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1. 1: Eye Tracking Analysis as a Means of Evaluating Aesthetic Result Following Toe to Thumb Transfers: A Pilot Study

Author

Thanapoom Boonipat, MD, Tarek Elgendy, MD, Nathan SD Hebel, BS, and Steven Moran, MD

Subjects
Surgery, RD1-811
Abstract

Purpose: Exceptional functional results can be obtained with toe to thumb transfers; however objective measures to evaluate the aesthetic outcome of a toe to thumb transfers remains elusive. Aesthetic evaluation of a reconstruction when performed by external raters or the patient, may be influenced by expert knowledge, emotional antecedent, or ethnic or regional bias. In this study, we were interested in determining the observers’ instantaneous, reflexive responses to the toe to thumb transfer as determined by eye-tracking analysis. Methods: 13 patients with unilateral great toe to thumb transfers were photographed using a standardized technique. None had undergone secondary procedures that changed the appearance of the transferred toe. Both hands were photographed side by side in each image. A dorsal and palmar image was taken, producing 26 photos in total. 40 observers (Average age 41.39, 14-65 yo, 18 males, 22 females), blinded to the procedure, were asked to evaluate each image for symmetry between the hands. An infrared eye-tracking camera continuously recorded their eye movements. Participants were allowed to evaluate each image for 6 seconds. Data was evaluated to determine the percent of time that was devoted to evaluating each portion of the photograph. The percent time spent in each of the lookzones was recorded. Results: i) Observers spent an average of 17.7% of their time evaluating the reconstructed thumb compared to the entire bilateral hand. This was on average 63% more time looking at the reconstructed thumb compared to the normal control thumb. (p value

Published
2021
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2. 5: Correlation Of Face Transplant Smile Excursion Measurements With Emotional Evaluation By Artificial Intelligence

Author

Nathan SD Hebel, BS, Thanapoom Boonipat, MD, Jason Lin, BS, and Samir Mardini, MD

Subjects
Surgery, RD1-811
Abstract

Purpose: Examining the outcomes and progression of face transplants has expanded to include the recent advancements in artificial intelligence. This novel methodology has allowed for the objective exploration of emotional expression. To our knowledge, this examined emotional expression has yet to be correlated to the hypothesized functioning of the allograft. We have combined the result of the AI software with a software analyzing smile excursion; demonstrating the progression of the allograft in our face transplant patient. This study helps illuminate the software possibilities for objective measures in transplant progression. Methods: Images were analyzed from our face transplant patient post-operatively at approximately 6-month intervals for four years. The still images for each time interval include both a neutral facial expression and a full-face smile with teeth. The images were taken from video clips of the patient and then analyzed using the FACEgram software (Hadlock & Urban, 2012). The measurements of the smile excursion were standardized based off of the pupil diameter and excursion was measured relative to the neutral expression of each time period. The emotional expression data was acquired using FaceReader AI software from Noldus Information Technology (Wageningen, The Netherlands). The emotional analysis was done on 2 second clips from clinical videos of the patient, the same videos used for the still images. This data was correlated with the smile excursion measurements. Results: The post-operative smile excursion analysis from 6 to 49 months demonstrated a near double in smile excursion from 3.58mm to 6.04mm. The smile excursion data has a squared correlation of 0.705; a strong upward linear trend of excursion. From 6 to 35 months, the happy emotion increased gradually from 0% to 15.8% (49-month data unavailable). Performed correlative analysis showed a positive correlation coefficient of 0.63. This moderate to strong correlation demonstrates the intuitive relationship of happy emotion and lip excursion during full face smiling. The findings also substantiate the AI software’s detection of increasing activity in the lip corner puller action unit from zero to 3/5 intensity over the same period. Conclusion: This study demonstrates the correlation of smile excursion to happy emotional expression in our face transplant patient. The correlation square of the lip excursion shows a trend of increased functioning of the allograft over time; substantiating the AI’s finding. This data provides evidence for the use of artificial intelligence as a measure of transplant strength progression. The conjoined analysis of patient images and videos has supported proof for the ability to analyze transplant healing progression and efficacy in an objective form. Hadlock, T. A., & Urban, L. S. (2012). Toward a Universal, Automated Facial Measurement Tool in Facial Reanimation. Archives of Facial Plastic Surgery,14(4). doi:10.1001/archfacial.2012.111

Published
2021
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3. Endoscopic Browlift in Patients With Receding Hairlines

Author

Thanapoom Boonipat, Nathan Sd Hebel, Nicholas Möllhoff, Daniel Shapiro, Konstantin Frank, Jason Lin, Elizabeth W. Bradley, Sebastian Cotofana, and Samir Mardini

Subjects
medicine.medical_specialty, business.industry, Scars, Endoscopy, Long term maintenance, General Medicine, Receding hairline, eye diseases, Chin, Surgery, body regions, Cicatrix, medicine.anatomical_structure, Otorhinolaryngology, Rhytidoplasty, Forehead, Humans, Medicine, In patient, Eyebrows, medicine.symptom, business, Retrospective Studies
Abstract

Patients with receding or high hairlines have traditionally been considered unfavorable candidates for endoscopic brow lift as this can further lengthen the hairline. We analyzed outcomes in patients that underwent a novel endoscopic brow lift technique with placement of incisions and anchoring Endotine Forehead Devices (CoApt Systems Inc, Palo Alto, CA, USA) directly at the natural forehead crease lines, in an effort to minimize elevation of the hairline, whereas providing well-hidden scars. We retrospectively reviewed all patients who underwent this new Endotine and incision placement between 2016 and 2020. Preoperative and postoperative photographs of all patients were analyzed to determine the postoperative changes in brow elevation and forehead length proportion (defined as length from cranium to chin).The forehead length proportion was unchanged pre- and post-operatively, with no statistically significant differences noted (P = 0.48). The average brow position elevation ranged from 2.78 mm in the medial location to 5.05 mm in the lateral location. All patients were happy with their appearance and had improved visual fields postoperatively. The forehead scars healed well and were well hidden in forehead rhytids at long term follow-up.This novel endoscopic brow lift technique provides an option to utilize a minimally invasive approach in patients with receding hairline. With this technique, visible scars were minimized, whereas still being able to achieve reasonable brow elevation. Thus, our approach enables long term maintenance of brow elevation with inconspicuous scars in the forehead.

Published
2021
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4. 5: Correlation Of Face Transplant Smile Excursion Measurements With Emotional Evaluation By Artificial Intelligence

Author

Samir Mardini, Nathan Sd Hebel, Thanapoom Boonipat, and Jason Lin

Subjects
Correlation, medicine.medical_specialty, Face transplant, RD1-811, business.industry, medicine.medical_treatment, Excursion, PSRC 2021 Abstract Supplement, Medicine, Surgery, Audiology, business
Abstract

Purpose: Examining the outcomes and progression of face transplants has expanded to include the recent advancements in artificial intelligence. This novel methodology has allowed for the objective exploration of emotional expression. To our knowledge, this examined emotional expression has yet to be correlated to the hypothesized functioning of the allograft. We have combined the result of the AI software with a software analyzing smile excursion; demonstrating the progression of the allograft in our face transplant patient. This study helps illuminate the software possibilities for objective measures in transplant progression. Methods: Images were analyzed from our face transplant patient post-operatively at approximately 6-month intervals for four years. The still images for each time interval include both a neutral facial expression and a full-face smile with teeth. The images were taken from video clips of the patient and then analyzed using the FACEgram software (Hadlock & Urban, 2012). The measurements of the smile excursion were standardized based off of the pupil diameter and excursion was measured relative to the neutral expression of each time period. The emotional expression data was acquired using FaceReader AI software from Noldus Information Technology (Wageningen, The Netherlands). The emotional analysis was done on 2 second clips from clinical videos of the patient, the same videos used for the still images. This data was correlated with the smile excursion measurements. Results: The post-operative smile excursion analysis from 6 to 49 months demonstrated a near double in smile excursion from 3.58mm to 6.04mm. The smile excursion data has a squared correlation of 0.705; a strong upward linear trend of excursion. From 6 to 35 months, the happy emotion increased gradually from 0% to 15.8% (49-month data unavailable). Performed correlative analysis showed a positive correlation coefficient of 0.63. This moderate to strong correlation demonstrates the intuitive relationship of happy emotion and lip excursion during full face smiling. The findings also substantiate the AI software’s detection of increasing activity in the lip corner puller action unit from zero to 3/5 intensity over the same period. Conclusion: This study demonstrates the correlation of smile excursion to happy emotional expression in our face transplant patient. The correlation square of the lip excursion shows a trend of increased functioning of the allograft over time; substantiating the AI’s finding. This data provides evidence for the use of artificial intelligence as a measure of transplant strength progression. The conjoined analysis of patient images and videos has supported proof for the ability to analyze transplant healing progression and efficacy in an objective form. Hadlock, T. A., & Urban, L. S. (2012). Toward a Universal, Automated Facial Measurement Tool in Facial Reanimation. Archives of Facial Plastic Surgery,14(4). doi:10.1001/archfacial.2012.111

Published
2021

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