Examining the Impact of Breast Augmentation vs Hormone Therapy on Chest Femininity of Transgender Women.

BACKGROUND: For transgender women, there is often the innate assumption that surgical breast augmentation will increase perceived chest femininity beyond hormone therapy alone. OBJECTIVES: This study aimed to evaluate whether lay individuals found surgically augmented breasts more feminine than breast development from hormone replacement therapy alone in transgender patients. METHODS: We obtained preoperative (maximal breast growth on hormone therapy) and postoperative chest (after primary augmentation) images of 22 transgender patients, and age- and BMI-matched cisgender male (n = 17) and female (n = 21) control patients. Survey respondents (n = 271) rated each image on a scale of 1 (very feminine) to 5 (very masculine). Results were compared by survey respondent gender identity and sexual orientation. RESULTS: There was a significant difference in mean femininity score between all image types. Mean score for transgender patients fell by 0.478 points after surgery (P < .0001). Subgroup analysis looking at transgender participants revealed the same significance trend postoperatively. Transgender respondents also found no difference in femininity between female controls and postoperative transgender patients (P = .132). We also compared mean femininity scores across 4 self-identified respondent subgroups: cisgender and heterosexual, cisgender and lesbian, gay, or bisexual (LGB), transgender and heterosexual, and transgender and LGB. The cisgender and heterosexual subgroup rated the postoperative transgender patients more feminine than any of the other respondent subgroups (LGB P < .001, transgender and LGB P < .001, transgender only P = .018). CONCLUSIONS: This study shows that breast augmentation significantly increased the perception of femininity. Furthermore, gender identity and sexual orientation are important in how lay persons perceive transgender patients.

Endoscopic Browlift in Patients With Receding Hairlines.

ABSTRACT: Patients with receding or high hairlines have traditionally been considered unfavorable candidates for endoscopic brow lift as this can further lengthen the hairline. We analyzed outcomes in patients that underwent a novel endoscopic brow lift technique with placement of incisions and anchoring Endotine Forehead Devices (CoApt Systems Inc, Palo Alto, CA, USA) directly at the natural forehead crease lines, in an effort to minimize elevation of the hairline, whereas providing well-hidden scars. We retrospectively reviewed all patients who underwent this new Endotine and incision placement between 2016 and 2020. Preoperative and postoperative photographs of all patients were analyzed to determine the postoperative changes in brow elevation and forehead length proportion (defined as length from cranium to chin).The forehead length proportion was unchanged pre- and post-operatively, with no statistically significant differences noted (P = 0.48). The average brow position elevation ranged from 2.78 mm in the medial location to 5.05 mm in the lateral location. All patients were happy with their appearance and had improved visual fields postoperatively. The forehead scars healed well and were well hidden in forehead rhytids at long term follow-up.This novel endoscopic brow lift technique provides an option to utilize a minimally invasive approach in patients with receding hairline. With this technique, visible scars were minimized, whereas still being able to achieve reasonable brow elevation. Thus, our approach enables long term maintenance of brow elevation with inconspicuous scars in the forehead.

Artificial Intelligence in Surgical Evaluation: A Study of Facial Rejuvenation Techniques.

Background: Aesthetic facial surgeries historically rely on subjective analysis in determining success; this limits objective comparison of surgical outcomes. Objectives: This case study exemplifies the use of an artificial intelligence software on objectively analyzing facial rejuvenation techniques with the aim of reducing subjective bias. Methods: Retrospectively, all patients who underwent facial rejuvenation surgery with concomitant procedures from 2015 to 2017 were included (n = 32). Patients were categorized into Groups A to C: Group A-10 superficial musculoaponeurotic system (SMAS) plication facelift (n = 10), Group B-SMASectomy facelift (n = 7), and Group C-high SMAS facelift (n = 15). Neutral repose images preoperatively and postoperatively (average >3 months) were analyzed using artificial intelligence for emotion and action unit alterations. Results: Postoperatively, Group A experienced a decrease in happiness by 0.84% and a decrease in anger by 6.87% (P >> .1). Group B had an increase in happiness by 0.77% and an increase in anger by 1.91% (P >> .1). Both Group A and Group B did not show any discernable action unit patterns. In Group C, the lip corner puller AU increased in average intensity from 0% to 18.7%. This correlated with an average increase in detected happiness from 1.03% to 13.17% (P = .008). Conversely, the average detected anger decreased from 14.66% to 0.63% (P = .032). Conclusions: This study provides the first proof of concept for the use of a machine learning software application to objectively assess various aesthetic surgical outcomes in facial rejuvenation. Due to limitations in patient heterogeneity, this study does not claim one technique's superiority but serves as a conceptual foundation for future investigation.

Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Faces.

Background: This study considers observers' reflexive responses to the rejuvenated face, and how instinctive responses relate to subjective judgment. We investigated observers' reflexive perception of faces both pre and post surgical intervention during the early stages of visual processing. Subjective character attribution for all test images was also assessed by the same observers. Method: Forty frontal facial images of 20 patients portraying the pre- and postoperative high superficial musculoaponeurotic system facelift along with variable concomitant procedures were studied. Nineteen lookzone regions were mapped post hoc onto each image. Forty observers examined the images, whereas an eye-tracking camera recorded their eye movements. Visual fixation data were recorded and analyzed. Observers also rated each image on the basis of five elemental positive character attributes. Results: A statistically coherent but nonsignificant (P > 0.05) trend was identified with the surgical intervention resulting in greater attention being paid to the central triangle region of the face with reduction in attention to the facial periphery. Facial rejuvenation significantly increased the subjective character ratings of all five positively valenced attributes tested. Average age estimate of the photos decreased significantly from 54 to 48.6 years (true average age of 57.4 years). Conclusions: We provide data illustrating both reflexive and subjective responses to facial rejuvenation. Observers reported a more favorable impression of the treated faces and evaluated them as being younger than their true age. A trend was detected for increased visual fixation of the central facial region following rejuvenation. Interpretation of these findings and indication for further research is provided.

Novel Method of Dual-innervated Free Gracilis Muscle Transfer for Facial Reanimation: A Case Series.

Background: Dynamic facial reanimation is the gold standard treatment for a paralyzed face. The use of the cross-face nerve graft (CFNG) in combination with the masseteric nerve to innervate the free gracilis muscle has been reported to provide both spontaneity and strong neural input. We report a case series of dual innervation, using a novel method where the branch to masseter is coapted to the side of the CFNG. Methods: Eight patients received free gracilis muscle transfer using the new dual innervation method between September 2014 and December 2017. The CFNG, which was performed nine months prior, was sutured in an end-to-end fashion to the obturator nerve. A nerve graft was coapted to the ipsilateral masseteric nerve and then sutured in an end-to-side fashion to the CFNG proximal to its coaptation to the obturator nerve. Results: All patients recovered smile function with and without teeth clenching around the same time period. Smiles without teeth clenching appeared later in two of eight patients and earlier in one of eight patients, being noted at an average of 8.25 months of follow-up versus 7.6 months. The estimate of true attainment is limited by the spacing of follow-up dates. Average follow-up time was 36.07 months (range: 10-71.5). FACE-Gram software smile analysis with and without biting demonstrated similar excursion on average (7.64 mm versus 8.6 mm respectively, P = 0.93), both of which are significantly improved from preoperation. Conclusion: This novel method of a dual-innervated free gracilis muscle transfer offers a viable technique that achieves a symmetric, strong, and emotional smile.

No Increase in Complications With Intravenous Tranexamic Acid Use in Vaginoplasty: A Retrospective Study.

Background: Across surgical specialties, tranexamic acid (TXA) is applied to reduce intraoperative and postoperative bleeding. Within plastic surgery, both topical and intravenous routes are used. The application of TXA has yet to be examined in vaginoplasties. Methods: The authors performed a retrospective chart review of Mayo Clinic patients receiving penile inversion vaginoplasty from January 2017 through July 2021. Incidence of hematoma formation was assessed as the primary outcome. Secondary outcomes included perioperative hemoglobin, vaginoplasty complications, and possible TXA complications. These outcomes were compared across topical only (t-TXA), any intravenous (IV- TXA), and no TXA groups. Results: Of the 124 vaginoplasties, 21 patients received t-TXA only and 43 received any IV-TXA. Only 4 patients developed a hematoma; 2 were from the no TXA group and 2 were from the any IV-TXA group. There was no significant change in perioperative hemoglobin across groups. Analysis showed lower incidence of divergent urine stream (odds ratio [OR], 0.499 [95% confidence interval (CI)], 0.316-0.789], P = .003) and neovaginal stenosis (OR, 0.435 [95% CI, 0.259-0.731], P = .002) within the any IV-TXA group and no increased incidence of other complications. Conclusions: The use of either t-TXA or IV-TXA in vaginoplasty cases did not result in an increased rate of complications. There was no significant reduction in hematoma formation or postoperative hemoglobin decrease across groups.

Using artificial intelligence to analyze emotion and facial action units following facial rejuvenation surgery.

INTRODUCTION: There remains a lack of standards in facial rejuvenation procedures, which may be attributed to the subjective measures used to determine surgical outcomes and success. The aim of this study was to evaluate the use of machine learning technology, i.e. FaceReader™, to objectively measure facial rejuvenation surgery outcomes. METHODS: Using a retrospective study design, we enrolled a cohort of patients undergoing high SMAS facelift with/without additional procedures during a one-year interval. The predictor variable was surgery done (pre- vs. postoperative). The outcome variables were 28 facial action units, happiness, and sadness emotions, detected by FaceReader™. Appropriate statistics were calculated at α = 0.05. RESULTS: The sample comprised of 15 patients (11 females, 15 Caucasians, mean age of 55.7 years). There was an average increase in detected happy emotion from 1.03% to 13.17% (p>0.01). Conversely, the average angry emotion detected decreased from 14.66% to 0.63% (p<0.05). There were no other distinct action unit patterns across the operation. CONCLUSION: Despite a small sample size, the results of this study suggest that FaceReader™ can be used as an objective outcome assessment tool in patients undergoing high SMAS facelift with/without its adjuncts.