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In This Issue of JAMA Facial Plastic Surgery
Jul/Aug 2017


JAMA Facial Plast Surg. 2017;19(4):249. doi:10.1001/jamafacial.2016.0603

Kandinov and colleagues analyzed 89 medical malpractice litigation cases involving rhytidectomy. Jury verdict and settlement reports related to rhytidectomy malpractice litigations were obtained using the Westlaw Next database. Fifty-three cases (60%) were resolved in the defendant’s favor, while the remaining 36 cases (40%) were resolved with either a settlement or a plaintiff verdict payment. The mean payment was $1.4 million. They found that patient dissatisfaction with cosmetic outcome and inadequate informed consent were the most commonly cited factors in pursuing litigation. In addition, intraoperative negligence and facial nerve injury allegations were more likely to result in poor defendant outcomes.

Invited Commentary

Joseph and coinvestigators conducted a multicenter prospective study recruiting a cohort of 597 patients who presented to academic and private facial plastic and oculoplastic surgery practices over 1 year to establish the prevalence of body dysmorphic disorder (BDD) across facial plastic and oculoplastic surgery practice settings and to estimate the ability of surgeons to screen for it. All patients were screened for BDD using the Body Dysmorphic Disorder Questionnaire (BDDQ). After each clinical encounter, surgeons independently evaluated the likelihood that a participating patient had BDD. They found that patients who screen positive on the BDDQ have lower satisfaction with their facial appearance at baseline, and surgeons have a poor ability to screen for patients with BDD when compared with validated screening instruments such as the BDDQ.

Continuing Medical Education

Santosa and colleagues sought to review the literature to evaluate the use of facial photography in the treatment of patients with facial palsy and to examine the use of photography in documenting facial nerve function among members of the Sir Charles Bell Society—a group of medical professionals dedicated to care of patients with facial palsy. Their cross-sectional study revealed that all survey respondents used photographic documentation, but there was variability in which facial expressions were used. Eighty-two percent (68 of 83) used some form of videography. Given this variability, they propose a set of minimum photographic standards for patients with facial palsy (10 static views) along with videography of dynamic movements of these standard views.


Patel and coinvestigators performed a cadaver study to determine if the anatomical pattern of an orbital floor fracture can point to the etiologic biomechanical force applied to the region and thus guide clinical management. They found that despite similar impact forces to the globe and rim, strain-gauge data displayed greater mean strain for globe impact, suggesting that trauma directly to the globe predisposes a patient to a more posterior fracture, whereas trauma to the rim demonstrates an anterior predilection. Both the hydraulic and buckling mechanisms of fracture exist and demonstrate similar fracture thresholds.