Demographic Predictors of Surgical Intervention and Revision Pathways in Facial Reanimation

Background/Objectives: Facial paralysis is a debilitating condition managed with dy-namic (e.g., gracilis or temporalis transfer) and static (e.g., fascial sling) surgical inter-ventions. This study evaluates demographic factors associated with procedure selection and revision pathways. Methods: Using the TriNetX database, we identified patients with facial paralysis undergoing gracilis transfer, temporalis transfer, or fascial sling procedures. Demographics (sex, ethnicity, race) were compared across procedure types, and revision patterns were analyzed. Results: Dynamic procedures were more common among female patients (35.5% vs 23.8%, OR=1.76, 95% CI [1.47-2.11], p< 0.001). Non-Hispanic patients were less likely to undergo dynamic procedures than Hispanic patients (OR=0.36, 95% CI [0.26-0.50], p< 0.001), while non-White patients were more likely than White patients (OR=1.58, 95% CI [1.25-1.99], p< 0.001). Among patients un-dergoing initial static procedures, White patients were less likely to transition to dynamic revision compared to non-White patients (OR=0.134, 95% CI [0.07-0.228], p< 0.001). Gra-cilis transfer demonstrated the highest revision rate among procedures studied. Con-clusions: Demographic differences exist in both initial procedure selection and revision pathways for facial reanimation. These findings highlight potential disparities in surgical management and underscore the need to further investigate structural drivers of these differences.