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Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
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Wide Awake Facial Reconstruction: A Literature Review, Cost Analysis, and Practical Guide.

Aidan Shulkin1, Yossi Cohen1, Gabriel Bouhadana2

  • 1From the Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.

Plastic and Reconstructive Surgery. Global Open
|June 1, 2026
PubMed
Summary
This summary is machine-generated.

Wide awake facial reconstruction (WAFR) using local or regional anesthesia is a safe and effective alternative to general anesthesia (GA) for complex facial procedures. This approach significantly reduces costs and improves patient satisfaction while maintaining excellent outcomes.

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Area of Science:

  • Plastic Surgery
  • Anesthesiology
  • Health Economics

Background:

  • General anesthesia (GA) is standard for complex facial reconstruction but carries risks and high costs.
  • Wide awake facial reconstruction (WAFR) under local anesthesia (LA)/regional anesthesia (RA) offers a safer, cost-effective alternative.
  • Current literature lacks comprehensive data and established best practices for WAFR.

Purpose of the Study:

  • To review existing literature on WAFR.
  • To compare the costs of WAFR versus GA for forehead flap reconstruction.
  • To develop a guide for optimizing patient comfort during WAFR.

Main Methods:

  • A systematic literature review identified 30 studies involving 1249 patients.
  • Forehead flap reconstruction costs under LA/RA were compared to GA.
  • Patient comfort strategies were analyzed.

Main Results:

  • WAFR was performed on 1262 flaps, with forehead and nasolabial flaps being most common.
  • Complications were infrequent (minor 10.0%, major 2.7%).
  • WAFR significantly reduced costs ($1280.03 vs $6646.74) and patients reported minimal pain and high satisfaction.

Conclusions:

  • WAFR is a safe, well-tolerated, and effective option for facial reconstruction, including advanced loco-regional flaps.
  • This technique enhances access to revision surgery, improving outcomes.
  • Avoiding GA substantially lowers healthcare expenses, making WAFR a highly advantageous approach.