Abstract
OBJECTIVE: To evaluate subjective and objective submental/neck aesthetic outcomes after hyoid myotomy and suspension (HMS) performed for obstructive sleep apnea (OSA). METHODS: Single-blind, single-center, prospective cohort study including 20 adults undergoing HMS (active) and 11 adults undergoing septoplasty (control) between July 2020 and November 2022. Participants completed FACE-Q Neck and Area Under Chin modules and underwent standardized frontal and lateral photography preoperatively and 6 weeks postoperatively. Primary outcomes were change in cervicomental angle (CMA), hyomental distance (HMD), Rainbow Scale (RS), and FACE-Q scores; frontal neck width was a secondary outcome. Between-group differences in change were assessed using ANCOVA adjusting for age and baseline values. RESULTS: HMS participants were older than controls (median 67 [IQR 54-74] vs. 47 [35-56] years; p = 0.021). In adjusted analyses, HMS demonstrated greater improvement than controls in FACE-Q Area Under Chin (adjusted mean difference + 17.48; 95% CI, 2.2 to 32.8; p = 0.022), FACE-Q Neck (+14.60; 95% CI, 2.1 to 27.2; p = 0.025), and CMA (-10.17°; 95% CI, -19.4 to -1.0; p = 0.026). Differences were not significant for RS (-0.36; p = 0.311), HMD (-0.69 cm; p = 0.095), or neck width (-0.20 cm; p = 0.547). CONCLUSION: In this feasibility cohort with 6-week follow-up, HMS for OSA was associated with improved patient-reported aesthetic satisfaction and a greater reduction in CMA compared with septoplasty controls. Larger studies with longer follow-up are needed to assess durability and longer-term outcomes. LEVEL OF EVIDENCE: 3.