{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:51:42Z","timestamp":1787752302390,"version":"build-2784847793"},"reference-count":22,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Facial Plastic Surgery & Aesthetic Medicine"],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"\n Introduction:<\/jats:title>\n Depressor anguli oris (DAO) myectomy improves smile symmetry and emotions conveyed with a smile in synkinesis patients. However, no long-term follow-up studies have been reported.<\/jats:p>\n <\/jats:sec>\n \n Objective:<\/jats:title>\n To evaluate long-term changes in smile symmetry and emotions conveyed with smile in synkinesis patients after DAO myectomy.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Synkinesis patients who underwent DAO myectomy between August 2021 and December 2023 with at least 12-months of follow-up were retrospectively reviewed. Patient-reported, clinician-graded, and objective outcomes were compared.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Fifty patients (84% female, median age 45.00 years old [16\u201379], median follow-up 21.57 months [12.10\u201337.10]) were included. Patients reported improved quality of life and smile symmetry on the facial clinimetric survey (\n p<\/jats:italic>\n < 0.001). Blinded electronic facial paralysis assessments revealed improved oral commissure excursion with smile (\n p<\/jats:italic>\n = 0.01). Emotrics+ analysis revealed improved upper lip (\n p<\/jats:italic>\n = 0.014), oral commissure (\n p<\/jats:italic>\n < 0.001), and dental display (\n p<\/jats:italic>\n < 0.001) symmetry with smile. FaceReader analysis demonstrated patients conveyed 13% more happiness with smile after surgery (\n p<\/jats:italic>\n < 0.001) and fewer negative emotions (\n p<\/jats:italic>\n = 0.05). While further improvements were seen after 3 months, these changes were not statistically significant.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n DAO myectomy likely results in long-term improvements in smile symmetry and happiness conveyed with smile in synkinesis patients. Postoperative outcomes at 3 months appear to be predictive of long-term results.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/26893614251361782","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T17:58:29Z","timestamp":1759255109000},"page":"416-422","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Changes in Smile Symmetry and Perceived Emotions in Patients with Facial Synkinesis after Depressor Anguli Oris Myectomy: A Long-Term Follow-up Study"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0914-9632","authenticated-orcid":false,"given":"Tyler M.","family":"Rist","sequence":"first","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology\u2014Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi R.","family":"Van Horn Lerner","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel P.","family":"O\u2019Rourke","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia E.","family":"Drake","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology\u2014Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2470-3897","authenticated-orcid":false,"given":"Matthew Q.","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology\u2014Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, 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