Facial Palsy: Techniques for Reanimation of the Paralyzed Face

Description

This book offers a comprehensive overview of the surgical techniques available in reconstruction of the paralyzed face. It is divided into six parts. The first part introduces the topic of facial palsy, and the following parts provide detailed information on facial nerve reconstruction techniques, management of eye closure and smile reanimation. The book highlights symmetrization techniques and synkinesis and presents innovations and new frontiers in facial palsy.Written by an international group of experts who are committed to maintaining high standards and service in treating this condition and improving outcomes, it is a valuable source of information for clinicians and practitioners in plastic and reconstructive surgery, neurosurgeons and oral-and-maxillofacial surgeons, but also useful for researchers in this field. Preface Contents About the Editors Part I: Facial Paralysis 1: Facial Paralysis: Etiology, Diagnosis, and Medical Treatment 1.1 The Facial Nerve 1.2 Facial Nerve Pathways 1.3 Terminology and Grading of Facial Palsy 1.4 Evaluation of Peripheral Facial Palsy 1.5 Causes of Peripheral Facial Palsy 1.6 Differential Diagnosis of Peripheral Facial Palsy 1.7 Bell’s Palsy 1.8 Acquired Peripheral Facial Palsy in Children 1.9 Herpes Zoster Oticus or Ramsay Hunt syndrome 1.10 Lyme Disease (Neuroborreliosis) 1.11 Sarcoidosis 1.12 Guillain–Barré Syndrome 1.13 Melkersson–Rosenthal Syndrome 1.14 Ear Infection 1.15 Intratemporal Facial Nerve Trauma 1.16 Extratemporal Facial Nerve Trauma 1.17 Iatrogenic Facial Nerve Trauma 1.18 Tumor 1.19 Peripheral Facial Palsy in Newborn, Congenital Facial Palsy References 2: A Multi-modal Approach to Outcome Tracking in Facial Palsy 2.1 Introduction 2.2 Patient-Reported Outcome Measures 2.3 Clinician Grading Scoring Systems 2.4 Objective Assessment Systems 2.5 Emerging Systems 2.6 Conclusion References 3: Documentation and Imaging in Facial Palsy 3.1 Documentation in Facial Palsy 3.1.1 Overview 3.1.2 Patient Assessment 3.2 Imaging in Facial Palsy Overview 3.2.1 Composition and Positioning 3.2.2 Post-paralytic Facial Synkinesis (PPFS) 3.3 Conclusion References 4: Pre- and Post-op Rehabilitation in Facial Palsy Patients 4.1 Facial Nerve Grading Instruments 4.2 House–Brackmann Score 4.3 Sunnybrook Score 4.4 Chuang’s Smile Excursion Score 4.5 Exercise Therapy 4.6 Electromyography-Biofeedback (EMG-Biofeedback) 4.7 Electrical Stimulation 4.8 Massage 4.9 Manual Lymphatic Drainage 4.10 Botulinum Toxin 4.11 Postoperative Facial Rehabilitation 4.11.1 Rehabilitation After Temporalis and Masseter Muscle Transposition 4.11.2 Rehabilitation After Labbé Technique 4.11.3 Rehabilitation After Nerve Transfers and Cross-Facial Nerve Grafting 4.11.4 Rehabilitation After Free Gracilis Muscle Transfer for Reconstruction of the Smile in Irreversible Facial Palsy References 5: Electrophysiology in Facial Paralysis 5.1 Nerve Conduction Studies (NCS) 5.1.1 Recording 5.1.2 Parameter 5.2 Electromyography (EMG) 5.3 Blink Reflex Studies 5.4 Magnetic Stimulation 5.5 Outcome Indicators References Part II: Facial Nerve Reconstruction 6: Principles of Facial Nerve Reconstruction 6.1 Introduction 6.2 Types of Facial Nerve Injuries 6.3 Methods of Facial Nerve Reconstruction 6.4 The Distal Target in Facial Nerve Reconstruction: Innervation of Mimetic Muscles 6.5 Timing of Facial Nerve Reconstruction 6.5.1 Timing or Nerve Reconstruction in Open Facial Nerve Injuries with Facial Nerve Deficits or Oncological Resections Including the Facial Nerve 6.5.2 Timing for Nerve Reconstruction in Acquired Facial Paralysis with Unknown Facial Nerve Status 6.6 Classification of Levels of Facial Nerve Injuries in Relation to Facial Reconstruction Method 6.6.1 Level 1: Central Nerve System or Intratemporal Nerve Injuries with Not Available Facial Nerve Stump 6.6.2 Clinical Example 6.6.3 Level 2: Intratemporal and Extratemporal Intraparotid Nerve Injuries with Available Facial Nerve Stump 6.6.4 Clinical Example 6.6.5 Level 3: Extratemporal Extraparotid or Distal Nerve Injuries 6.6.6 Clinical Example References 7: Anatomy of the Facial Nerve 7.1 Cranial Nerve (CN)7 7.1.1 Targets of CN7 7.2 Facial Nerve: Motoric Portion of CN7 7.2.1 Intracerebral Segment 7.2.2 Intracranial Segment 7.2.3 Extracranial Segment 7.2.4 Parotid Plexus 7.2.5 Innervation of Facial Muscles References 8: Nerve Transfers to the Facial Nerve 8.1 Background 8.2 Patient Presentation 8.3 Nerve Transfers: Goals, Indications, and Rationale 8.3.1 Goals 8.3.2 Indications 8.3.3 Rationale 8.3.4 Advantages of Nerve Transfers 8.3.5 Disadvantages of Nerve Transfers 8.4 Masseteric to Facial Nerve Transfer 8.5 Cross-Facial Nerve Grafting 8.6 Dual Innervation 8.7 Summary References 9: Vascularized Nerve Grafts in Facial Nerve Reconstruction 9.1 Introduction 9.2 A Historical Overview 9.3 The Blood Supply of Nerves 9.4 Evidence for Vascularized Nerve Grafts 9.4.1 Blood Supply 9.4.2 Motor Versus Sensory Nerve Grafts 9.5 Clinical Applications 9.5.1 The Dilemma 9.5.2 Facial Nerve Defects in the Head and Neck Cancer Patient 9.6 Pedicled Nerve Graft Options 9.7 Vascularized Nerve Grafts and the ALT Free Flap 9.8 Clinical Example of a Chimeric Free Flap Reconstruction of Soft Tissue and Facial Nerve 9.9 Clinical Example of Vascularized Nerve Graft to the Marginal Mandibular Nerve 9.10 Conclusion References 10: Non-vascularized Nerve Grafts 10.1 Introduction 10.2 Donor Nerves 10.2.1 Sural Nerve 10.2.1.1 Surgical Technique for Sural Nerve Harvest 10.2.2 Greater Auricular Nerve 10.2.3 Motor Nerves 10.3 Ipsilateral Nerve Repair 10.4 Cross-Face Nerve Grafts 10.4.1 Timing of Surgery 10.4.2 Donor Branch Selection 10.4.3 Augmentation of Partial Function 10.4.4 Sensory Pathway Protection 10.5 Coaptation Techniques References 11: Avoiding Damage of the Facial Nerve in Parotid Surgery 11.1 Introduction 11.2 Type of Parotidectomy 11.2.1 Extracapsular Dissection 11.2.2 Superficial Parotidectomy 11.2.3 Total Parotidectomy 11.3 Pre- and Perioperative Considerations 11.3.1 Facial Nerve Monitoring 11.3.2 Surgical Microscope or Surgical Loupes for Parotidectomy? 11.3.3 Single Shot Antibiotic Treatment 11.4 Superficial Parotidectomy 11.4.1 Positioning and Skin Incision 11.4.2 SMAS Flap 11.4.3 Landmark I: Posterior Belly of the Digastric Muscle 11.4.4 Landmark II: Tragal Pointer 11.4.5 Dissection 11.4.6 Wound Closure, Dressing, and Postoperative Antibiotic Treatment 11.5 Neck Dissection and Facial Nerve 11.5.1 Level I: Boundaries 11.5.2 Risk for Damage of the Marginal Mandibular Branch 11.6 Level Ib Neck Dissection 11.6.1 Skin Incision 11.6.2 Elevation of Platysma Flaps 11.6.3 Identification of the Marginal Mandibular Branch References 12: Avoiding Facial Nerve Injury in Oral and Maxillofacial Surgery 12.1 Introduction 12.2 Retromandibular Approach to the TMJ 12.2.1 Surgical Anatomy 12.2.2 Retromandibular Anteroparotid Transmasseteric Approach 12.2.3 Retromandibular Transparotid Approach 12.3 Preauricular Approach to the TMJ 12.3.1 Surgical Anatomy 12.3.2 Subfascial Approach 12.3.3 Deep Subfascial Approach 12.4 Approaches to the TMJ and Risk for Facial Nerve Injury References Part III: Smile Reanimation in Long Standing Facial Paralysis 13: Principles of Smile Reanimation 13.1 Introduction 13.1.1 History of the Smile 13.1.2 Evolution of the Human Smile 13.1.3 Social and Cultural Aspects of the Smile 13.1.4 Types of Smile and Anatomical Variations 13.1.5 The Dimple and the Smile 13.2 Preoperative Evaluation of the Smile 13.2.1 Mouth Corner Vector for Smile Reanimation 13.2.2 Donor Nerves and Muscles in Smile Reanimation 13.3 Intraoperative Evaluation of the Smile 13.4 Postoperative Care of the Smile 13.4.1 Immediate Postoperative Care 13.4.2 Long-Term Postoperative Care References 14: One-Stage Facial Reanimation Using Masseter Nerve Free Flap 14.1 Anatomy 14.2 Diagnostics 14.3 Indications 14.4 Technique 14.5 Summary References 15: Spinal Accessory Nerve-Innervated Gracilis (XI-Gracilis) for Facial Reanimation: Chang Gung Experience 15.1 Inroduction 15.2 Materials and Methods 15.3 Anatomy Review 15.3.1 Spinal Accessory Nerve (XI) 15.4 Technique of XI-Gracilis for Facial Reanimation, One-Stage Procedure 15.4.1 Preoperative Evaluation 15.4.2 Operative Method 15.5 Postoperative Cares and Rehabilitation 15.6 Outcome Assessment 15.7 Statistical Analysis 15.8 Results 15.8.1 Denervation Time 15.8.2 Ischemic Time for Gracilis Transfer 15.8.3 Complications 15.8.4 Smile Excursion Score 15.8.5 Cortical Adaptation Stage 15.8.6 Patient Questionnaire 15.8.7 Hadlock’s SMILE Lip Excursion Scale 15.8.8 Terzis’s Functional and Aesthetic Grading System 15.9 Discussion 15.9.1 Why Is the XI-Gracilis Not Popular? 15.9.2 Sequelae by XI Transect 15.9.3 Why Patients of Postparalysis Facial Synkinesis Are Included? 15.9.4 Cortical Adaptation 15.9.5 Result Evaluation 15.9.6 Indication and Contraindication 15.10 Summary References 16: One-Stage Latissimus Dorsi Muscle Transfer for Facial Reanimation: Comparison Between Single and Dual Innervation 16.1 History of One-Stage Latissimus Dorsi Muscle Transfer 16.2 Dual-Innervation Technique 16.2.1 Emergence of the Dual-Innervation Technique 16.2.2 Surgical Technique 16.2.2.1 Preoperative Planning 16.2.2.2 Preparation of the Cheek Pocket 16.2.2.3 Harvesting the Latissimus Dorsi Muscle Segment 16.2.2.4 Transfer of the Harvested Muscle 16.2.2.5 Postoperative Course 16.3 Comparison Between the Single and Dual-Innervation Technique 16.3.1 Clinical Efficacy of the Dual-Innervation Technique 16.3.2 Single-Innervation Versus Dual-Innervation Technique 16.3.3 Donor Morbidity References 17: Two-Stage Facial Reanimation Using CFNG 17.1 Introduction 17.2 Technique 17.2.1 Stage One: Cross Face Nerve Grafting 17.2.1.1 Sural Nerve Harvest 17.2.1.2 Cross Face Nerve Grafting 17.2.2 Stage 2: Free Functional Muscle Transfer 17.2.2.1 Gracilis Harvest 17.2.2.2 Muscle Transplantation to Face 17.3 Complications 17.4 Conclusion References 18: Bilateral Facial Reanimation in Möbius Syndrome 18.1 Introduction 18.2 Preoperative Evaluation 18.3 Surgical Technique 18.4 Postoperative Period and Follow-Up 18.5 Results 18.6 Discussion 18.7 Summary References 19: Dual Innervation of Free Muscle Transfer with Masseter and CFNG 19.1 Background 19.2 Surgical Technique 19.2.1 First Stage 19.2.2 Second Stage 19.3 Postoperative Period and Follow-Up 19.4 Discussion 19.5 Summary References 20: Simultaneous Use of Static Support and Free Muscle Transfer 20.1 Introduction 20.2 Patient Presentation 20.2.1 Complete Flaccid Facial Palsy 20.2.1.1 Mid and Lower Face 20.2.1.2 Periorbital 20.2.1.3 Forehead 20.2.2 Incomplete Facial Palsy 20.2.2.1 Incomplete Weak Facial Palsy 20.2.2.2 Incomplete Synkinetic Facial Palsy 20.2.2.3 Mid and Lower Face 20.2.2.4 Periorbital 20.2.2.5 Forehead 20.3 Patient Selection 20.3.1 Duration: Subacute vs. Longstanding 20.3.2 Etiology 20.3.3 Facial Nerve Continuity 20.3.4 Patient’s Demographics: Age and Facial Features 20.3.4.1 Patient’s Wishes 20.4 Treatment Options 20.4.1 The Flaccid Complete Facial Palsy Patient 20.4.1.1 Mid and Lower Face Treatment Goals Static Support Oral Commissure, Nasolabial Fold, and Alar Support Lower Lip Dynamic Solutions Oral Commissure, Nasolabial Fold, and Alar Support Subacute Facial Paralysis Longstanding Facial Paralysis Free Functional Muscle Transplant Regional Muscle Transfer Midface 20.4.1.2 Lower Lip 20.4.1.3 Periorbital Treatment Goals Static Procedures for the Eye Upper Eyelid Lagophthalmos Lower Eyelid Ectropion Malar Soft Tissue Dynamic 20.4.1.4 Forehead Brow Lift 20.4.2 Incomplete Synkinetic Facial Palsy 20.4.2.1 Perioorbita, Midface, and Lower Face Periorbital Synkinesis Midface and Lower Face Synkinesis and Hypertonicity 20.5 Summary References 21: Temporal Muscle Transposition for Smile Reanimation of the Paralyzed Face (Modified McLaughlin-Procedure) 21.1 Introduction and Indication 21.2 Anatomic Consideration 21.3 Operative Technique of the Modified McLaughlin Temporalis Muscle Transfer: A Step-by-Step Instruction 21.4 Summary References 22: Lengthening Temporalis Myoplasty for Smile Reanimation: Labbé Technique 22.1 Introduction 22.2 Preoperative Planning 22.3 Surgical Technique 22.4 Rehabilitation 22.5 Conclusion References Part IV: The Paretic Eye 23: Clinical Care from the Perspective of the Eye Doctor 23.1 Background 23.2 Basic Assessment by the Eye Doctor 23.3 Prognosis 23.4 Ocular Therapy 23.5 Surgical Management 23.6 Summary References 24: Oculoplastic Techniques and Gold Weight Implant 24.1 Correction of Lagophthalmos 24.2 Correction of Ectropion 24.3 Conclusion References 25: Dynamic Eye Closure 25.1 Introduction 25.2 Regional Muscle Transfer 25.2.1 Temporalis Muscle Transposition 25.2.2 Frontalis Muscle Transposition 25.2.3 Orbicularis oculi Transposition 25.2.4 Free Functional Muscle Grafts 25.2.5 Free Functional Gracilis Transfer 25.2.6 Free Functional Platysma Transfer References 26: Corneal Neurotization 26.1 Definition of Corneal Neurotization 26.2 Background 26.2.1 Corneal Nerve Fibers Maintain Ocular Surface Health 26.2.2 Indications and Contraindications for Corneal Neurotization 26.2.3 History and Recent Developments in Corneal Neurotization 26.2.4 Relevant Anatomy 26.2.4.1 Potential Axon Donor Nerves 26.2.4.2 Nerve Grafts for Corneal Neurotization Sural Nerve Grafts Great Auricular Nerve Grafts Acellular Nerve Allografts 26.3 Methods and Technique 26.3.1 Pre-surgical Assessment and Planning 26.3.1.1 Past Medical History 26.3.1.2 Ophthalmic Examination 26.3.1.3 Sensory Mapping of the Donor Nerve Dermatomes 26.3.2 Surgical Technique 26.3.3 Neurotization with Nerve Transfers Alone (“Direct” Neurotization) 26.3.4 Neurotization with Nerve Transfers and Nerve Grafts (“Indirect” Neurotization) 26.3.4.1 Facial Donor Site Preparation 26.3.4.2 Sural Nerve Harvest and Nerve Graft Design 26.3.4.3 Tunneling and Corneoscleral Insertion of the Nerve Graft 26.3.4.4 Proximal Nerve Coaptation 26.3.5 Postsurgical Management and Potential Complications 26.3.6 Prognosis 26.3.6.1 Corneal Reinnervation and Recovery of Corneal Sensation 26.3.6.2 Corneal Clarity and Surface Health 26.3.6.3 Donor Site Sensory Deficit 26.3.6.4 Necessity of Adjunct Treatment Following Corneal Neurotization 26.4 Conclusion References Part V: Facial Simmetrization 27: Principles of Symmetrisation Techniques in Facial Palsy 27.1 Botulinum Toxin 27.2 Harvest of the Fascia or Tendon 27.2.1 The Forehead 27.2.2 The Periocular Complex 27.2.3 The Cheek 27.2.4 The Nose 27.2.5 The Lips 27.2.6 The Neck 27.3 Ancillary Procedures Simultaneously with Dynamic Reconstruction 27.4 Outcome of Ancillary Procedures References 28: Aesthetic Consideration and Ancillary Procedures in Facial Paralysis Reanimation 28.1 Personal Background 28.2 Introduction 28.3 Acute and Subacute Facial Paralysis 0–18 Months 28.4 Aesthetic Consideration in Chronic Facial Paralysis (>18 Months Duration) with Free Muscle Transplants 28.4.1 Incisions 28.4.2 The Dissection Plane 28.4.3 The Fixation Points 28.4.4 The Fixation Technique 28.4.5 The Pulling Vectors 28.4.6 The Muscle Tension 28.4.7 The Facial Volume 28.5 Aesthetic Considerations and Ancillary Procedures in Facial Paralysis Reanimation 28.6 Botulinum Toxin (BoNt) 28.7 Hyaluronic Acid Injection 28.8 Fat Grafting 28.9 Lip Lifting Procedures 28.10 Forehead Lifting 28.11 Blepharoplasty 28.12 Canthopexy 28.13 Midface and Face Lifting 28.14 Summary References 29: Reconstructing Facial Contour Deformities with Vascularized Flaps in Facial Reanimation Surgery 29.1 Introduction 29.2 Surgical Considerations for Simultaneous Reconstruction of Complex Facial Paralysis 29.2.1 Chimeric Flap Design Combining a Functional Muscle Segment with Vascularized Tissue for Contour Correction 29.2.2 Tissue Component for Contour Deformity Correction 29.2.3 Donor Sites 29.3 Secondary Revision References 30: Myectomies and Neurectomies in the Management of Hyperkinetic Asymmetries and Synkinesis in Facial Palsy 30.1 Introduction 30.2 Upper Zone of the Face 30.2.1 Forehead and Eyebrows 30.2.1.1 Anatomy 30.2.1.2 Evaluation 30.2.1.3 Surgical Management 30.2.2 The Eye 30.2.2.1 Anatomy 30.2.2.2 Evaluation 30.2.2.3 Surgical Management Myectomy Neuromyectomy 30.2.3 Selective Neurectomy 30.3 Lower Zone of the Face 30.3.1 Lower Lip 30.3.1.1 Anatomy 30.3.2 Evaluation 30.3.2.1 Marginal Mandibular Lip Deformity 30.3.3 Surgical Management 30.3.3.1 Myectomy of the Lower Lip Depressors Case 1. Lower Lip Myectomy (Figs. A–F) 30.3.3.2 Selective Marginal Mandibular Neurectomy 30.4 Neck 30.4.1 Anatomy 30.4.2 Evaluation 30.4.3 Surgical Management 30.4.3.1 Platysmectomy 30.4.3.2 Neurectomy of the Cervical Branch Case 2 Combined Platysmectomy and Neurectomy of the Cervical Branch (Figs. A–F) References 31: Management of Synkinesia 31.1 Facial Synkinesia 31.2 Etiology of Synkinetic Facial Movements 31.3 Postparalysis and Post-facial Reanimation Synkinesia 31.4 Types of Facial Synkinesia and Associated Symptoms 31.5 Diagnosis of Synkinetic Facial Movements 31.6 Treatment of Synkinetic Facial Movements References Part VI: Innovations and New Frontiers 32: Frontiers and Innovations in Facial Palsy 32.1 Surgical Advances 32.1.1 Top-Down State of the Art 32.1.1.1 Reanimation of the Forehead 32.1.1.2 Reanimation of the Periocular Complex 32.1.1.3 Reanimation of the Nose 32.1.1.4 Reanimation of the Lower Lip 32.2 Surgery for Synkinesis 32.3 Technical Advances 32.3.1 Multidimensional Training Models 32.3.1.1 Endoscopic Surgery 32.3.1.2 Bionic Reanimation References 33: Endoscopic-Assisted Free Muscle Flaps for Facial Reanimation 33.1 Surgical Technique 33.2 Discussion 33.3 Conclusion References 34: Free Muscle Transfer in Partial Facial Palsy 34.1 Introduction 34.2 Etiology and Epidemiology 34.3 Diagnosis and Patient Presentation 34.4 Patient Selection 34.5 Operative Techniques 34.6 Outcome and Complications 34.7 Conclusions and Future Study 34.8 Pearls and Pitfalls References 35: Gracilis Insetting Under SMAS in Smile Reanimation 35.1 Introduction 35.2 Advantage of Dynamic Rejuvenation 35.3 Vectors of Facial Symmetry in Smile Reanimation with SMAS 35.4 Operative Procedure 35.4.1 Skin Flap Elevation 35.4.2 SMAS Elevation 35.4.3 Nasolabial Fold Reset 35.4.4 Tunnelling Under SMAS 35.4.5 Gracilis Insetting 35.4.6 SMAS Fixation 35.5 One-Stage Surgery with Double Innervated FFMT References 36: Fascicular Turnover Flap for Facial Nerve Gaps and Nerve Transfer for Trigeminal Palsy 36.1 Operative Techniques 36.2 Case Reports 36.2.1 Fascicular Turnover Flap 36.2.1.1 Case 1 30y Double Fascicular Flaps from the Both Digital Nerve Stump 36.2.1.2 Case 2 65y Fascicular Turn Over Flap for Facial Nerve Gap 36.3 Cross-Face Trigeminal Nerve Transfer 36.3.1 Anatomy 36.3.2 Operative Techniques 36.4 Case Report 36.4.1 Case 3 36.4.2 Case 4 36.5 Discussion 36.5.1 Vascular System Within Peripheral Nerve and Nerve Flap Concept 36.5.2 Fascicular Plexus Within Nerve Trunk 36.5.3 Nerve Graft vs Nerve Flap 36.5.4 Advantages of Fascicular Turnover Flap 36.5.5 Trigeminal Nerve Transfer with Supermicrosurgery 36.5.6 Advantages of Trigeminal Nerve Transfer References 37: Facial Reanimation in Face Transplantation 37.1 Introduction 37.2 Goals of Facial Reanimation in Face Transplantation 37.3 Assessment of Facial Nerve Function in the Recipient and Donor 37.4 Mapping Facial Nerve Branches During Allograft Procurement 37.5 Mapping the Facial Nerve Branches in the Recipient 37.6 Principles of Motor Nerve Repair 37.6.1 Nerve Grafts to Bridge Nerve Gaps 37.6.2 Proximal Versus Distal Coaptation 37.7 Nerve Transfers and Cross-Face Nerve Grafts 37.8 Recovery of the Facial Motor Function After Face Transplantation 37.9 The Role of Immunosuppression in Facial Nerve Regeneration 37.10 Treatment of Suboptimal Recovery of Facial Motor Function 37.11 Sensory Recovery, Trigeminofacial Communication, and Their Role in Motor Function Recovery 37.12 Synkinesis in Face Transplant Patients 37.13 Physical Therapy and Rehabilitation 37.14 Reporting and Comparison of Surgical Outcomes References 38: 3D, 4D, Mobile APP, VR, AR, and MR Systems in Facial Palsy 38.1 Introduction 38.1.1 Subjective Diagnostic Tools 38.1.2 Objective Diagnostic Tools 38.1.3 Current Status 38.2 Technical Aspects 38.2.1 Structured Light 38.2.2 Stereophotogrammetry 38.2.3 Analysis of Images 38.2.3.1 Landmark-Based Approaches 38.2.3.2 Intensity-Based Approaches 38.3 Overview of 3D and 4D Surface-Imaging Software 38.3.1 3D Video Analysis 38.3.2 3dMD 38.3.3 Artec3D 38.3.4 Di4D 38.3.5 Canfield 38.3.6 Crisalix 38.3.7 Facegramm 38.3.8 FACE System 38.3.9 Kinect 38.3.10 RealSense 38.3.11 Smart Facial System 38.4 Mobile Apps 38.4.1 FACE2FACE® App 38.4.2 eFace App 38.5 Virtual, Augmented, and Mix Reality in Plastic Surgery 38.6 Telemedicine 38.7 Conclusion References Index