Effect of Filler Therapy on Psychosocial Distress in Facial Paralysis: Patients with Major Asymmetry Derive Greater Benefit

Background: Facial filler is an effective nonsurgical treatment option for improving facial symmetry in patients with facial paralysis (FP).Objective: To compare the effects of filler among patients with FP that is self-perceived as major or minor asymmetry, by measuring psychosocial distress.Methods: In this prospective cohort study of patients with FP undergoing filler at a tertiary academic center, patients were classified as having minor or major self-perceived asymmetry using a visual analog scale (VAS). FACE-Q Appearance-Related Psychosocial Distress was administered before and after filler. Descriptive statistics and a random-effects generalized linear model assessed the relationship between perceived facial asymmetry and change in psychosocial distress.Results: A total of 28 patients participated. Twenty-five (89%) patients were female with median age of 54 (interquartile range [IQR]: 49-66). Median VAS score was 2 (IQR: 1-3.5, 0 = completely asymmetric, 10 = no asymmetry). Psychosocial distress improved in all patients after filler. In multivariable modeling, patients with major asymmetry experienced 2.45 (confidence interval: 0.46-4.44, p = 0.016) points more improvement in psychosocial distress than patients with minor asymmetry. Age, gender, and FP duration were not associated with change in psychosocial distress.Conclusion: Facial filler treatment was seen to improve psychosocial distress in patients with FP, especially by those with more self-perceived deficit

Targeted Nipple Areola Complex Reinnervation: Technical Considerations and Surgical Efficiency in Implant-based Breast Reconstruction

Background:. Despite promising pilot study results, adoption of neurotization of immediate implant-based reconstructions has not occurred. Methods:. For surgeons interested in adopting breast reinnervation techniques, we present ways to overcome initial barriers by decreasing operative time and maximizing chances of sensory recovery. Results:. We discuss the combined experience at two academic teaching hospitals, where neurotization of both immediate tissue expander cases and direct-to-implant reconstructions are performed through varying mastectomy incisions. Conclusion:. Initial barriers can be overcome by shortening operative time and providing an individualized reinnervation approach that aims to increase the chance of meaningful sensation