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Linear and area measurements on the surface contour of the face have been recorded in a variety of chosen facial postures using surface laser scanning techniques on healthy volunteers. Subjects were scanned before and after active and voluntary (against resistance) movements. Quantitative measurements of changes in these lengths and areas were made by computer integration to provide an impression of the changes that accompany facial expression. Lip movements were found to be associated with dimensional changes at all facial locations tested, imposed by the action of the underlying muscles. The system has a potential value for dynamic monitoring of facial movement.

Recent events have made us question our ability to monitor the introduction and performance of a new prosthetic joint replacement. These concerns are mirrored in many other countries, even those with joint registries and other systems for detecting poorly performing implants. In the United Kingdom, as is the case in most European Union countries, we have assessment processes in place, particularly the CE (Conformité Européenne) mark, the National Joint Registry, and the Orthopaedic Data Evaluation Panel. It is important to realize that these organizations can only react to poor performance; it is not within their power as monitoring agencies to prevent a poor implant from entering the market. When an implant has been shown to perform badly, it is referred to the Medicines and Healthcare products Regulatory Agency (MHRA), which then discusses the report with the manufacturer. When it is deemed that there is unequivocal evidence of a serious problem with the implant, the MHRA issues alerts to all hospitals and practitioners. We have continuing concerns about how to assess and monitor modifications to already existing devices. Suggestions are made for improvements to this system, and the authors will welcome feedback.

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