Artificial Intelligence Versus Human Focus Group Rating of Facial Attractiveness.

Background: Many open-access artificial intelligence (AI)-based websites that rate facial attractiveness are available, but none have been compared with human focus group outcomes. Objective: To compare human and AI-based websites scoring of facial attractiveness of adult female white faces. Methods: A 40-photograph database of AI-generated adult, white, female, expressionless, and frontal-view facial images were scored by otolaryngology residents and five AI-based facial rating websites: prettyscale.com, attractivenesstest.com, face-score.com/en, hotchat3000.com, and beautyscoretest.com. Sample t-test and bivariate correlation were performed for statistical analyses. Results: The focus group of 24 otolaryngology residents consisted of 62.5% males and 58.3% white participants. There was a strong positive correlation between average human score and average AI score for each photo (Pearson's correlation 0.84, p < 0.01). The average human raters' scores were significantly lower than the average AI scores (5.0 ± 1.8 vs. 6.9 ± 0.9, p < 0.01). Thirty images (75.0%) had statistically higher scores from the AI websites versus the focus group. On correlation analysis, all AI-based websites individually had scores that positively correlate with the human scores (all p < 0.05). Conclusion: AI-based websites and human focus-group scoring of facial attractiveness of adult white female faces were significantly correlated with the AI ratings biased toward higher values, encouraging their cautious utilization in future research.

Boomerang Modification of the Septal Extension Graft: Graft Design and Functional Outcomes.

Background: A "boomerang" graft is an end-to-end caudal septal extension graft (SEG) that conforms to the geometry of the anterior septal angle, and avoids septal overlap, unlike a side-to-side SEG. Objective: To compare breathing improvements in rhinoplasty patients receiving boomerang SEGs and patients receiving side-to-side SEGs. Methods: Retrospective cohort analysis of patients undergoing rhinoplasty with either end-to-end boomerang SEG or a side-to-side SEG. Functional outcomes were assessed through the Nasal Obstruction Symptom Evaluation (NOSE) survey. Results: The boomerang SEG cohort had a mean age of 34 years and were 68% female compared with 38 years and 67% female in the side-to-side SEG cohort (p > 0.05). The cohorts did not differ in the proportion of the lateral crural tensioning, spreader graft placement, or history of rhinoplasty. The boomerang cohort demonstrated a 67% reduction in NOSE scores compared with a 70% reduction among the side-to-side SEG cohort (p = 0.14). Men undergoing boomerang graft placement reported significantly less postoperative functional improvement than men undergoing placement of a side-to-side SEG (62% vs. 77%, p = 0.01). Conclusion: Use of a boomerang graft is not likely to negatively affect rhinoplasty functional outcomes when compared with a side-to-side SEG.

A Thirteen-Year Analysis of Facial Fractures among Professional Soccer Players.

This study aims to identify the epidemiology and effects of facial fractures on return to play (RTP) in Major League Soccer (MLS) and the English Premier League (EPL). A total of 39 MLS players and 40 EPL players who sustained facial fractures from 2007 to 2019 were identified. Data on player demographics, the injury, and the impact of their injury on RTP were collected. Elbow-to-head was the most common mechanism of injury (20.3%). The most common fracture involved the nasal bone (48.3%). Most players (90%) RTP the same season. Players who sustained nasal fractures missed significantly fewer games (p < 0.001) than those who suffered other craniofacial fractures. Players treated surgically missed significantly more games (3.21 vs. 0.71, p = 0.006) and days (30.1 vs. 8.70, p = 0.002) than those managed nonoperatively. Significantly more EPL players who sustained facial fractures wore headgear upon RTP compared to MLS players (82% vs. 56%, p <0 .01). Most professional soccer players who sustain a facial fracture RTP the same season, but their recovery time can vary depending on the type of fracture, injury management, or injury severity. Our findings can help inform future craniofacial injury management as well as guidelines on player safety and fracture prevention.

Complications, Treatment, and Outcomes of Self-Injecting Substances Into the Face: A Systematic Review.

BACKGROUND: The increased demand for minimally invasive facial cosmetic procedures in tandem with the ease of acquiring injectable cosmetics through direct-to-consumer retailers has led to a rise in self-injecting cosmetics among untrained individuals. OBJECTIVE: To analyze complications, treatments, and outcomes associated with self-injecting fillers into the face. METHODS: A systematic review of the literature from PubMed and Embase databases was performed from inception to September 10, 2022, to identify studies pertaining to self-injection of facial fillers. RESULTS: A total of 15 articles describing 38 complications among 18 patients were included in the data collection. The most commonly injected substance was hyaluronic acid (76.4%). The lips were the most common site of injection (33%). The most reported complication was edema (61%). Severe complications included acute vascular compromise (11%) and acute hearing loss (5%). The most common intervention was use of hyaluronidase and/or antibiotics (87.5%). Patients generally healed after treatment although residual localized hyperpigmentation was noted among 11% of patients. CONCLUSION: Injecting commercially available substances into the face is associated with potentially irreversible aesthetic, infectious, and vascular complications, especially in the hands of untrained consumers. Patients and providers should be aware of this dangerous trend.

Factors Influencing Graduates of American Academy of Facial Plastic and Reconstructive Surgery Fellowships Career Choice of Academic or Private Practice: A 20-Year Review.

Background: Absence of published literature on facial plastic and reconstructive surgery (FPRS) fellows' pursuit of academic careers hampers informed decision making for those interested in the specialty, fellowship program directors, and leaders in the American Academy of Facial Plastic and Reconstructive Surgery. Objective: To examine career choices among FPRS fellows from 2000 to 2019 and identify factors linked to academic or private practice employment after fellowship. Methods: Data from 796 fellows were analyzed, including gender, medical school, residency program, fellowship program, fellowship year, and degrees, to categorize them based on academic or nonacademic career placement. Logistic regression analyses were conducted to explore the association between demographic factors and academic career placement. Results: Forty-three percent (n = 345) obtained academic positions, with significant associations found between academic placement and additional advanced degrees, completion of fellowship training in the northeast, and residency training at an institution offering FPRS fellowship. Conclusion: Although fellows in FPRS predominantly pursue private practice, the decision to pursue academia is influenced by complex and multifactorial factors among graduates in the field.

Understanding the Impact of Aging on Attractiveness Using a Machine Learning Model of Facial Age Progression.

Background: Advances in machine learning age progression technology offer the unique opportunity to better understand the public's perception on the aging face. Objective: To compare how observers perceive attractiveness and traditional gender traits in faces created with a machine learning model. Methods: Eight surveys were developed, each with 10 sets of photographs that were progressively aged with a machine learning model. Respondents rated attractiveness and masculinity or femininity of each photograph using a sliding scale (range: 0-100). Mean attractiveness scores were calculated and compared between men and women as well as between age groups. Results: A total of 315 respondents (51% men, 49% women) completed the survey. Accuracy of the facial age progression model was 85%. Females were considered significantly less attractive (-10.43, p < 0.01) and less feminine (-7.59, p < 0.01) per decade with the greatest drop over age 40 years. Male attractiveness and masculinity were relatively preserved until age 50 years where attractiveness scores were significantly lower (-5.45, p = 0.39). Conclusions: In this study, observers were found to perceive attractiveness at older ages differently between men and women.

A Nearly Obstructive Intratracheal Mass in a Pediatric Patient.

A 12-year-old girl presented to the clinic with a 3-month history of intermittent stridor; her symptoms were initially most prominent while playing sports and were suspected to be due to asthma or seasonal allergies. What is your diagnosis?

Preparing for a Paradigm Shift in Medical Conference Development and Implementation.

The coronavirus disease 2019 pandemic has led to innovation in the way scientific advancements are disseminated and the structure of physician continuing medical education. With in-person medical conferences and meetings throughout the world impacted by travel restrictions and many geographically confined, virtual teleconferences with exceptional attendance have become an integral part of medical education. Our group has successfully produced >50 virtual educational seminars, including multiple global webinar conferences ranging between 24 and 55 h of continuous lectures each. In this special communication, we discuss some of the challenges we overcame in learning "on the job" and share key elements to successful implementation of long-format virtual teleconference events. We hope our experience will guide future online continuing medical education efforts and assist others in planning their own online initiatives.

Assessing the efficacy of a modified crushing technique for the management of concha bullosa: a cone beam computer tomography study / Avaliando a eficácia de uma técnica de esmagamento modificada para o manejo da concha bolhosa: um estudo com tomografia por feixe cônico

Abstract Introduction: Although many surgical techniques exist to manage obstructive concha bullosa, there continues to be a drive to find the least invasive technique with the fewest complications and best results. Objectives: The purpose of this study is to describe and assess the short- and long-term efficacy of a modified crushing technique for concha bullosa management. Methods: Patients who met inclusion criteria underwent a detailed nasal examination and cone beam computed tomography imaging prior to and after septoplasty with crushing surgery for obstructive concha bullosa. Patients were divided into short- and long-term groups based on their followup period such that the short-term group had a mean followup of 15.14 months (range 6->22 months) and the long-term group had a mean followup of 56.66 (range 29->80) months. Results: Twenty-four cases of obstructive concha bullosa were included in this study with 13 short-term and 11 long-term follow-ups. All patients showed a significantly decreased postoperative CB size (p< 0.001). There was no correlation between age and postoperative CB change in area (p = 0.39) and no significant difference in the amount of postoperative CB area reduction between the short-term and long-term groups (p = 0.35). No patients experienced bleeding, synechia, conchal destruction, or olfactory dysfunction on followup evaluations. Conclusion: Our modified crushing technique is a simple, effective, and lasting treatment option for concha bullosa. From our experience, there have been no complications and no instances of concha bullosa reformation during the follow-up period.

Resumo Introdução: Embora existam muitas técnicas cirúrgicas para o tratamento da concha bolhosa, ainda se busca encontrar uma técnica menos invasiva com menor número de complicações e melhores resultados. Objetivos: Descrever e avaliar a eficácia em curto e longo prazo de uma técnica de esmagamento modificada para o manejo da concha bolhosa. Método: Os pacientes que preencheram os critérios de inclusão foram submetidos a exame nasal detalhado e tomografia computadorizada de feixe cônico antes e após septoplastia com cirurgia de esmagamento de concha bolhosa. Os pacientes foram divididos em grupos de curto e longo prazo de acordo com o período de seguimento, de modo que o grupo de curto prazo teve um seguimento médio de 15,14 meses (intervalo de 6 a 22 meses) e o grupo de longo prazo teve uma média de seguimento de 56,66 (variação de 29 a 80) meses. Resultados: Vinte e quatro casos de concha bolhosa foram incluídos neste estudo, com 13 seguimentos de curto prazo e 11 de longo prazo. Todos os pacientes apresentaram uma redução significante no tamanho da concha bolhosa no pós-operatório (p< 0,001). Não houve correlação entre a idade e a mudança na área da concha bolhosa no pós-operatório (p = 0,39) e nem diferença significante na redução da área da CB no pós-operatório entre os grupos de curto e longo prazo (p = 0,35). Nenhum paciente apresentou sangramento, sinéquia, destruição da concha ou disfunção olfatória nas avaliações de seguimento. Conclusões: Nossa técnica de esmagamento modificada é uma opção de tratamento simples, eficaz e duradoura para a concha bolhosa. Com base nessa experiência, não houve complicações e qualquer caso de recorrência na formação da concha bolhosa durante o período de seguimento.

Assessing the efficacy of a modified crushing technique for the management of concha bullosa: a cone beam computer tomography study.

INTRODUCTION: Although many surgical techniques exist to manage obstructive concha bullosa, there continues to be a drive to find the least invasive technique with the fewest complications and best results. OBJECTIVES: The purpose of this study is to describe and assess the short- and long-term efficacy of a modified crushing technique for concha bullosa management. METHODS: Patients who met inclusion criteria underwent a detailed nasal examination and cone beam computed tomography imaging prior to and after septoplasty with crushing surgery for obstructive concha bullosa. Patients were divided into short- and long-term groups based on their followup period such that the short-term group had a mean followup of 15.14 months (range 6-22 months) and the long-term group had a mean followup of 56.66 (range 29-80) months. RESULTS: Twenty-four cases of obstructive concha bullosa were included in this study with 13 short-term and 11 long-term follow-ups. All patients showed a significantly decreased postoperative CB size (p < 0.001). There was no correlation between age and postoperative CB change in area (p = 0.39) and no significant difference in the amount of postoperative CB area reduction between the short-term and long-term groups (p = 0.35). No patients experienced bleeding, synechia, conchal destruction, or olfactory dysfunction on followup evaluations. CONCLUSIONS: Our modified crushing technique is a simple, effective, and lasting treatment option for concha bullosa. From our experience, there have been no complications and no instances of concha bullosa reformation during the follow-up period.

Exploring feedback-controlled versus open-circuit electrochemical lipolysis in ex vivo and in vivo porcine fat: A feasibility study.

OBJECTIVES: Minimally invasive fat sculpting techniques are becoming more widespread with the development of office-based devices and therapies. Electrochemical lipolysis (ECLL) is a needle-based technology that uses direct current (DC) to electrolyze tissue water creating acid and base in situ. In turn, fat is saponified and adipocyte cell membrane lysis occurs. The electrolysis of water can be accomplished using a simple open-loop circuit (V-ECLL) or by incorporating a feedback control circuit using a potentiostat (P-ECLL). A potentiostat utilizes an operational amplifier with negative feedback to allow users to precisely control voltage at specific electrodes. To date, the variation between the two approaches has not been studied. The aim of this study was to assess current and charge transfer variation and lipolytic effect created by the two approaches in an in vivo porcine model. METHODS: Charge transfer measurements from ex vivo V-ECLL and P-ECLL treated porcine skin and fat were recorded at -1 V P-ECLL, -2 V P-ECLL, -3 V P-ECLL, and -5 V V-ECLL each for 5 min to guide dosimetry parameters for in vivo studies. In follow-up in vivo studies, a sedated female Yorkshire pig was treated with both V-ECLL and P-ECLL across the dorsal surface over a range of dosimetry parameters, including -1.5 V P-ECLL, -2.5 V P-ECLL, -3.5 V P-ECLL, and 5 V V-ECLL each treated for 5 min. Serial biopsies were performed at baseline before treatment, 1, 2, 7, 14, and 28 days after treatment. Tissue was examined using fluorescence microscopy and histology to compare the effects of the two ECLL approaches. RESULTS: Both V-ECLL and P-ECLL treatments induced in-vivo fat necrosis evident by adipocyte membrane lysis, adipocyte denuclearization, and an acute inflammatory response across a 28-day longitudinal study. However, -1.5 V P-ECLL produced a smaller spatial necrotic effect compared to 5 V V-ECLL. In addition, 5 V V-ECLL produced a comparable necrotic effect to that of -2.5 V and -3.5 V P-ECLL. CONCLUSIONS: V-ECLL and P-ECLL at the aforementioned dosimetry parameters both achieved fat necrosis by adipocyte membrane lysis and denuclearization. The -2.5 V and -3.5 V P-ECLL treatments created spatially similar fat necrotic effects when compared to the 5 V V-ECLL treatment. Quantitatively, total charge transfer between dosimetry parameters suggests that -2.5 V P-ECLL and 5 V V-ECLL produce comparable electrochemical reactions. Such findings suggest that a low-voltage closed-loop potentiostat-based system is capable of inducing fat necrosis to a similar extent compared to that of a higher voltage direct current system.

Improving on the Do-It-Yourself Ultrasound-Guided Fine-Needle Aspiration Simulation Phantom.

The increasing use of ultrasound (US) for the diagnostic workup of thyroid lesions has subsequently been met with an increasing demand for effective US and US-guided fine-needle aspiration models. Although numerous do-it-yourself phantoms have been previously described, to our knowledge, this is the first to describe a more realistic US thyroid model using inexpensive consumer-grade materials. A simple phantom was developed and successfully used to obtain US images that realistically mimic thyroid anatomy and echogenicity. The phantom was constructed for a total cost of $6.69. It served as an inexpensive and anatomically realistic means to simulate thyroid US and US-guided fine-needle aspiration.