Perception of aesthetics and personality traits in orthognathic surgery patients: A comparison of still and moving images

Evaluating the Use of IncobotulinumtoxinA in Combination with Calcium Hydroxylapatite with Integral Lidocaine for Improving Chin Profile Projection Aesthetics

Background

Microgenia resulting from congenital deficiency or aging can significantly affect the facial profile and render it less attractive. This study assessed the effectiveness of treatment with incobotulinumtoxinA (Inco) and calcium hydroxylapatite with integral lidocaine (CaHA[+]) for improving chin profile.

Methods

Subjects with a hyperactive mentalis and at least moderate chin retrusion according to the Asian Chin Projection Scale (ACPS) were recruited. At Visit 1, subjects received Inco injection into the mentalis, followed by deep, pre-periosteal injections of CaHA(+) into the pogonion. The primary endpoint was an ACPS improvement of one point at one and six months. Photographs at baseline and each follow-up visit were rated by physicians using the Global Aesthetic Improvement Scale (GAIS). All subjects completed a satisfaction questionnaire.

Results

Ten female subjects were recruited. Mean age was 42.5 years and all had moderate-to-severe chin retrusion at baseline (ACPS score ≥2). All subjects demonstrated at least a one-point improvement in ACPS compared with baseline at both the one-month and six-month posttreatment visits. Physician GAIS ratings of subject appearance confirmed that 100 percent of subjects experienced improved chin projection at each follow-up visit compared to baseline. All 10 subjects were pleased with their chin profile after treatment, with 90 percent noting that it was still "very much improved" at six months.

Conclusion

Based on our results, combined treatment with CaHA and Inco appears to be effective and well tolerated for improving the facial profile of subjects with chin retrusion. Treatment was associated with a high degree of patient satisfaction and was well tolerated.

Refining Orthognathic Surgery Results by Synchronous Cheek Fat Compartment Augmentation with Fat Grafting in Adult Females with Class III Skeletal Profiles

SUMMARY

Patients with maxillomandibular disharmony may present with a flat to concave midface. The effects of orthognathic surgery concomitant with midface fat grafting on facial appearance and midface volumetric and positional change have not formally been assessed to date. The authors' approach for synchronous orthognathic surgery and fat grafting is described and evaluated. Adult female patients (n = 20) who underwent synchronous two-jaw orthognathic surgery and cheek-specific fat grafting (1.9 ± 0.6 cm3 per side) for correction of skeletal class III deformity and anteromedial cheek deficiency were prospectively included. Preoperative and postoperative photographs were appraised by 42 blinded raters using facial appearance scales for beauty, attractiveness, and pleasantness parameters. The three-dimensional midface soft-tissue volume change and postoperative cheek mass position were computed. Facial imaging data from gender-, ethnic-, and facial pattern-matched adult patients (n = 20) who underwent isolated two-jaw orthognathic surgery (n = 20) were included for comparison. The three-dimensional facial norms database-derived cheek mass position information (2.19 ± 1.31mm) was also adopted for analysis. Patients treated with the synchronous procedure had significantly (p < 0.001) increased facial appearance-related perception change for beauty (2.9 ± 1.6), attractiveness (2.8 ± 1.8), and pleasantness (3.0 ± 1.5) parameters, three-dimensional midface volume change (1.8 ± 0.5 cm3), and postoperative cheek mass position (2.16 ± 0.47 mm) in comparison with those treated with the isolated procedure (2.0 ± 1.5, 1.9 ± 1.6, 2.3 ± 1.6, 0.6 ± 0.2 cm3, and 1.84 ± 0.43 mm, respectively). Healthy female individuals had similar and larger cheek mass position than patients treated with synchronous (p > 0.05) and isolated (p < 0.001) procedures, respectively. Synchronous orthognathic surgery and check-specific fat grafting resulted in superior enhancement of facial appearance and midface volume and position compared with isolated orthognathic surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Evaluation of ortogonblender software bone movement tools in bimaxillary orthognatic surgeries performed in dolphin software

The aim of this observational, longitudinal and retrospective study was to evaluate the fidelity of virtual surgical planning (VSP) performed on Dolphin Imaging & Management Solutions® 11.95 software on hard tissues, using the tools of the open-source software OrtogOnBlender - Blender3D. For this, linear, angular and 7-point anatomical measurements of the skeletal profile were used, and the discrepancies between the VSP and the result after bimaxillary orthognathic surgery were calculated. Pre- and postoperative cone beam CT (CBCT) scans of 43 consecutive patients with class II and III skeletal deformities were evaluated and the results of the VSP were compared to the 1-month postoperative results. All overlapping points presented values within the range considered clinically irrelevant (< 2 mm and < 4°) and differences were not significant (p > 0.05). The comparison of anatomical points showed lower values (≤ 2.11 mm) in point A of class II. For hard tissues, the comparison between VSP and 1-month postoperative tomography demonstrated the faithful results of virtual planning using this software.

Effect of Observer's Sex and Chin Prominences on the Perception of the Lower Lip-Chin Prominence Angle

ABSTRACT

This study aimed to identify the preferred range of lower lip-chin prominence angles in the Korean population and evaluate the effect of the individual lower lip-chin prominence angle on perceptions of esthetic chin profile.Chin prominence silhouettes were used to assess the lower lip-chin prominence preference. The observers randomly categorized each image as (1) normal, (2) slightly abnormal but not requiring surgical correction, and (3) abnormal and requiring surgery. Individual lower-chin prominence angles of all observers were analyzed using standardized clinical photographs.The normal range of lower lip-chin prominence angle is 0° to 25°; socially acceptable range is 0° to -10°, 25° to 40°; range needing surgery is -10° to -30° and 40° to 45°. Women are more tolerant to chin protrusion. A protrusive chin is more acceptable in observers with retrusive chin profile.Skeletal Class II profile is more acceptable than skeletal Class III in the Korean population. The individual lower-chin prominence angle could affect perception of desired surgery. These findings indicate that patient-specific treatment planning is important in achieving satisfaction in chin surgery.

The influence of orthognathic surgery on the perception of personality traits: A scoping review

The purpose of this scoping review was to determine the current state of evidence regarding the influence of orthognathic surgery on the perception of personality traits in dysmorphic patients by laypersons. The MEDLINE database was searched for relevant studies using the search strategy: ("Personality"[Mesh]) AND ("Orthognathic Surgery"[Mesh] OR "Orthognathic Surgical Procedures"[Mesh]). A qualitative and quantitative synthesis of the results was performed. Descriptive statistics were used. The PRISMA-ScR guidelines were followed. Five studies, published between 2012 and 2018, remained after screening. Seventy-two dysmorphic patients and 12 class I control individuals were rated based on a total of 296 pre- and postoperative photographs or videos. The available data showed concordant results. Dysgnathic patients were more negatively perceived than class I patients for both aesthetic and personality dimensions. Compared to control class I patients, class II patients were perceived as more flexible, less confident, and less intelligent, whereas class III patients were characterized by dominance, aggressivity, and brutality. Dysgnathic patients showed an improvement in the postoperative ratings but did not reach the ratings attributed to the control class I group in most traits evaluated. This added understanding should help surgeons to counsel their patients in a realistic and reasonable manner.

Facial Appearance and Psychosocial Features in Orthognathic Surgery: A FACE-Q- and 3D Facial Image-Based Comparative Study of Patient-, Clinician-, and Lay-Observer-Reported Outcomes

Outcome measures reported by patients, clinicians, and lay-observers can help to tailor treatment plans to meet patients' needs. This study evaluated orthognathic surgery (OGS) outcomes using pre- and post-OGS patients' (n = 84) FACE-Q reports, and a three-dimensional facial photograph-based panel assessment of facial appearance and psychosocial parameters, with 96 blinded layperson and orthodontic and surgical professional raters, and verified whether there were correlations between these outcome measurement tools. Post-OGS FACE-Q and panel assessment measurements showed significant (p < 0.001) differences from pre-OGS measurements. Pre-OGS patients' FACE-Q scores were significantly (p < 0.01) lower than normal, age-, gender-, and ethnicity-matched individuals' (n = 54) FACE-Q scores, with no differences in post-OGS comparisons. The FACE-Q overall facial appearance scale had a low, statistically significant (p < 0.001) correlation to the facial-aesthetic-based panel assessment, but no correlation to the FACE-Q lower face and lips scales. No significant correlation was observed between the FACE-Q and panel assessment psychosocial-related scales. This study demonstrates that OGS treatment positively influences the facial appearance and psychosocial-related perceptions of patients, clinicians and lay observers, but that there is only a low, or no, correlation between the FACE-Q and panel assessment tools. Future investigations may consider the inclusion of both tools as OGS treatment endpoints for the improvement of patient-centered care, and guiding the health-system-related decision-making processes of multidisciplinary teams, policymakers, and other stakeholders.