The aesthetic value of reef fishes is globally mismatched to their conservation priorities.

Reef fishes are closely connected to many human populations, yet their contributions to society are mostly considered through their economic and ecological values. Cultural and intrinsic values of reef fishes to the public can be critical drivers of conservation investment and success, but remain challenging to quantify. Aesthetic value represents one of the most immediate and direct means by which human societies engage with biodiversity, and can be evaluated from species to ecosystems. Here, we provide the aesthetic value of 2,417 ray-finned reef fish species by combining intensive evaluation of photographs of fishes by humans with predicted values from machine learning. We identified important biases in species' aesthetic value relating to evolutionary history, ecological traits, and International Union for Conservation of Nature (IUCN) threat status. The most beautiful fishes are tightly packed into small parts of both the phylogenetic tree and the ecological trait space. In contrast, the less attractive fishes are the most ecologically and evolutionary distinct species and those recognized as threatened. Our study highlights likely important mismatches between potential public support for conservation and the species most in need of this support. It also provides a pathway for scaling-up our understanding of what are both an important nonmaterial facet of biodiversity and a key component of nature's contribution to people, which could help better anticipate consequences of species loss and assist in developing appropriate communication strategies.

Aesthetic experience enhances first-person spatial representation.

Episodic autobiographical memories are characterized by a spatial context and an affective component. But how do affective and spatial aspects interact? Does affect modulate the way we encode the spatial context of events? We investigated how one element of affect, namely aesthetic liking, modulates memory for location, in three online experiments (n = 124, 79, and 80). Participants visited a professionally curated virtual art exhibition. They then relocated previously viewed artworks on the museum map and reported how much they liked them. Across all experiments, liking an artwork was associated with increased ability to recall the wall on which it was hung. The effect was not explained by viewing time and appeared to modulate recognition speed. The liking-wall memory effect remained when participants attended to abstractness, rather than liking, and when testing occurred 24 h after the museum visit. Liking also modulated memory for the room where a work of art was hung, but this effect primarily involved reduced room memory for disliked artworks. Further, the liking-wall memory effect remained after controlling for effects of room memory. Recalling the wall requires recalling one's facing direction, so our findings suggest that positive aesthetic experiences enhance first-person spatial representations. More generally, a first-person component of positive affect transfers to wider spatial representation and facilitates the encoding of locations in a subject-centered reference frame. Affect and spatial representations are therefore important, and linked, elements of sentience and subjectivity. Memories of aesthetic experiences are also spatial memories of how we encountered a work of art. This linkage may have implications for museum design.

The neurobiology of aesthetic chills: How bodily sensations shape emotional experiences.

The phenomenon of aesthetic chills-shivers and goosebumps associated with either rewarding or threatening stimuli-offers a unique window into the brain basis of conscious reward because of their universal nature and simultaneous subjective and physical counterparts. Elucidating the neural mechanisms underlying aesthetic chills can reveal fundamental insights about emotion, consciousness, and the embodied mind. What is the precise timing and mechanism of bodily feedback in emotional experience? How are conscious feelings and motivations generated from interoceptive predictions? What is the role of uncertainty and precision signaling in shaping emotions? How does the brain distinguish and balance processing of rewards versus threats? We review neuroimaging evidence and highlight key questions for understanding how bodily sensations shape conscious feelings. This research stands to advance models of brain-body interactions shaping affect and may lead to novel nonpharmacological interventions for disorders of motivation and pleasure.

Sparsity in an artificial neural network predicts beauty: Towards a model of processing-based aesthetics.

Generations of scientists have pursued the goal of defining beauty. While early scientists initially focused on objective criteria of beauty ('feature-based aesthetics'), philosophers and artists alike have since proposed that beauty arises from the interaction between the object and the individual who perceives it. The aesthetic theory of fluency formalizes this idea of interaction by proposing that beauty is determined by the efficiency of information processing in the perceiver's brain ('processing-based aesthetics'), and that efficient processing induces a positive aesthetic experience. The theory is supported by numerous psychological results, however, to date there is no quantitative predictive model to test it on a large scale. In this work, we propose to leverage the capacity of deep convolutional neural networks (DCNN) to model the processing of information in the brain by studying the link between beauty and neuronal sparsity, a measure of information processing efficiency. Whether analyzing pictures of faces, figurative or abstract art paintings, neuronal sparsity explains up to 28% of variance in beauty scores, and up to 47% when combined with a feature-based metric. However, we also found that sparsity is either positively or negatively correlated with beauty across the multiple layers of the DCNN. Our quantitative model stresses the importance of considering how information is processed, in addition to the content of that information, when predicting beauty, but also suggests an unexpectedly complex relationship between fluency and beauty.

Aesthetic outcome of intermediate closure versus intermediate closure followed by 2-octyl cyanoacrylate: A randomized evaluator-blinded split-wound comparative effectiveness trial.

BACKGROUND: Dermatologic surgeons are increasingly using surgical adhesives in their practice. Studies comparing sutured wounds to those that utilize a combination of suturing and skin adhesive have not been previously conducted. OBJECTIVE: To compare the cosmetic outcome and patient wound care satisfaction of an intermediate suture closure with an intermediate suture closure followed by the application of 2-octyl cyanoacrylate (2-OCA). METHODS: Fifty patients were enrolled in a randomized, evaluator-blinded, split-scar study. Following intermediate sutured closure of a surgical defect, one side of the wound was randomized to receive an additional application of 2-OCA. After 3 months, the scar was assessed using the POSAS tool and patients reported wound care preferences. RESULTS: As the primary outcome measure, the mean sum of observer POSAS was 12.80 for sutured closure alone versus 12.40 for sutured closures followed by 2-OCA (P = .49). LIMITATIONS: Single-center study of a relatively homogenous population. CONCLUSION: Although there were no significant differences in scar cosmesis, both patients and observers tended to prefer the side with an additional application of 2-OCA in most POSAS components, in overall opinion, and in patient wound care satisfaction. Dermatologic surgeons may add this to their practice without sacrificing scar outcomes or patient satisfaction.

Aesthetic outcome of running subcuticular suture versus running horizontal mattress suture in closure of linear wounds of the trunk and extremities: A randomized evaluator-blinded split-wound comparative effectiveness trial.

BACKGROUND: Both running horizontal mattress (HM) and running subcuticular (SQ) suturing techniques have been suggested to be superior to other running cuticular suturing techniques. These 2 techniques have not been directly compared. OBJECTIVE: To compare cosmetic outcomes between a running HM and a running SQ technique in a split scar model following linear closure of trunk and extremity defects. METHODS: Fifty patients were enrolled in a randomized, evaluator-blinded, split-scar study. One side of the surgical wound was randomized to receive one intervention (HM vs SQ) with the other side receiving the alternate intervention. The primary outcome was the Patient and Observer Scar Assessment Scale (POSAS) score at a minimum of 3 months postoperatively. RESULTS: Observer POSAS sum of components was 19.49 and 17.76 for HM and SQ, respectively (P = .14). The mean score for patient overall opinion was 4.71 for HM and 3.50 for the SQ technique (P = .02). Overall opinion scores of evaluators were 3.87 and 3.29 for HM and SQ, respectively (P = .03). LIMITATIONS: Single-center study of a relatively homogenous population. CONCLUSION: Although there was no significant difference in the sum of POSAS components between HM and SQ (P = .14), both patients and evaluators had a superior overall opinion of the SQ-treated side (patient P = .02, evaluator P = .03).

Aesthetic chills mitigate maladaptive cognition in depression.

BACKGROUND: Depression is a major global health challenge, affecting over 300 million people worldwide. Current pharmacological and psychotherapeutic interventions have limited efficacy, underscoring the need for novel approaches. Emerging evidence suggests that peak emotional experiences characterized by awe, transcendence, and meaning hold promise for rapidly shifting maladaptive cognitive patterns in depression. Aesthetic chills, a peak positive emotion characterized by physical sensations such as shivers and goosebumps, may influence reward-related neural pathways and hold promise for modifying core maladaptive beliefs rooted in early adverse experiences. METHODS: We enrolled 96 patients diagnosed with major depressive disorder. A validated database of multimedia known to elicit chills responses (ChillsDB) was used for stimulus presentation. Participants' emotional responses were assessed using the Emotional Breakthrough Inventory (EBI), while shifts in self-schema were measured via the Young Positive Schema Questionnaire (YSPQ). RESULTS: The study found that chill-inducing stimuli have the potential to positively influence the core schema of individuals with depression, impacting areas of self-related beliefs. The associated phenomenology triggered by chills appears to share similarities with the altered states of consciousness induced by psychedelic substances like psilocybin. CONCLUSIONS: These preliminary results suggest that the biological processes involved in aesthetic chills could be harnessed as a non-pharmacological intervention for depression. However, further investigation is necessary to comprehensively understand the neurophysiological responses to chills and to evaluate the practicality, effectiveness, and safety of utilizing aesthetic chills as a preventive measure in mental health care.

Horizontal necklines correction with absorbable braided polydioxanone threads: Case series.

INTRODUCTION: The prevalence of horizontal neck lines as a cosmetic concern is widely acknowledged, yet the available treatment options are limited, and no studies have investigated the use of polydioxanone-barbed threads. These threads, characterized by a finely braided structure, function as a scaffold to attract regenerative factors and facilitate the migration and proliferation of cells. This study aims to evaluate the outcomes of concurrent application of braided polydioxanone-barbed threads for addressing horizontal neck wrinkles. METHODOLOGY: A retrospective case series involving four female participants (aged 41, 43, 45, and 46) treated with polydioxanone-barbed threads for horizontal neck wrinkles between January 2023 and July 2023 was conducted. Adult patients were assessed at an 8-week follow-up, revealing a significant reduction in wrinkle intensity based on the Horizontal Neck Wrinkle Severity Scale. RESULTS: The analysis of horizontal neck lines demonstrated a notable decrease in wrinkle intensity according to the Horizontal Neck Wrinkle Severity Scale at the 8-week mark, and this improvement maintained statistical significance. Both patient Global Aesthetic Improvement Scale (GAIS) scores (90%-100%) and physician GAIS scores (100%) were rated as excellent. CONCLUSION: The subdermal application of polydioxanone-barbed threads for horizontal neck lines proves to be a secure and efficacious approach for treating horizontal neck wrinkles, with no observed Tyndall effect. This technique shows promise for rejuvenating the skin in the horizontal neckline region.

Aesthetic doctors' perception and attitudes toward tolerance in botulinum toxin.

BACKGROUND: Botulinum toxin is a crucial therapeutic tool with broad indications in both cosmetic and medical fields. However, the expanding cosmetic use and increased dosages of botulinum toxin have raised concerns about resistance, making it essential to study the awareness and management practices among healthcare professionals. METHODS: A survey was conducted among clinical physicians using botulinum toxin. The study investigated their experiences, awareness, and management practices related to toxin resistance. Real-time mobile app-based surveys were administered to clinicians attending the 45th International Academic Conference of the Korean Academy of Laser and Dermatology (KALDAT) on December 3, 2023. RESULTS: Among 3140 participants, 673 clinical physicians completed the survey. Of these, 363 clinicians (53.9%) reported experiencing botulinum toxin resistance. Regarding the resistance rate, 59.4% indicated less than 1%, 36% reported approximately 1%-25%, and 95.4% reported less than 25%. Efforts to prevent resistance included maintaining intervals of over 3 months (54.8%), using products with lower resistance potential (47.0%), employing minimal effective doses (28.2%), and minimizing re-administration (14.9%). CONCLUSION: In the South Korean aesthetic medicine community, a majority of clinical physician's report encountering botulinum toxin resistance. Given the potential loss of various benefits associated with resistance, there is a need to establish appropriate guidelines based on mechanistic studies and current status assessments. Educating clinicians on applicable guidelines is crucial.

A smartphone application for personalized facial aesthetic monitoring.

BACKGROUND: Methods available at home for capturing facial images to track changes in skin quality and evaluate skincare treatments are limited. In this study, we developed a smartphone camera application (app) for personalized facial aesthetic monitoring. MATERIALS AND METHODS: A face alignment indicators (FAIN) system utilizing facial landmark detection, an artificial intelligence technique, to estimate key facial parts, was implemented into the app to maintain a consistent facial appearance during image capture. The FAIN system is composed of a fixed target indicator and an alignment indicator that dynamically changes its shape according to the user's face position, size, and orientation. Users align their faces to match the alignment indicator with the fixed target indicator, and the image is automatically captured when alignment is achieved. RESULTS: We investigated the app's effectiveness in ensuring a consistent facial appearance by analyzing both geometric and colorimetric data. Geometric information from captured faces and colorimetric data from stickers applied to the faces were utilized. The coefficients of variation (CVs) for the L*, a*, and b* values of the stickers were higher compared to those measured by a colorimeter, with CVs of 14.9 times, 8.14 times, and 4.41 times for L*, a*, and b*, respectively. To assess the feasibility of the app for facial aesthetic monitoring, we tracked changes in pseudo-skin color on the cheek of a participant using skin-colored stickers. As a result, we observed the smallest color difference ∆Eab of 1.901, which can be considered as the experimentally validated detection limit using images acquired by the app. CONCLUSION: While the current monitoring method is a relative quantification approach, it contributes to evidence-based evaluations of skincare treatments.

Intracorporeal evaluation of hyaluronic acid fillers with varied rheological properties and correlations with aesthetic outcomes.

BACKGROUND: Understanding the differences in soft tissue filler rheology and how these properties can impact clinical results is a fundamental concepts for any injector. This study aimed to assess the tissue integration characteristics of hyaluronic acid (HA) fillers manufactured with different technologies (Non-Animal Stabilized HA [HA-N] or Optimal Balance Technology [HA-O]) using ultra-high-frequency ultrasound. METHODS: Twelve female participants with mild-to-moderate midface volume loss and temporal hollowing were enrolled and treated with HA-N and/or HA-O. Participants were seen at five visits (screening/baseline [treatment], and Weeks 1 [optional touch-up], 4, 6, and 8 [follow-up visits]). Ultrasound was used to evaluate the degree of product integration. RESULTS: On ultrasound, HA-N presented with distinct borders, minimal tissue integration, and a capacity to displace tissues. Conversely, HA-O tended to spread horizontally within the same tissue plane and integrated within tissues. The volumizing capacity of the HA-O fillers was dependent on particle size. CONCLUSION: HA-N is suited for deep injections in areas such as the upper lateral cheek and under the muscle of the temporal region when a lifting effect is desired; HA-O is best suited for subcutaneous injections, in areas of dynamic movement or for patients with thin skin; and can be injected subcutaneously or supraperiosteally when a volumizing effect is desired.

Development and psychometric testing of the Aesthetics of Everyday Life Scale in Aging (AELSA).

BACKGROUND: The aesthetics of everyday life improves physical and mental health and social communication. This study aims to develop and test a novel instrument that assesses the aesthetics of the everyday life of older adults. METHODS: A mixed-methods study with a sequential exploratory approach was conducted from November 2021 to December 2022. Item generation and questionnaire formation were developed through interviews with older adults and a literature review (stage 1). A cross-sectional study was then conducted to test the psychometric properties of the novel scale among 380 older adults referred to Urban Comprehensive Health Service Centers (stage 2). The construct validity was tested via exploratory factor analysis (EFA) and with the principal component analysis method. Internal consistency and reliability of the scale were evaluated with Cronbach's alpha and test-retest with a 2-week interval. RESULTS: The initial scale was prepared with 39 items. In stage 2, EFA revealed a seven-factor model with 34 items. Internal consistency was acceptable for extracted sub-scales (Cronbach's alpha range: 0.67- 0.93) and the total score (0.926). The intra-class correlation coefficient for test-retest reliability was 0.90. CONCLUSIONS: The AELSA is a valid and reliable instrument for evaluating the aesthetics of everyday life in older adults. the scale will help policymakers in formulating interventions to improve mental health and well-being in older adults. Moreover, Further studies is need to provide more support of construct validity.

Applicability of Patient-Reported Outcome Measures to Aesthetic Medicine Patient Archetypes.

BACKGROUND: Patient-reported outcome measures (PROMs) are valuable in understanding patient motivations, setting expectations, and ensuring satisfaction. As the aesthetic industry expands globally, factors that motivate the treatment goals of the aesthetic patient reflect evolving social, cultural, and commercial influences. OBJECTIVE: This article will assess the applicability of current PROMs used in aesthetic medicine to an increasingly diverse patient population and consider their ability to measure the underlying motives that drive different types of patients to pursue their specific goals. METHODS: PubMed database was searched for studies using PROMs to evaluate the motivations and expectations of aesthetic patients. RESULTS: Seven validated aesthetic PROM tools were reviewed against a backdrop of different patient segments as represented by the 4 patient archetypes: Positive Aging, Beautification, Correction, and Transformation. None of the tools could universally represent the individual motivations and expectations of all 4 patient archetypes. CONCLUSION: There is a need for updated PROMs in aesthetics that are applicable to patients with different motivations or expected outcomes than the traditional rejuvenation patient. PROMs that help decode patient motivations and that are developed with more diverse patient involvement will help aesthetic clinicians better understand the goals and expectations of new patient segments.

Comparing Cosmetic Outcomes of Straight-Line Versus W-Plasty Techniques for Linear Postauricular Wound Closure: A Randomized Evaluator Blind Split-Scar Trial.

BACKGROUND: Surgeons' opinions vary on the cosmetic outcome of straight-line (SL) versus broken-line (W-plasty) closure methods. To date, no studies have compared the 2 techniques in the split-scar design model that resolves the confounding individual patient factors that affects the scar outcome. OBJECTIVE: Compare outcomes and wound cosmesis with SL versus W-plasty closure techniques. METHODS: This clinical trial was conducted with 50 linear surgical wounds randomized to SL closure on half and W-plasty on the other half. At 3 months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (Patient Observer Scar Assessment Scale [POSAS]). RESULTS: The mean (SD) sum of the POSAS observer component scores were 16.6 (6.18) for the SL side and 15.5 (6.37) for the W-plasty side ( p = .49). The mean (SD) sum of the POSAS patient scores were 14.4 (6.8) in SL and 15.1 (8.2) in W-plasty ( p = .59). The mean (SD) complications were 0.08 (0.06) for SL and 0.02 (0.14) for W-plasty ( p = .18). CONCLUSION: No statistically significant difference in wound cosmesis or complications was noted between SL versus W-plasty closure techniques. Surgeons may want to consider whether the extra time involved in placing zigzag W-plasty lines is worthwhile.

IncobotulinumtoxinA for Aesthetic Treatments: Review and Recommendations From Latin America.

BACKGROUND: As new aesthetic treatment techniques are developed, the understanding of botulinum toxin type A safety and treatment outcomes continues to evolve. OBJECTIVE: This article was developed to provide a comprehensive up-to-date reference for clinicians using incobotulinumtoxinA (INCO; Xeomin/Bocouture, Merz Pharmaceuticals GmbH, Frankfurt, Germany) for aesthetic treatments. PATIENTS AND METHODS/MATERIALS: A Latin American panel of 11 physicians was assembled to discuss and develop recommendations on the use of INCO for aesthetic treatment based on the literature review and their private medical practice. RESULTS: The panel found that INCO is a highly purified botulinum toxin, without other clostridial proteins (hemagglutinins and nonhemagglutinins). IncobotulinumtoxinA has proven its efficacy and duration over time, maintaining response after multiple treatment cycles. CONCLUSION: This recommendation provides up-to-date information on the use of INCO for aesthetic treatment, focusing on the differential properties of this product regarding its purity, performance, customization, and patient satisfaction.

Practice-Based Learning in Aesthetic Medicine: Assessing Scientific Literacy Among Cosmetic Practitioners.

BACKGROUND: The field of aesthetic medicine has expanded substantially in the past decade, with significant practitioner diversification and departure from core-specialty supervision. The increased autonomy of nonphysician practitioners in a rapidly evolving field has raised accentuated the importance of scientific literacy and practice-based learning standards in the delivery of aesthetic medical care. OBJECTIVE: To assess the degree of scientific literacy among aesthetic medicine practitioners of different educational and training backgrounds in the United States and abroad. MATERIALS AND METHODS: A cross-sectional survey of 52 national and international aesthetic medicine practitioners employing a validated, 28-item, scientific literacy tool. RESULTS: The average score for all participants was 76% (SD = 18%, range = 43%-100%). Physician practitioners scored higher in all competencies compared non-physicians (86% vs 68%, p < 0.001), with a greater discrepancy among US practitioners (95% vs 71%, p < 0.001). Competencies relating to identification of bias/confounding variables, graphical data representation, and statistical inference/correlation showed the lowest proficiency. Practitioners with a doctorate or equivalent degree were significantly more likely to report frequent engagement with medical literature than non-physicians ( p = 0.02). CONCLUSION: There exists a significant disparity in scientific literacy between physician and nonphysician aesthetic medicine practitioners. This gap underscores the need for enhanced educational programs and continuous professional development to ensure safe and effective patient care in the evolving field of aesthetic medicine.

Versatility of OnabotulinumtoxinA in Aesthetic Medicine.

BACKGROUND: OnabotulinumtoxinA is an injectable product that was introduced into medicine in the 1970s and has been the subject of thousands of clinical and nonclinical publications. OBJECTIVE: To review the data related to the versatility of onabotulinumtoxinA in medical aesthetics. METHODS: PubMed was searched to identify literature evaluating the effects of onabotulinumtoxinA, with preference given to randomized, placebo-controlled trials and safety meta-analyses. RESULTS: OnabotulinumtoxinA is effective and safe across multiple facial indications, racial and ethnic groups, age groups, genders, and facial line severities. Patient-reported outcomes have been prioritized in aesthetic clinical trials and indicate high patient satisfaction and appearance-related psychological outcomes. Integrated safety meta-analysis and immunogenicity analyses have documented acceptable adverse event rates and low immunogenicity of onabotulinumtoxinA. CONCLUSION: OnabotulinumtoxinA is a versatile aesthetic product supported by a strong literature base and positive physician and patient-reported outcomes that reflect a meaningful impact on patient's quality of life.

Aesthetic Considerations for Neuromodulator Use in Transgender Patients.

BACKGROUND: The aesthetic dimension of transgender experiences involves various aspects linked to the visual representation and expression of one's gender identity. Nonsurgical cosmetic procedures, such as neuromodulators, have consequently become a viable treatment option for patients with gender dysphoria because of the ability to yield significant, although temporary, results with minimal associated risks and downtime. OBJECTIVE: To comprehensively review literature pertaining to the aesthetic considerations for use of neuromodulators in transgender and nonbinary individuals. MATERIALS AND METHODS: A literature review of PubMed/MEDLINE for studies was published through January 2024 for nonsurgical facial and body modification using neuromodulators. Searches were conducted with relevant keywords. Peer-reviewed articles and their references published within the past 10 years were given emphasis in the review. RESULTS: Based on the limited publications to date, the authors prepared a comprehensive review on indications for neuromodulator treatment in this population, including brow positioning, lower face contouring, lip eversion, trapezius slimming, and leg contouring. CONCLUSION: Dermatologists play a crucial role in facilitating the achievement of gender affirmation goals.

A Natural Flat Volumized Lips Filler Technique: Retrospective Analysis of 920 Patients.

BACKGROUND: Traditionally, hyaluronidase (HYAL) is used after hyaluronic acid (HA) injection to dissolve the undesired migration of product. OBJECTIVE: To describe a novel lip augmentation technique that uses HA and HYAL simultaneously in patients who previously had HA migration. METHODS AND MATERIALS: Nine hundred twenty female patients were included. In the first group ( n = 793), HA injections were performed in subcutaneous plane of the lips. In the second group who had previous product migration ( n = 127), 7.5 units of HYAL is injected in 4 points in ergotrid area before proceeding with HA injection. RESULTS: The medicis lip fullness scale scores after 2 weeks improved in all patients, while 92% of patients perceived the results as "very much improved" with Global Aesthetic Improvement Scale ( p ˂ .001). There was no difference between 2 groups regarding the patient satisfaction rates ( p ˃.05), while filler migration was seen in 0.2% ( n : 15) of patients in the first group during the follow-up period. CONCLUSION: The new vertical injection approach provided an increased vertical height, optimal eversion, and an incisor display on the lips. The simultaneous use of HYAL before HA injection seems to be a safe and effective practice in 1-stage treatment of the previously injected lips with filler migration into ergotrid area.

Reconstruction of Broad Lower Lip Defects Using Karapandzic-Type Flaps.

BACKGROUND: Reconstruction of lower lip defects is challenging because of the functional and aesthetic demands of the lower face. We review the functional and aesthetic outcomes of the Karapandzic-type flaps for reconstructing lower lip defects. METHODS: A retrospective review of patients who underwent repair using Karapandzic-type flaps. RESULTS: Fifty patients with lower lip defects ranging from 20% to 95% (mean 59.2% ± 20%) were included. Eighteen patients (36%) were repaired using a bilateral flap, and 32 (64%) were reconstructed using a unilateral flap design. All patients had preservation of oral competency and a satisfactory aesthetic result. No patient complained of microstomia. A complication rate of 8% was noted ( n = 4) with postoperative wound infection and small areas of dehiscence. There was no statistically significant difference in complication rates in patients older than 75 years, in patients with a history of head/neck radiation, or in defects greater than 70% of lower lip breadth. CONCLUSION: Karapandzic-type flaps are versatile and reliable for the reconstruction of a broad range of lower lip defects. This one-stage procedure can produce superior functional and aesthetic results as compared with other local and distant flaps with minimal risk of functional microstomia.