Submental hematoma after genioplasty is rare but can be life-threatening, and current imaging data give limited patient-specific guidance for chin osteotomy design. We combined targeted cadaveric dissection of two perfused heads with cranial CT analysis of 211 adults (70 long chin, 71 retrogenia, 70 controls; 621 lingual foramina). Standardized three-dimensional measurements described lingual foramen (LF) number, diameter, location, and canal trajectory, and their distances to tooth apices, genial spines, the mental foramen, and the mandibular border. Multivariable linear regression models related these metrics to facial type and chin height. Nonlinear machine learning regressors, including random forest, were trained and internally validated to predict midline LF depth. LFs clustered in the symphyseal midline, where they were larger and mainly descended toward the submental region. Facial pattern and chin height changed LF position relative to lower incisor roots but not to the inferior border. Chin height and LF–genial spine relationship were the dominant predictors in midline multivariable linear regression models (adjusted R2 up to 0.77). A random forest model predicted midline LF position with R2 0.85 and mean absolute error 1.6 mm, close to typical surgical tolerances, and highlighted canal course, chin height, and genial spine zone as the key features; lateral predictions were weaker. Cadaveric dissection confirmed that central LFs transmit branches linking the sublingual and submental systems. This integrated cadaveric, CT, and modeling study defines a central high-risk corridor for chin surgery and provides interpretable, millimeter-level tools to refine osteotomy and fixation planning in aesthetic genioplasty. 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 .

BACKGROUND:A clear understanding of the superficial musculoaponeurotic system (SMAS) perfusion during extended SMAS rhytidectomy is helpful for surgical planning and for elucidating the structural characteristics of the SMAS. OBJECTIVES:The aim of this study was to determine the vascularity of the SMAS during extended SMAS rhytidectomy, as assessed using indocyanine green angiography (ICGA), and to discuss the clinical relevance of the SMAS perfusion pattern for surgical practice. METHODS:A total of 20 patients who underwent extended SMAS rhytidectomy were evaluated intraoperatively. The perfusion patterns of the buccal-mandibular area SMAS and the superficial temporal fascia before and immediately after dissection were assessed by means of ICGA. RESULTS:Perfusion of the buccal-mandibular area SMAS originated from a transverse facial artery perforator in the deep layer before dissection but was absent after dissection. No perfusion was observed after elevation of the buccal-mandibular area SMAS. In contrast, a prominent axial vessel was visible within the superficial temporal fascia. When this fascia was dissected, it was predominantly perfused by the parietal branch of the superficial temporal artery, which was present bilaterally in all patients. The superficial temporal fascia showed a marked peak in blood perfusion after dissection. CONCLUSIONS:Perfusion of the buccal-mandibular area SMAS originated from a transverse facial artery perforator in the deep layer and remained poor during extended SMAS rhytidectomy. Because of the poor perfusion of the buccal-mandibular area SMAS after elevation, high-risk patients may benefit from composite facelifts, less extensive skin dissection, or preservation of the transverse facial artery perforator. The superficial temporal fascia can be harvested as an inferior-pedicled flap down to the zygomatic arch, whereas the buccal-mandibular area SMAS cannot be reliably harvested in this manner. LEVEL OF EVIDENCE: 4 (THERAPEUTIC):For image description, please refer to the figure legend and surrounding text.

Condylar hyperplasia (CH), characterized by progressive facial deviation, occlusion disorders, and temporomandibular joint dysfunction, often requires combined temporomandibular joint (TMJ)-orthognathic interventions to reconstruct joint and occlusal functions as well as rebuilding harmonious facial expressions. Managing the dentomaxillofacial deformities secondary to CH involves hyperplastic condylar resection, orthognathic surgery, facial contour surgery and orthodontic treatment. Based on the activity of condylar hypertrophy, the severity of dentomaxillofacial deformity and malocclusion, an individualized treatment plan should be formulated to reconstruct joint functions, correct deformities and recover occlusal relationships. This expert consensus, informed by the latest clinical research and practical experience, addresses clinical considerations for surgical treatment strategies for patients with different CH types, delineating indications, objectives, procedures, and principles with the aim of providing clear and practical guidance for clinical practitioners.

OBJECTIVE:This study aimed to characterize the three-dimensional (3D) upper airway morphology in children with bilateral craniofacial microsomia (BCFM) and to evaluate its association with obstructive sleep apnea (OSA). METHODS:A retrospective cross-sectional study was conducted involving 9 BCFM children and 10 age- and gender-matched controls. All participants underwent craniofacial CT imaging and polysomnography. The upper airway was segmented into four anatomical regions (nasopharynx, velopharynx, glossopharynx, and laryngopharynx) using a standardized 3D coordinate system. Morphometric parameters including volume, vertical height, minimum cross-sectional area (CSA), and maximum diameters were measured. Statistical analyses were performed to compare groups and assess correlations with obstructive apnea-hypopnea index (OAHI) and oxygen saturation (SpO₂). RESULTS:Significant reductions in nearly all airway dimensions were observed in the BCFM group compared to controls (P < 0.05), with large effect sizes (Cohen's d > 0.8 or |r| > 0.5). Total airway volume was markedly smaller in BCFM patients (median 10,569.86 mm³ vs. 22,957.68 mm³, P < 0.001). The velopharynx and glossopharynx showed the most pronounced decreases. Strong negative correlations were identified between OAHI and both velopharyngeal volume (r = -0.717, P = 0.030) and total airway volume (r = -0.800, P = 0.014). SpO₂ was positively correlated with laryngopharyngeal volume (r = 0.778, P = 0.017). CONCLUSIONS:Children with BCFM exhibit significant 3D morphological alterations in the upper airway, characterized by reduced volumes and restricted dimensions. This preliminary study suggests a strong association between airway morphological alterations and OSA severity in children with BCFM and provides a foundation for tailored therapeutic interventions.

Craniosynostosis results from premature fusion of the cranial sutures, yet the contribution of suture mesenchymal stem cell (SuSC) dysfunction to this process remains incompletely understood. Here, we combined single-cell RNA-seq with 2-µm Visium HD spatial transcriptomics to define stage-specific changes in Prrx1+ SuSCs in the Fgfr2C342Y/+ mouse model. We observed early downregulation of Frizzled-7 (Fzd7), increased mitophagy-associated signatures and readouts with elevated Pink1 expression, and premature osteogenic activation within the SuSC niche. In vitro, loss of Fzd7 increased mitophagy and osteogenic activity, whereas Fzd7 overexpression attenuated these changes. In vivo, conditional deletion of Fzd7 accelerated coronal suture fusion, while AAV-mediated Fzd7 overexpression reduced fusion. Conditional deletion of Pink1 suppressed the effects of Fzd7 loss, supporting Pink1-dependent mitophagy as a required component of the Fzd7-deficiency-associated osteogenic and fusion phenotypes. These findings support a model in which an Fzd7-Pink1 mitophagy axis contributes to the maintenance of suture patency in craniosynostosis and provide a mechanistic basis for future targeted studies.

Craniosynostosis is defined by premature cranial suture fusion and is biologically heterogeneous. To map mitochondrial-associated signals in craniosynostosis and rank follow-up candidates, we integrated two public microarray datasets (GSE27976, GSE50796), corrected batch effects, and analyzed 14,186 shared genes using limma. This identified 798 nominal DEGs (388 upregulated and 410 downregulated), of which 19 remained significant after Benjamini–Hochberg correction. Intersecting the nominal DEG list with the MitoCarta 3.0 inventory yielded 24 mitochondrial DEGs (MitoDEGs). Complementary feature selection reduced these 24 MitoDEGs to an eight-gene panel (TMEM11, SLC25A21, GPT2, CYP27A1, MRPS30, ACAA2, GSR, and LIG3); a multigene score reached an apparent AUC of 0.806 in the integrated dataset. Correlation-based co-expression analyses linked the panel to mitochondrial translation, electron transport, amino-acid metabolism, redox control, and cell–matrix signaling. Among craniosynostosis cases, consensus clustering on the eight genes separated two molecular subtypes with distinct GSVA pathway profiles. For experimental support in a genetically defined mouse model, we profiled bilateral coronal suture complexes from Fgfr2C361Y/+ knock-in (KI) pups and WT littermates. Jess capillary immunoassay showed higher CYP27A1 abundance in KI sutures (P = 0.0276), whereas ACAA2, LIG3, MRPS30, and TMEM11 were not significant. Data-independent acquisition (DIA) proteomics identified 523 differentially abundant proteins (516 increased, 7 decreased in KI), followed by stricter-threshold reporting, sensitivity analysis, and threshold-free rank-based enrichment. MitoCarta proteins and mitochondrial pathways remained supported under these more conservative analyses. These results support mitochondria-associated transcriptomic and proteomic changes in craniosynostosis and prioritize a limited set of mitochondrial candidates for future mechanistic work.

Abstract Background Craniosynostosis is a congenital disorder characterized by premature suture fusion and aberrant skull morphogenesis. The cellular dynamics and regulatory mechanisms of suture mesenchymal stem cells (SuSCs) in this disease remain poorly defined. Methods We integrated single-cell RNA sequencing and 2-μm-resolution Visium HD spatial transcriptomics to build a spatiotemporal atlas of coronal suture cells in Fgfr2 C342Y/ + mice, a murine model recapitulating human Crouzon syndrome, alongside wild-type controls across three key developmental stages (E14.5, E18.5, and P3). To obtain near single-cell spatial resolution, we created SpatialCell, which combines morphology-based segmentation and machine-learning classification using a reference trained on our single-cell datasets. Results The atlas reveals stage-specific remodeling of SuSC niches and a shift of SuSC spatial associations toward osteogenic mesenchyme in craniosynostosis. Along the SuSC-to-osteoblast trajectory, pre-osteoblasts were depleted earlier than upstream SuSCs, and SuSCs displayed premature acquisition of osteogenic programs near the suture midline. Temporal Gene Ontology patterns indicated early extracellular-matrix disruption, mid-gestation chondrogenic activation, and postnatal mineralization. Network analysis nominated Foxa3 as a candidate regulator in SuSC subsets; siRNA knockdown of Foxa3 reduced ex vivo mineralization in the craniosynostosis background. Spatial communication analyses implicated signals from suture meningeal fibroblasts and immune cells that converge on SuSC fate. Conclusions Our results support a model where craniosynostosis may involve disrupted temporal coordination of developmental programs, not merely accelerated bone formation. The atlas and analytic framework pinpoint when and where SuSC fate diverges, propose Foxa3 as an intervention target, and provide a high-resolution resource for mechanistic and therapeutic exploration.

BACKGROUND:Progressive hemifacial atrophy is a rare craniofacial disease that commonly involves withered skin, soft tissue, cartilage, or bone on one side of the face. The author proposed a therapeutic algorithm tailored to PHA's severity, which revealed a paradigm shift from subjective evaluation on 2D photographs to more objective assessment using 3D stereophotogrammetry. METHODS:This retrospective observational study comprised all patients diagnosed with PHA between February 2000 and August 2025. Patients were categorized into three tiers according to deficits in soft tissue, facial skeletal contour, and occlusal function. Photographs, three-dimensional laser scanning, and computed tomography were obtained if needed to evaluate facial asymmetry, the defective area, and depth. RESULTS:186 patients were treated. Thirty - three patients (17.7%) had concurrent linear scleroderma (mainly en coup de sabre). 59.7% underwent sequential autologous fat grafting as the primary therapeutic method. 29.6% underwent adipofascial tissue transplantation combined with subsequent procedures, including graft debulking or lipofilling. 10.8% had bony and soft tissue reconstruction approaches. The complication rate (3.8%) was acceptable with rational treatment. CONCLUSION:Treating PHA is a challenge, and 3D stereophotogrammetry is a useful adjunct for formulating therapeutic modalities. The authors shared their personal experiences and proposed a therapeutic algorithm. Although there is no "perfect" strategy, hopefully, this algorithm will enrich the current body of literature and inspire further thoughts.

Adipose precursor cells (APCs), present within the stromal vascular fraction (SVF) of adipose tissue, play an important role in adipose biology. However, its regulatory functions in adipogenesis and tissue homeostasis remain incompletely characterized. Here, we isolated APC from the subcutaneous adipose tissue of Prx1-Cre; Rosa26-tdTomato mice and confirmed that APC has a high adipogenic differentiation efficiency. Next, RNA sequencing analysis indicates that APC may have dual effects of promoting adipogenesis and anti-inflammatory effects. Subsequent in vivo studies identified clusterin (Clu) as a key secretory factor through which APC exerts its regulatory functions. By utilizing gene regulation and APC/adipocyte co-culture, we further demonstrated that APC-derived Clu promotes its own adipogenic differentiation and improves local resistance to oxidative stress. Collectively, data from conditional Clu knockout mice establish its key function in preserving adipose tissue homeostasis. These findings highlight Clu as a potential therapeutic target for interventions aimed at adipose tissue homeostasis and regeneration.

Orthognathic surgery increasingly relies on digital transfer workflows, most commonly CAD/CAM occlusal splints or patient-specific implants (PSI). However, prior meta-analyses were limited by methodological heterogeneity, sparse randomized evidence, and insufficient axis-specific analyses, leaving the magnitude and clinical relevance of any accuracy advantage unclear. This systematic review and meta-analysis aimed to compare PSI and CAD/CAM splint workflows in orthognathic surgery. This study followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251039754). PubMed, Embase, and Cochrane were searched from inception to August 23, 2025. Comparative clinical studies evaluating PSI versus CAD/CAM splints in orthognathic surgery were included. Outcomes included linear accuracy, angular accuracy, operative time, and postoperative complications. The primary linear accuracy outcomes were axis-specific translational deviations across the mediolateral, anteroposterior, and superoinferior directions. Angular accuracy was assessed across pitch, roll, and yaw. Randomized trials were assessed using RoB 2.0, and non-randomized studies using the Newcastle–Ottawa Scale. Thirty studies (12 RCTs and 18 cohort studies; 1317 patients) were included; 21 provided sufficient quantitative data for meta-analysis and 9 were synthesized narratively. Compared with CAD/CAM splints, PSI was associated with smaller axis-specific linear deviations across all three translational axes (all P < 0.01); a supportive combined linear summary showed the same direction but was not treated as a primary outcome. A possible advantage in angular accuracy was suggested (MD − 0.54°, 95

BACKGROUND AND OBJECTIVE:Parry-Romberg syndrome (PRS) is a rare facial asymmetric deformity. The pathogenesis of PRS is poorly understood. The role of predisposing genetic factors in the development of PRS is still unclear. This study aims to identify pathogenic variants associated with PRS by performing whole-genome sequencing (WGS) and genetic variation analysis. METHODS:Nineteen peripheral whole blood samples were collected and sent for WGS from sporadic PRS patients in our department from September 2020 to January 2023. Single-nucleotide variation (SNV), insertion or deletion (InDel), and copy number variation (CNV) were called, filtered, and interpreted for pathogenicity using the PUMP pipeline. An enrichment analysis was performed. RESULTS:A common pathogenic gene related to PRS was not found through the analysis of SNV/InDel and CNV annotation files. A young female patient diagnosed with right Parry-Romberg syndrome carried a missense mutation in the PORCN gene on the X chromosome. Verifying the relationship between this mutation and the pathogenesis of PRS is needed. CONCLUSION:Based on the genetic variation analysis of the WGS data of 19 patients, we believe that the combined effect of genetic and environmental factors should be considered in the pathogenesis of PRS, and the role of genetic factors in the development of PRS needs to be further explored.

Paranasal concavity, particularly prevalent in East Asian females, contributes to a prematurely aged facial profile. The paranasal augmentation with customized polyetheretherketone (PEEK) implants offers an effective solution for this aesthetic concern. However, conventional design strategies often encounter challenges in bridging the knowledge gap between surgical requirements and engineering implementation, which may result in unsatisfactory aesthetic outcomes. The optimized interdisciplinary approach is required to integrate clinical and engineering expertise. Therefore, the present study aims to introduce a novel design strategy for customized PEEK implants in paranasal augmentation and to investigate clinical outcomes. The present study enrolled 36 consecutive female patients with bilateral paranasal concavity. A surgeon-engineer collaboration workflow was established. The placement position, size, thickness, screw channel, and surface morphology of the implant were the key factors for implant design. Perioperative medical data were meticulously collected and analyzed. The outcomes were evaluated by objective quantitative measurements (maximum concavity depth of paranasal region, nasolabial angle, alar base width, nasorostral angle, philtrum length, and nasal columella length), and subjective questionnaire focused on satisfaction and design experience. The mean operative duration was 55.28 ± 10.89 minutes with minimal intraoperative blood loss. The most common complication was transient perioral numbness. The wound nonunion and infection were not observed in all patients at final follow-up. Quantitative analysis demonstrated significant improvements in paranasal region: maximum concavity depth decreased from 5.45 ± 0.68 to 1.64 ± 0.53 mm (right side, p<0.001) and from 5.62 ± 0.70 to 1.53 ± 0.64 mm (left side, p<0.001). The nasolabial angle demonstrated a statistically significant increase from 90.49 ± 4.53° preoperatively to 95.33 ± 4.75° at final follow-up (p < 0.001). The subjective outcomes of patients revealed 83.33 www.springer.com/00266 .

OBJECTIVE:To explore the genetic basis of a patient with suspected Oculocutaneous albinism (OCA). METHODS:An OCA patient presented at the West China Second Hospital of Sichuan University and his mother were selected as the study subjects. Peripheral blood samples were collected for the extraction of, genomic DNA, and whole exome sequencing (WES) was carried out. Candidate variants were verified through specific primer amplification, Sanger sequencing, and agarose gel electrophoresis. Bioinformatic analysis and pathogenicity rating were conducted on the candidate variants. This study has been approved by the Medical Ethics Committee of West China Second Hospital (No. 2024-228). RESULTS:Genetic testing revealed that the patient had harbored variants in exon 1 of the TYR gene, including a c.157G>T (p.G53C) missense variant and a c.609dup (p.A204fs) frameshifting variant. Specific primer amplification and Sanger sequencing, combined with agarose gel electrophoresis, confirmed that these are compound heterozygous variants. Based on the guidelines from the ACMG, the c.157G>T was rated as likely pathogenic, and c.609dup was rated as pathogenic. Alphafold3 predicted that the variant proteins had significant structural changes. CONCLUSION:The patient was diagnosed with OCA due to compound heterozygous variants of the TYR gene. Discovery of the c.609dup variant has enriched the mutational spectrum of OCA and provided a basis for genetic counseling and prenatal diagnosis for this patient.

Craniosynostosis is a congenital cranial developmental disorder that frequently leads to craniofacial deformities and even neurological dysfunction. The abnormalities in cranial suture progenitor cells (SPC) are considered a key event in craniosynostosis; however, the specific mechanism remains unclear. Using a syndromic craniosynostosis mouse model, we found that hyperactivation of p38α mitogen-activated protein kinase (MAPK) induced senescence in SPC of craniosynostosis mice. Integrated analysis of datasets from human patients and murine models, combined with cellular validation, revealed that p38/p53 activation and cellular senescence were prevalent across multiple forms of craniosynostosis and corresponding experimental models. Additionally, senescent cells significantly promoted osteogenic differentiation of SPC by paracrine Tgf-β1. Through in vivo and in vitro experiments, our evidence demonstrates that pharmacological inhibition of p38 MAPK, conditional knockout of Mapk14, and scAAV-mediated shRNA knockdown differentially attenuate SPC senescence, suture fusion, and elevated intracranial pressure, while ameliorating behavioral abnormalities in craniosynostosis mouse model. The present study supports p38α MAPK as potential therapeutic target for craniosynostosis.

PURPOSE:Craniofacial microsomia (CFM), the second most common congenital craniofacial anomaly, is poorly characterized in bilateral cases because conventional cephalometry cannot accurately assess facial asymmetry. This study aims to characterize craniofacial morphology in children with bilateral CFM using three-dimensional (3D) cephalometric analysis. MATERIALS AND METHODS:A retrospective 3D cephalometric analysis was conducted on 8 bilateral CFM patients and 10 age-/sex-matched normal patients as controls. A coordinate system was established with three reference planes: the Frankfurt Horizontal Plane (FHP), the Midsagittal Plane (MSP) and the Nasion Perpendicular Plane (CP). Fifteen linear and angular measurements assessed maxillary, mandibular, chin, and occlusal parameters. Subgroups were stratified by bilateral mandibular deficiency severity according to Pruzansky-Kaban classification (Group A: similar; Group B: different). Statistical comparisons utilized independent t-tests (CFM vs. controls) and Mann-Whitney U tests (subgroups), with Pearson's correlation analysis exploring variable relationships. RESULTS:Bilateral CFM patients exhibited significant reductions in ramal height (Co-Go: p < 0.001) and mandibular body length (Go-Me: p < 0.001), a posteriorly inclined occlusal plane (OP-FHP: 27.63° ± 5.50° vs. 8.13° ± 3.33°, p < 0.001), and pronounced chin retrusion (Me-NP: 46.08 ± 6.66 mm vs. 8.28 ± 7.71 mm, p < 0.001) and lateral deviation (Me-MSP: 5.84 ± 4.64 mm vs. 1.73 ± 0.93 mm, p < 0.05). Me-NP and Me-MSP differed significantly in subgroup analyses. Pearson correlation analysis revealed strong associations between Me-NP and Me-MSP and OP-MSP, posterior maxillary height (U6-FHP) and Co-Go. CONCLUSION:Bilateral CFM is mainly characterized by posteriorly inclined occlusal plane and pronounced mandibular retrognathia. The occlusal plane and chin will consistently deviate toward the more severely affected side. When bilateral mandibular involvement is similar in extent, chin deviation tends to be mild, resulting in less severe facial asymmetry.

Autologous fat grafting is widely used for soft-tissue augmentation but remains limited by low graft survival, largely due to inefficient purification. Here, we report a hydrophilic modification of polypropylene (PP) SMS nonwoven membranes that enables efficient fat purification with minimal cellular loss. The modified SMS10 material exhibited a reduced water contact angle (130.23° → 46.20°) and rapid fluid penetration (4.15 s), while maintaining a smooth, multi-porous architecture superior to gauze. Human adipose-derived stem cells (ASCs) adhered and proliferated on SMS10 with typical “S”-shaped growth kinetics. Cell viability remained high (85.36% vs. 86.45% control, p > 0.05) and apoptosis rates were unaffected (3.71% vs. 3.34%). These findings demonstrate that hydrophilic SMS10 membranes combine effective filtration with excellent biocompatibility, offering a promising platform to improve fat graft retention and clinical outcomes.

Craniofacial microsomia (CFM) accompanied by a congenital tongue cleft is an exceedingly rare developmental anomaly, with fewer than 10 cases reported globally. This study presents 3 nonsyndromic cases of CFM with concurrent midline tongue cleft, characterized by mandibular hypoplasia (M2B), auricular malformations (E1-E3), soft tissue deficiencies (S1-S3), and hypoglossal/facial nerve dysfunctions. Despite the morphologic presence of tongue clefts, all cases were functionally benign and managed conservatively. Surgical treatment focused on mandibular distraction osteogenesis and auricular reconstruction, resulting in improved facial symmetry and function. The consistent involvement of first and second pharyngeal arch derivatives across cases suggests a shared embryopathological mechanism, likely involving disrupted cranial neural crest cell (cNCC) migration and dysregulation of key signaling pathways, such as SHH, BMP, and FGF. The study highlights the importance of tongue-mandible biomechanical coupling during embryogenesis and proposes potential genetic contributors, including FLNA and Meis2 mutations. These findings underscore the diagnostic significance of tongue cleft as an indicator of underlying craniofacial dysmorphogenesis and provide new clinical and mechanistic insights for future research and individualized therapeutic strategies.

BACKGROUND:The mentalis muscle is a significant component of the lower lip; its injury could impair appearance and function. This study presents a surgical strategy for treating mentalis muscle rupture to restore muscle tension and improve function.METHODS:Medical records and photographs of 2 patients with mentalis muscle rupture were reviewed. After physical examinations, 3-dimensional computed topographies were conducted to evaluate chin appearance further. The surgical strategy was designed according to individual malformations and requests.RESULTS:Both patients injured their mentalis muscles in childhood and presented to our clinic with a concave deformity at the center of the chin and impaired mentalis muscle function. The surgical procedure involved the reconstruction of the mentalis muscle by reassembling the muscle flaps and releasing the scarred soft tissue. Both patients were satisfied with the outcome.CONCLUSIONS:Mentalis muscle rupture requires surgical correction. The study proposes an innovative approach that enables patients to achieve a more harmonious appearance and improve function.

Background: Hyaluronic acid (HA) is a widely used filler for face contouring and is generally believed to be safe and effective. However, there have been reports of HA-related bone erosion in the chin area without clear scientific data regarding its existence, incidence, and severity. This exploratory study was to evaluate HA-related mental bone resorption through a prospective, controlled, observer-blind, nonrandomized clinical trial and a retrospective cohort study. Methods: On the one hand, a prospective, controlled, nonrandomized, single-shot HA-injection clinical trial was conducted. Computed tomographic scans were collected at baseline and at 6–12 months of follow-up for both HA-injection and control groups. On the other hand, an updated retrospective cohort study compared the HA-injection with a blank control group. The primary outcomes composed of three quantitative parameters [bone resorption index (BRIM and BRIN), bone resorption thickness ratio] and one subjective evaluation index (severity ranking). Information about demographics, complications, and injection volume were also recorded. Results: From June 2021 to March 2023, 78 patients were prospectively recruited for the study. There was a significant association between HA-injection and bone resorption [BRIM: pre (84.24±8.10%) vs post (79.21±8.70%), P<0.001; BRIN: pre 92.50% (73, 144%) vs 87.99% (63, 132%), P<0.001; bone thickness ratio: HA 24.08% (0, 48%) vs control 0 (0, 17%), P<0.001]. However, there was no difference in large-volume (>1 ml) and small-volume (≦1 ml) injection subgroups [bone resorption thickness ratio: (21.50±10.91%) vs (24.51±11.92%), P=0.350]. The imaging manifestation revealed discernible bone resorption in 35.90% of the patients, with an median bone resorption thickness ratio of 24.08%. Between October of 2019 and March 2023, 95 HA-injection patients (190 semimandibular cases), 95 normal controls were enrolled. The BRIM was significantly lower in the HA-injection group compared to the controls (P<0.001). Conclusions: HA may induce bone resorption in the mentum. Large-scale randomized controlled clinical trial is warranted for further confirmation. Patients should be informed of this potential complication.

ObjectiveThe objective of this study was to assess satisfaction and psychosocial status before and after facial bone contouring surgery using the Face-Q.MethodsThe Face-Q, a multimodular patient-reported outcome (PRO) instrument, comprises independently functioning scales and checklists designed to assess outcomes in facial aesthetic patients. A prospective cohort study was conducted from November 2020 to May 2022. Participants undergoing facial bone contouring surgery (reduction mandibuloplasty and/or malarplasty) were asked to complete the Face-Q preoperatively and 12 months postoperatively. Comparative analyses were conducted using normative Face-Q data from 534 matched normal individuals. Face-Q scores were evaluated for each domain on a scale of 0 to 100, with higher scores indicating greater satisfaction with appearance or a superior quality of life.ResultsA total of 284 patients (274 female and 10 male) completed the Face-Q preoperatively and 12 months postoperatively. Of these, 146 underwent reduction mandibuloplasty, 18 underwent malarplasty, and 120 underwent both procedures. Post-surgery, patients experienced significant improvements in overall appearance, features altered by surgery, and quality of life, excluding the patient-perceived age. Preoperatively, patients demonstrated significantly lower scores compared to normative data, with scores significantly increasing postoperatively to levels representative of the general population. Satisfaction with outcome was significantly correlated with postoperative Face-Q measurements but not preoperatively.ConclusionFacial bone contouring surgery significantly improves the satisfaction and quality of life in patients with square faces, reaching a level at least equivalent to the normative population. The use of Face-Q should be highlighted in the clinic practice.Level of Evidence IVThis 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