Introduction: Durable correction of midfacial descent remains technically challenging, and no single operative approach has emerged superior. The transoral–transtemporal Endotine-assisted technique has been described yet lacks robust long-term outcome data. Objective & Hypotheses: Evaluate long-term effectiveness of transoral-transtemporal Endotine-assisted endoscopic midface lift (TTEEM). Study Design: Retrospective cohort study Methods: Any patient undergoing TTEEM lift with photographic documentation from 2003–2025 were included (n=113, 97.3% female, mean age 61.7 years). Photographs were assessed using a validated midface scoring scale, GAIS, and intraclass correlation coefficients. Results: Statistically significant improvements were observed: infraorbital hollow (1.71 to 1.24, p<0.00001), upper cheek fullness (2.01 to 1.27, p<0.00001), lower cheek fullness (1.71 to 1.36, p<0.0001), and nasolabial fold depth (1.58 to 1.32, p=0.0007). Mean GAIS score was 2.96. Follow-up photographic analysis averaged 2.6 years, extending to 17 years. Conclusion: TTEEM lifts produce durable improvements in midfacial contour, and is worthy of consideration when planning midface lift surgery.
Abstract As artificial intelligence (AI) becomes increasingly integrated into aesthetic medicine, its influence on beauty standards and clinical practice warrants closer evaluation, especially among a diverse population. This study aimed to evaluate whether AI-based facial attractiveness platforms assign differing attractiveness scores across ethnic groups despite standardized image characteristics, with the hypothesis that significant differences would exist between ethnic groups and AI platforms, reflecting potential preferential scoring patterns favoring Eurocentric facial features. Cross-sectional comparative study evaluating AI-generated facial attractiveness scores across ethnic groups using multiple AI-based rating platforms. A database of 120 stock AI-generated images of women from diverse ethnic backgrounds (Black, White, Latino, and Asian) was developed from an online platform, with 30 photos per ethnicity. Images were of young adult women in frontal view with neutral expressions. These photographs were then evaluated using five different AI-based facial rating websites: Prettyscale (PS), Attractivenesstest (AT), Beautyscoretest (BST), Hotchat3000 (HC), and Attractivenessscore. White females received the highest average score (8.18), followed by Asian (7.79), Latino (7.72), and Black (6.91). Among AI-based platforms, PS yielded the highest scores (8.50), while BST yielded the lowest (6.65). Post hoc pairwise comparisons indicated significant differences in attractiveness scores between certain ethnicities, such as White versus Black (+ 1.27, p < 0.001), White versus Asian (+ 0.39, p = 0.05), and White versus Latino (+ 0.46, p < 0.001). Pairwise differences in attractiveness scores between AI-based platforms were also significant, such as PS versus BST (+ 1.85, p < 0.001), PS versus AT (+ 0.38, p = 0.007), and PS versus HC (+ 1.54, p < 0.001). These findings suggest that some AI platforms may exhibit bias toward White females. Understanding these trends is essential when consulting with patients who seek cosmetic enhancement based on societal standards.
INTRODUCTION:Determining when to perform combined eyelid and brow surgery for functional deficits remains subjective, despite measurable visual field (VF) impairment in affected patients. OBJECTIVES:We sought to identify VF patterns associated with selection for combined eyelid-brow surgery. STUDY DESIGN:Retrospective cohort study Methods: Patients with preoperative Humphrey Visual Field testing undergoing isolated eyelid surgery or combined eyelid-brow surgery for VF deficits were matched 1:2 by demographic and surgical characteristics. VF patterns were analyzed using generalized estimating equations. RESULTS:Among 171 patients, the mid-temporal VF zone was the only independent predictor of combined-repair selection on multivariable analysis (OR=1.38 per dot missed, 95% CI 1.06-1.81, p=0.018). Combined repair was also independently associated with lower odds of need for revision surgery (OR=0.31, 95% CI 0.10-0.97, p=0.044). CONCLUSIONS:The mid-temporal VF may serve as a marker of brow-related visual obstruction, helping guide selection for combined eyelid-brow surgery in functional blepharoptosis.
Introduction:The lateral crura of the lower lateral cartilages are crucial in tip rhinoplasty. Their deformity or malposition causes aesthetic imbalance, alar insufficiency, and functional airway compromise. Objectives and Hypotheses:The objective of this study is to describe a classification system for lateral crura deformity and evaluate the outcomes of a structured surgical management algorithm. Study Design:This is a retrospective-prospective study. Methods:This study included patients undergoing primary or revision rhinoplasty involving lateral crural intervention between 2022 and 2025. Outcomes were assessed using standardized photographic analysis, a 5-point Likert scale for patient satisfaction, and the Nasal Obstruction Symptom Evaluation (NOSE) scale for valve stability. Results:This study included 50 patients (primary: 80%, revision: 20%). The mean follow-up was 14.2 months (range: 6-24). The mean preoperative NOSE score improved. Patient satisfaction scores were high, 90% of patients reported significant improvement in both aesthetic and functional outcomes, and two patients (4%) required revision surgery for minor asymmetry correction. Conclusion:Lateral crural deformity management should prioritize preservation and restoration over excessive excision. An algorithmic, preservation-based approach improves predictability, airway stability, and long-term nasal tip support. Modern management should focus on repositioning, reinforcement, and reconstruction.
Introduction:Septal extension grafts (SEGs) are widely used in structural rhinoplasty to provide stable control of nasal tip projection and rotation. However, conventional fixation methods may increase cartilage consumption, intranasal bulk, and the potential for asymmetry. The Slice Extension (SE) graft was developed as a cartilage-preserving modification of the SEG that maintains graft continuity while creating an embracing fixation pattern around the caudal septum. Objective and Hypothesis:The objective of this study is to describe the SE graft and evaluate its clinical performance in a case series of patients undergoing rhinoplasty. We hypothesized that the SE graft would provide stable nasal tip support while preserving cartilage length and maintaining graft centralization. Study Design:This is a retrospective case series. Methods:Forty-one patients undergoing primary or secondary rhinoplasty with the SE graft between 2023 and 2026 were included. Minimum follow-up was 12 months. Demographic data, postoperative complications, revision procedures, and patient-reported satisfaction were reviewed. Outcomes included tip deviation, overrotation, nostril asymmetry, nasal obstruction, infection, and fixation-related instability. Results:Forty-one patients were included in the study, comprising 18 male and 23 female patients. Mean age was 31.3 ± 8.8 years (range, 18-53). At 12-month follow-up, 36 patients (87.8%) reported satisfaction with nasal tip appearance and support. Revision surgery related to nasal tip appearance was required in two patients (4.8%), including one minor and one major revision procedure. Postoperative complications were infrequent. No cases demonstrated clinically significant fixation failure or loss of nasal tip support during the follow-up period. Conclusion:The SE graft provided predictable control of nasal tip projection and rotation with acceptable complication and revision rates. By preserving graft continuity and minimizing cartilage loss for fixation, the technique may offer a reproducible alternative to conventional SEG fixation in selected patients.
