Nerve injuries and treatment in facial cosmetic surgery

Post-Face Lift Facial Paralysis: A 20-Year Experience

BACKGROUND

Facial nerve (FN) injury during a face lift is a relatively rare but potentially devastating complication. Despite extensive literature discussing FN anatomy and danger zones, few studies describe detailed management, FN exploration intraoperative findings, and outcome after post-face lift facial paralysis (PFFP). The authors reviewed a 20-year experience in managing iatrogenic PFFP.

METHODS

Patients with PFFP were retrospectively identified between 2002 and 2022. Demographic data, operative details from the face lift procedure, facial function after face lift, medical and surgical management, intraoperative findings, and long-term outcomes were analyzed.

RESULTS

A total of 25 patients who experienced PFFP were referred for evaluation over the past 20 years. Eight patients required FN exploration, 6 of whom underwent nerve repair; all recovered to some degree, with 50% achieving essentially normal facial function. Fourteen patients underwent nonsurgical management, including physical therapy, chemodenervation, and filler therapy. Of these nonsurgical patients who were not lost to follow-up, 50% achieved normal facial function and 42% achieved nearly normal facial function. The single patient who had no spontaneous improvement presented outside the reinnervation window and was not an operative candidate.

CONCLUSIONS

PFFP outcome depends on injury type and location, accurate assessment, and appropriate treatment; however, the overall prognosis is favorable. FN exploration is warranted when nerve transection is suspected. Observation is suitable for patients demonstrating early signs of recovery. Patients presenting beyond a reasonable reinnervation window will need other facial reanimation techniques. When FN exploration is required, outcomes may be superior in a facial nerve center setting. Adjunctive interventions for symmetry improvement while awaiting recovery are available.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Facial Nerve Considerations for the Deep Plane Facelift and Neck Lift

The surgical approach to facial rejuvenation has evolved significantly over the last century. As surgeons have deepened their understanding of facial anatomy over the last half century, so have their surgical approaches to the rhytidectomy, with increasingly extensive manipulation of the underlying soft tissue in the face. While these procedures have become more comprehensive and natural in their approach, the risk of temporary facial palsy also appears to be on the rise. In this text, we review the technique for deep plane facelifts and neck contouring with an emphasis on the facial nerve anatomy and methods to preserve the intricate facial nerve network during tissue dissection and modification. Careful execution of the surgical steps involved, including deep neck contouring, SMAS (superficial musculoaponeurotic system) suspension, and skin management, is essential to achieve the authentic aesthetic outcomes that patients desire while ensuring patient safety.

Facial nerve: A review of the anatomical, surgical landmarks and its iatrogenic injuries

Facial nerve iatrogenic injuries are serious and can negatively affect the quality of life of the patients. Due to the properties of the nerve, the complications are devastating involving the aesthetic appearance and the function of the face. Moreover, the multiple branches of the nerve increase the risk of an iatrogenic injury making the detailed knowledge of the anatomical correlations around them critical. In this review, a meticulous analysis was performed including the surgical procedures posing the greater risk of an iatrogenic injury as well as the full description of all the reported anatomical landmarks involving the extracranial course of the facial nerve.

Quality attributes of partially hydrolyzed collagen in a liquid formulation used for skin care

BACKGROUND

The deterioration of the skin accentuates over time, affecting its aesthetic appearance. This is characterized by the weakening of the mechanisms involved in the regeneration and repair of the dermal matrix. Consequently, the skin losses elasticity and smoothness resulting in the formation of wrinkles. The alternatives for facial rejuvenation include surgery, injection of botulinum toxin, and the application of masks. Topic products are less invasive, can be self-applied, and have an increased benefit/risk relationship.

AIM

We developed a liquid formulation containing collagen hydrolyzed and evaluated the product by cutting-edge technology in order to define proper its quality attributes.

METHODS

We employed nuclear magnetic resonance (NMR), size-exclusion chromatography (SEC), and mass spectrometry (MS). Additionally, we analyzed its cosmetical effect in five volunteers and we demonstrate the product safety.

RESULTS

Our results demonstrate the following: (a) a stable secondary structure identity associated to the known triple helix arrangement in liquid and solid states; (b) a typical conformational flexibility depending on its hydration state; (c) thermal stability confirmed by liquid- and solid-state nuclear magnetic resonance schemes; and (d) a molecular mass distribution of peptides between 0.5 and 19.5 kDa. The product faded wrinkles in the forehead, an effect that remained after removing the mask. The formula was non-irritating and hypoallergenic.

CONCLUSION

We characterized, using state-of-the-art methodologies, the quality attributes that are critical for the safety and beneficial effect of a new collagen-containing formula.

Psychological and Personality Characteristics of Applicants for Facial Cosmetic Surgery

OBJECTIVE

The aim of this study was to investigate the psychological and personality characteristics of the applicants for facial cosmetic surgery.

METHODS

This descriptive-analytical study was conducted on 385 facial cosmetic surgery applicants who referred to medical centers in Ahvaz (south Iran). The data collection tool included three questionnaires: (1) demographic questions, (2) the General Health Questionnaire (GHQ), and (3) the NEO Five-Factor Inventory (NEO-FFI).

RESULTS

The results showed that 45.2% of the participants had abnormal health status. The mean score of the participants on the openness subscale was insignificantly lower than that of the general population (p > 0.05). On the other hand, the mean scores of the participants on the conscientiousness and agreeableness subscales were significantly lower (p < 0.001). Finally, the mean score of the samples on the extroversion subscale was significantly higher than that of the general population (p < 0.001).

CONCLUSION

Given the results of the study, it is strongly recommended to address the personality and psychological characteristics of the applicants for cosmetic surgery before operating on them.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Investigating Psychosocial Causes of the Tendency for Facial Cosmetic Surgery

INTRODUCTION

Despite the importance of cosmetic surgery in improving body image and promoting individuals' physical and mental health, it is accompanied with some physical, mental, and economic problems, because it is an invasive procedure. Considering such extensive consequences and given the rising demand for performing such surgeries, it is essential to consider programs for reducing such requests. The present study aimed to investigate the psychosocial causes of the tendency for facial cosmetic surgery in patients referred to medical centers in Ahvaz in 2016-2017.

MATERIALS AND METHODS

This study was conducted on 385 facial cosmetic surgery applicants referred to medical centers in Ahvaz and were selected using a sequential non-probability sampling method. The data collection tool was a questionnaire divided into two sections namely: (1) demographic questions and (2) a questionnaire on the psychosocial causes of the tendency for facial cosmetic surgery.

RESULTS

The mean scores of the psychological and social causes of the tendency for facial cosmetic surgery were 4.46 (SD = 1.67) and 3.44 (SD = 2.57), respectively. "Being interested in being beautiful" was the most frequent positive response of the participants regarding the cause of tending to undergo facial cosmetic surgery (88.6%) and the least frequent response was estimated to be 35.1% for the "inappropriate psychological state" cause.

CONCLUSION

The results of this study showed that psychological factors affected the participants' tendency for facial cosmetic surgery more than social factors. Determining and identifying such psychological pressures and providing individual training and psychological support can prevent individuals from undergoing facial cosmetic surgery.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .