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In This Issue of JAMA Facial Plastic Surgery
Jul/Aug 2016


JAMA Facial Plast Surg. 2016;18(4):239. doi:10.1001/jamafacial.2015.1230

Dey and colleagues examine the impact of facial defects on quality of life and willingness to pay, as perceived by society, and highlights the quality of life penalty associated with facial defects and the value society places on their surgical reconstruction. Observers viewed images of faces with defects of varying sizes and locations before and after surgical reconstruction. They imagined if the defect in each image were on their own face and rated their health state utility with the defect and how much they would be willing to pay to have the defect surgically repaired to normal (perfect repair). They were willing to pay an average of $1170 to repair a small peripheral defect; they were willing to pay $4274 more than the average to repair a large defect and $2372 more to repair a central defect.

Invited Commentary

Gaudin and colleagues sought to establish the correlation between the scores on the eFACE, an electronic and digitally graded facial measurement scale, and the Sunnybrook Facial Grading Scale (FGS) among patients with facial paralysis and to compare the reliability of the 2 scales. Two independent physical therapists evaluated patients using both the eFACE and the Sunnybrook FGS. Scores were compared, and the Spearman rank correlation coefficient was calculated between the total scores and each of the 3 subscores, including static, dynamic, and synkinesis scores. They found moderately good agreement between the Sunnybrook FGS and the eFACE. Given the ease of using the eFACE on mobile devices, the authors propose that eFACE may represent a reasonable facial grading option across disciplines in the future.

Ratnarathorn and coauthors used an internet-based survey to compare the perceived cosmetic appearance of linear vs zigzag facial scars by the general public in white men and women of different ages. A computer-generated image of a mature scar was designed in linear and zigzag configurations and overlaid on the faces of standardized headshots of 4 white individuals. Respondents rated each scar on the 10-point Patient and Observer Scar Assessment Scale. They found that the lay public had a significantly better perception of the appearance of linear scars compared with zigzag scars in 3 facial locations (temple, cheek, and forehead).

Invited Commentary

In this review, Rodman and Kridel propose a novel classification system for patients presenting for revision rhinoplasty for the purposes of helping patients understand the complexity of the repair required, facilitate exchange of information between surgeons, and potentially allow for meaningful comparisons of surgical techniques and evaluations of outcomes of rhinoplasty procedures. They describe 3 major components that determine the overall difficulty of surgery for revision rhinoplasty. In the PGS system, “P” represents “problem,” consisting of the specific anatomic anomaly; “G,” for “graft,” based on the number of grafts required; and “S,” for “number of previous surgical procedures.” In addition, they include a category “E,” for “patient expectations.”

Invited Commentary

Continuing Medical Education