NSP closure with symptomatic improvement was achieved in 95% of participants. Postoperative NOSE scores decreased on average by 42 points. Residual crusting occurred in 29% of patients, independent of external factors.

TPF–PDS interposition grafting is highly effective for NSP repair in a wide variety of settings, and NOSE scores correspond well with patient-reported outcomes.

Acellular human dermis (AHD) has many uses in rhinoplasty, but its long-term use as a camouflaging graft has not been adequately described.

To measure the long-term outcomes (infections/contour irregularities) of AHD used as a camouflage graft in rhinoplasty.

A retrospective study of 91 patients who underwent rhinoplasty requiring AHD as a camouflage graft for a 20-year time period (2000–2020) was performed. Complications, revisions, and long-term outcomes were assessed. Surgical technique for AHD use as a dorsal and tip camouflage graft was described in detail and illustrated using intraoperative photography.

Of the 91 patients who required AHD in their rhinoplasties, 70 (77%) were performed in revision cases to thicken thinned and scarred skin envelopes. Only 1% had postoperative contour problems that were attributable to AHD, and only 3% had resorption of the AHD. Four percent had postoperative infections, all of which resolved with a single course of oral antibiotics. Patients were followed a mean of 3.8 years.

AHD can be a safe, effective, and readily available option for use in thickening the nasal skin envelope in rhinoplasty.

Lateral tarsal techniques alone for lower eyelid correction in paralytic lagophthalmos may yield suboptimal outcomes.

To describe a lower eyelid sling technique for primary and revision correction of lower eyelid ptosis and ectropion and evaluate outcomes as measured by margin reflex distance 2 (MRD2).

A retrospective review of patients with long-standing unilateral paralytic lagophthalmos who underwent primary or revision lower eyelid ptosis correction by sling suspension between January 2016 and August 2020 at a tertiary medical center was performed. Surgical technique is illustrated with video and technical considerations are discussed. Pre- and postoperative MRD2 values were quantified from databased photographs.

Thirty-eight patients were included. Eighteen patients had undergone prior procedures for ptosis correction. Lower eyelid symmetry and paralyzed side MRD2 significantly improved after lower lid sling for primary and revision cases (p < 0.05), and improvement was sustained over the study period (mean follow-up duration 13.3 months, range 1–33 months). No postoperative complications occurred.

Lower eyelid sling yielded safe, effective, and durable correction of lower eyelid position in a cohort of patients with paralytic lagophthalmos.

Parotidectomy defects can leave patients with considerable functional and cosmetic deformities. We aim to compare the success rates and complications associated with vascularized versus nonvascularized adipofascial grafts for reconstruction, including flap failure, return to surgery, infection, and delay to adjuvant treatment.

Retrospective case series of patients undergoing either adipofascial anterolateral thigh (AFALT) free tissue transfer or free fat transfer (FFT) after parotidectomy from January 2010 to January 2020. Group comparisons and logistic regression were used to determine predictors of outcome measures.

Seventy-six patients underwent AFALT reconstruction, and 73 patients underwent FFT reconstruction. Patients treated with AFALT reconstruction had more aggressive tumor characteristics and underwent more complex resections, most commonly radical parotidectomy (n = 55, 72.4%). Postoperative complications at both the donor and recipient sites were more common in the FFT group (N = 20, 27.4% in FFT vs. N = 11, 14.5% in AFALT, odds ratio = 0.45, 95% confidence interval = 0.20–1.02, p = 0.052).

Although used in more advanced disease and in a more heavily treated wound bed, the AFALT free flap was safe and associated with fewer infectious complications than that offered by FFT.

Bifid nose is a representative indicator of a facial cleft in patients with frontonasal dysplasia. There is no consensus on effective methods to correct bifid nose deformities due to their varied expressions and limited reports of surgical treatments. In this article, we propose using a split M-shaped flap to treat severe dorsal and alar deformities in patients with a bifid nose.

From 2012 to 2021, a total of 26 bifid nose patients underwent surgical correction of their nasal deformities, which were characterized by cleft and board dorsum, alar defects, shortened nose, and shortened or absent nasal tip. These surgeries were performed with the transposition of an M-shaped split flap. Nasal length and nasolabial angle were assessed before and after surgery. Indications, outcomes, and complications were analyzed. Patient satisfaction was evaluated using a self-assessment survey.

Postoperative evaluation showed stable results with increased nasal length and improved nasal appearance. Complications were seen in difficulty breathing through the nose and persistent nostril deformities. The majority of patients (92.3%) were satisfied with their surgical outcome.

Split M-shaped flap for bifid nose treatment provides improved nasal appearance with a high patient acceptance and stable postoperative results. Clinical Trial registration: chictr.org identifier ChiCTR2000039275

Motor overflow refers to involuntary movements that accompany voluntary movements in healthy individuals. This may have a role in synkinesis.

To describe the frequency and magnitude of facial motor overflow in a healthy population.

Healthy participants performed unilateral facial movements: brow elevation, wink, snarl, and closed smile. Two reviewers analyzed the magnitude of each movement and cocontraction. Patterns of movements are described. Univariate analysis was used to assess the relationship between efficacy of unilateral facial control and the frequency and magnitude of cocontractions.

Eighty-nine participants completed the videos. Consensual mirror movements occurred in 96% of participants during unilateral eye closure and 86% during brow elevation. The most common associated movement was ipsilateral eye constriction occurring during snarl (90.1%). Improved unilateral facial control was associated with a decrease in frequency and magnitude of associated movements during brow elevation, wink, and snarl.

This study showed stereotyped patterns of motor overflow in facial muscles that resemble those in synkinesis and become more evident as unilateral control of the face decreases.

To address the lack of non-cytotoxic, non-surgical options to treat undesirable focal adiposity of the face, we propose use of the anti-glaucoma medication and prostaglandin F2α analogue latanoprost, which has a well-described side effect of periorbital adipose shrinkage.

To evaluate the safety and efficacy of soluble and liposomal latanoprost for focal fat reduction.

To compare efficacy, single administrations of either the FDA-approved cytolytic drug deoxycholic acid (DOCA), latanoprost, or liposomal latanoprost were injected into ob/ob mouse inguinal fat pads. Study outcomes included mouse weight, inguinal fat pad volume, architecture, and cytotoxicity.

Both DOCA and soluble latanoprost significantly reduced inguinal fat pad volume whereas liposome encapsulation reduced inguinal fat pad volume insignificantly over the 14-day study period. Hematoxylin and eosin demonstrated effective reduction in adipocyte volume without histologic evidence of cytolysis or inflammation whereas DOCA caused dermal ulcerations, adipocyte lysis, and increased tissue inflammation.

Latanoprost reduced fat volume without inducing cell lysis or inflammation.

Facial palsy (FP) impacts verbal and nonverbal communication, but the effect of synkinesis on communicative ability is unknown.

Among patients with nonflaccid FP, or synkinesis, is there a correlation between disease-specific quality-of-life and communicative ability or dysfunction?

Retrospective study of a series of adult patients with unilateral synkinesis. Subjects were evaluated using the Communicative Participation Item Bank (CPIB) Short Form, Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Associations between these scales were evaluated by computing Pearson correlation coefficients.

A total of 69 confirmed synkinesis patients were included. Synkinesis patient mean (standard deviation) CPIB score was 20.68 (±8.27; range of scale 0–30), indicative of communication restriction. A strong correlation was observed between total CPIB and FaCE scores (r = 0.66), indicating patients with synkinesis who reported better facial function also reported greater communicative ability. There was a weak correlation between CPIB and SAQ scores (r = −0.27).

Synkinesis is associated with significant deficits in communicative ability. Communication restrictions track strongly with the FaCE scale.