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1.
J Craniofac Surg ; 33(1): e84-e87, 2022.
Article En | MEDLINE | ID: mdl-34967532

BACKGROUND: This study demonstrates a novel and simple design to create a low cost frontal sinus surgical cutting guide, using patient's frontal sinus cavities as references, to perform an anterior cranioplasty in facial feminization surgery. A clinical series demonstrates its clinical use and safety. MATERIAL AND METHODS: Authors used a 4 open-source software protocol for the virtual surgical modeling (VSP). Retrospectively, pre- and post-operative complications were reviewed, and a FACE-Q questionnaires were used to evaluate patient's postoperative "Satisfaction with forehead and eyebrows." Recordings of the VSP and surgical technic are presented. RESULTS: Sixteen patients were operated between November 2018 and November 2020 using in-house surgical guides. All were performed by authors in 5 to 10 minutes using Blender open-source Software. No complications were reported and authors always found an optimal retention of the surgical guide on the convex bony surface of the forehead and frontonasal area. FACE-Q questionnaire reported a very high satisfaction for all patients (mean score: 22/24). DISCUSSION: This simplify organic design can be performed efficiently by any surgeon even without previous training in home staging VSP. Patient satisfaction was very high, along with an absence of postoperative complications.


Feminization , Frontal Sinus , Face/surgery , Frontal Sinus/surgery , Humans , Male , Retrospective Studies , Skull
2.
J Craniofac Surg ; 32(3): e276-e278, 2021 May 01.
Article En | MEDLINE | ID: mdl-34779591

ABSTRACT: Dermal filler injections, one of the most commonly performed procedures in facial esthetic surgery, are rising in popularity. This has also led to an increase in nonmedical grade filler injections performed by nonmedical personnel, including that of injectable silicone. Surgical removal of silicone fillers is challenging, as the hydrophobic material often disperses within the soft tissue as droplets. This can lead to a systemic inflammatory reaction requiring steroid treatment. MRI localization of the filler material does not enable intraoperative guidance, and palpitation of the material is challenging since the filler droplets are often too small to palpate and located in multiple planes. We present a case demonstrating the advantages of utilizing intraoperative ultrasound to localize and silicone filler material. Utilizing this technique, we were able to achieve a high degree of excision of silicone filler material and the patient was able to stop her previous necessary immunosuppressive steroid regimen successfully.


Cosmetic Techniques , Dermal Fillers , Face/diagnostic imaging , Face/surgery , Female , Humans , Injections , Silicones , Ultrasonography
3.
J Craniofac Surg ; 32(7): 2384-2387, 2021 Oct 01.
Article En | MEDLINE | ID: mdl-34705383

ABSTRACT: Facial feminization surgery (FFS) with its proven safety and efficacy has become a mainstay surgical approach for those desiring gender-specific perceived feminine facial aesthetics. To date, specific characteristics of patients seeking FFS have been limited, with no studies investigating the role of the Human Immunodeficiency Virus (HIV) on FFS outcomes. The potential clinical implications of HIV and more specifically HIV-associated lipodystrophy, which can cause facial lipoatrophy, require further investigation. Given the importance of midface projection in feminizing the face, the authors aimed to investigate any associations HIV or Highly Active Antiretroviral Therapy may have on outcomes, including clinical consequences of facial lipoatrophy. The authors performed a retrospective chart review of all patients with a diagnosis of gender dysphoria referred to the senior author (EDR) for FFS between 2017 and 2020. Patients were grouped based on HIV status and demographics, history, and outcomes were assessed. Seventy-seven patients were included, with 28 patients (36.4%) having a diagnosis of HIV. A total of 25 (32.5%) and 23 (29.9%) patients underwent malar fat grafting and cheek implants, respectively. No significant difference was found between HIV-positive and HIV-negative patients when looking at the use of malar fat grafting, cheek implants, age, or complication rates. To the best of our knowledge, this study presents the largest cohort of HIV status assessment of FFS patients to date. Future studies, particularly on the long-term outcomes, are warranted, as is continued information sharing among providers and centers performing FFS, in order to continue advancing the literature and subsequently patient care.


Dental Implants , Feminization , Esthetics, Dental , Face/surgery , Humans , Male , Retrospective Studies
4.
J Craniofac Surg ; 32(7): 2397-2400, 2021 Oct 01.
Article En | MEDLINE | ID: mdl-34705385

BACKGROUND: The demand for facial feminization surgery (FFS) amongst transgender women is on the rise, and requests for a single-stage full FFS (F-FFS) are becoming more frequent. The specific aim of this article is to present our institutional experience with both partial-FFS (P-FFS) and F-FFS with a specific emphasis on safety of each approach. METHODS: We examined the electronic medical record of all patients with the diagnosis of gender dysphoria that were referred to the senior author for FFS consultation at our institution, between June 2017 and October 2020. Patients were sub-grouped into those who underwent F-FFS (upper, middle, and lower facial thirds in a single anesthetic event) and those who underwent P-FFS. Univariate analysis was used to assess for difference in postoperative complications. RESULTS: We identified 77 patients who underwent 382 total procedures. The mean follow-up time was 7.5 months (Sd = 7.3) (interquartile range 1.75-12.0 months). Fifty-one (71.4%) patients underwent F-FFS and 21 (28.6%) patients underwent P-FFS. Compared to P-FFS, F-FFS was not associated with an increase in postoperative complication (1 out of 21 [4.8%] versus 4 out of 51 [7.8%]) ( P < 0.556). When comparing characteristics of patients with postoperative complications to patients with no postoperative complications, the average body mass index was significantly higher (30.9 versus 25.4, respectively). ( P < 0.029). CONCLUSIONS: Full-FFS is a set of procedures that has gained increased popularity among male-to-female transgender patients. Our results support the understanding that F-FFS is a safe and reliable approach, which may be preferable to patients and providers alike.


Gender Dysphoria , Transsexualism , Face/surgery , Female , Feminization , Gender Dysphoria/surgery , Humans , Male , Retrospective Studies , Transsexualism/surgery
6.
J Clin Ethics ; 32(3): 256-265, 2021.
Article En | MEDLINE | ID: mdl-34548434

With the recent advent of facial transplant (FT) treatment, patients who live with facial disfigurement have a new hope of improved facial aesthetics and quality of life. However, FT has been the subject of intense ethical debate, and there are numerous important ethical considerations surrounding FT that require further in-depth exploration. In the present review, the numerous ethical issues surrounding FT are elucidated, especially the weighty psychosocial impacts of FT, issues surrounding patients' consent, selection and donor matching, and current challenges with postoperative complication management and the facial reconstruction of donors. These are discussed with a key focus on stakeholders' perspectives including recipients, donors' families, and the medical teams involved. This review found that a number of key ethical questions remain unanswered in the field of FT, and further consideration is needed for this novel surgical procedure to have the same evidence-based ethical backing as conventional surgical procedures.


Facial Transplantation , Face/surgery , Humans , Morals , Quality of Life , Tissue Donors
8.
Adv Exp Med Biol ; 1334: 157-179, 2021.
Article En | MEDLINE | ID: mdl-34476749

Surgical and educational challenges exist in relation to the teaching of facial reconstructive surgery due to the complexities of the facial landscape and training models available. This chapter will describe the development and implementation of alternative modes of teaching facial reconstructive techniques in a multi-disciplinary setting, pioneered by Surgical Art ( www.surgical-art.com ), through the use of a bespoke multimodal training model-the Surgical Art Face©.


Reconstructive Surgical Procedures , Surgery, Plastic , Face/surgery
9.
Facial Plast Surg Clin North Am ; 29(4): 471-486, 2021 Nov.
Article En | MEDLINE | ID: mdl-34579831

The Asian facelift requires an adaptation of current techniques to achieve a desired aesthetic outcome. Cultural differences and differences in anthropomorphologic features alter a patient's vision of beauty and youthfulness. Rejuvenation of the aging Asian face mandates a set of strategies, including understanding cultural aspects of Asian patients, anatomy of Asian patients, and appropriate techniques based on these cultural and anatomic considerations. For stable application and results, the surgeon must understand surgical facial anatomy. If performed properly, facelifts can improve facial balance and can yield aesthetically more appealing results. The deep plane facelift technique presented is well suited for Asian patients.


Rhytidoplasty , Aging , Esthetics , Face/surgery , Humans , Rejuvenation
12.
Laryngoscope ; 131(11): 2465-2470, 2021 11.
Article En | MEDLINE | ID: mdl-34378801

OBJECTIVES: Mid and upper face free flaps frequently are associated with challenges due to pedicle length. We sought to evaluate the frequency at which alternative pedicle maneuvers were required for these reconstructions and determine if there was any association with flap survival or postoperative complications. STUDY DESIGN: Retrospective review at three tertiary care institutions. METHODS: Database review. RESULTS: Free flap reconstruction of the upper and midface was performed in 295 patients (108 bony, 187 soft tissue). In 82% of cases, the vessels reached the ipsilateral neck for anastomosis to traditional target vessels. Arterial grafts were required in 2% of reconstructions (4% bony and 1% soft tissue). Venous grafting was required in 7% of reconstructions (21% fibula, 16% scapula, and 3% soft tissue) and was associated with an increase in flap failure rate (19% vs 3%, P = .003). The most common recipient artery for revascularization was the cervical facial artery (78%). Alternate recipient vessels were selected in 13% of cases, including the superficial temporal vessels (7%), distal facial branches through a separate facial incision (4%), and angular vessels (2%). Vein grafting was associated with a higher flap failure rate. Alternative maneuvers did not affect need for intraoperative pedicle revision or complications. CONCLUSIONS: In upper and midface reconstruction, vascular grafting, targeting more distal branches of the facial system, or additional maneuvers to optimize pedicle orientation is often required to secure revascularization. Vein grafting is associated with a higher free flap failure rate. Scapular border flaps often require vascular grafting or atypical anastomotic locations. LEVEL OF EVIDENCE: 3-Non randomized cohort study 4 Laryngoscope, 131:2465-2470, 2021.


Face/surgery , Free Tissue Flaps/transplantation , Postoperative Complications/epidemiology , Reconstructive Surgical Procedures/methods , Aged , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Arteries/surgery , Face/blood supply , Female , Free Tissue Flaps/adverse effects , Humans , Male , Microvessels/surgery , Middle Aged , Postoperative Complications/etiology , Prospective Studies , Reconstructive Surgical Procedures/adverse effects , Retrospective Studies , Treatment Outcome
13.
J Craniofac Surg ; 32(8): 2816-2820, 2021.
Article En | MEDLINE | ID: mdl-34456279

ABSTRACT: The pre-expanded medial arm flap provides suitable skin for the resurfacing of a periorbital or perioral defect. However, the flap must be intraoperatively split to imitate the appearance of the oral or ophthalmic fissure, which can compromise flap perfusion. This study aimed to evaluate the safety and effectiveness of splitting pre-expanded medial arm flaps with the aid of indocyanine green angiography. All 8 patients underwent periorbital or perioral soft tissue reconstruction using a split pre-expanded medial arm flap. Flap splitting was aided by indocyanine green angiography. It was used during 2 stages of the procedure, tissue expander placement and flap transfer. The pedicle was divided 3 weeks later, and the flaps were used to resurface the defect. The distal portion of the flap was split into a fishmouth pattern in 5 patients and a window pattern in 3 patients. The donor sites were closed directly or by using a latissimus dorsi myocutaneous flap. There were no perioperative complications or flap necrosis. A pre-expanded split medial arm flap could be an option for the reconstruction of periorbital and perioral defects. With the assistance of indocyanine green angiography, vessel distribution and distal flap perfusion can be reliably evaluated, facilitating the safe splitting of the flap for the reconstruction of defects.


Face , Reconstructive Surgical Procedures , Angiography , Face/surgery , Humans , Indocyanine Green , Surgical Flaps
15.
Khirurgiia (Mosk) ; (8): 107-111, 2021.
Article Ru | MEDLINE | ID: mdl-34363452

Periorbital soft tissue reconstruction has always been a difficult problem. There are several techniques for correction of supraorbital defects, most often we are talking about aged patients with sagging skin. Local skin grafting is usually used. However, this approach can result additional scars on the face requiring further multiple corrections. We report a good functional and aesthetic result in a young patient after reconstruction of supraorbital region with a pedicled skin flap from periauricular region under reverse blood flow. This technique can be taken into account for complex small periorbital soft tissue defects up to 5.0 x 5.5 cm. The flap adequately closes the defect and repairs facial contour and symmetry.


Reconstructive Surgical Procedures , Skin Transplantation , Aged , Cicatrix/surgery , Face/surgery , Humans , Surgical Flaps
16.
J Craniofac Surg ; 32(6): 2091-2096, 2021 Sep 01.
Article En | MEDLINE | ID: mdl-34320578

ABSTRACT: Aesthetic plastic surgery is a most unusual and unique subspecialty. Unlike other medical and surgical specialties driven primarily by objective medical diagnosis and outcome, aesthetic surgery is patient driven; it represents a special exercise in professional competence by adapting objective medical standards to a mostly subjective field. Given the subjectivity of facial beauty and of the projected aesthetic intervention outcome, in addition to be able to determine beauty of the final result as precisely and objectively as possible, it is also essential to be able to assess patient's satisfaction. However, lack of standardized facial measurements and clear definition of aesthetic outcome and beauty are still major obstacles preventing real change in the consultation dynamics to help better serve patients' expectations. Because of the tremendous increase in demand for all types of facial aesthetic procedures, an objective understanding of aesthetics and beauty is becoming of utmost importance. Recognition of the importance of science and evidence-based medicine is long overdue in our specialty. This study aims at identifying the most recently available evidence-based measures to quantitatively assess beauty and measure outcome of rhytidoplasty that can be useful in everyday aesthetic practice.


Surgery, Plastic , Beauty , Esthetics, Dental , Face/surgery , Humans , Rejuvenation
17.
Georgian Med News ; (314): 134-139, 2021 May.
Article En | MEDLINE | ID: mdl-34248043

High-resolution ultrasound (US) was used to examine 25 patients before the procedure and at the 2nd, 7th, 21st days and in 1.5 months after combined exposure to the skin of the face and neck with the Er:YAG laser in cold ablation mode and with the neodymium (Nd:YAG) laser in long pulse mode. The maximum dermis thickness was noted in the middle third (the standard measurement point along the mid-pupillary line in the projection of the infraorbital foramen) and composed 1,75±0,29 mm, the minimum on the neck and in infraorbital area - 1,2 (1,15; 1,3) mm and 1,15±0,15 mm, respectively. On the second day after the procedure, there was a significant increase up to 2,63±0,33 mm in the dermal thickness in the middle third in the projection of the infraobital foramen and up to 1,57±0,23 mm in the submental area of the neck due to all its layers in comparison with the values given ​​before the procedure (p=0.005, p<0.0001). Visualization of the dermis layers was difficult in B-mode during ultrasound, the toughness of the tissues decreased at compression elastography, pronounced vascularization was detected in the CDI mode in comparison with the initial one before the procedure and persisted up to 6 weeks. The ultrasound image in B-mode corresponded to the initial parameters starting from the 7th day.


Laser Therapy , Skin Aging , Face/diagnostic imaging , Face/surgery , Humans , Lasers , Neck/diagnostic imaging , Neck/surgery , Skin
19.
Facial Plast Surg Clin North Am ; 29(3): 375-381, 2021 Aug.
Article En | MEDLINE | ID: mdl-34217439

Static facial sling procedures are one of many facial reanimation options to address long-standing and irreversible facial paralysis. The primary goals of static reanimation are to provide symmetry at rest and improve static function at repose. Choosing the best option depends on patient factors, such as age, comorbidities, and injury factors. Different materials are available for static sling surgery; we believe autologous tendon offers the most reliable and long-lasting results. Static suspension procedures provide immediate results, improved resting position, and can augment other techniques. This article discusses available options for static reanimations to address the eye complex, midface, and mouth.


Facial Paralysis , Reconstructive Surgical Procedures , Face/surgery , Facial Paralysis/surgery , Humans
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