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Journal of Cosmetic Dermatology Jun 2021Current injection algorithms for treating the glabella rely on a five- or seven-point injection technique with possible medial eyebrow ptosis and lateral eyebrow...
BACKGROUND
Current injection algorithms for treating the glabella rely on a five- or seven-point injection technique with possible medial eyebrow ptosis and lateral eyebrow elevation as undesirable outcomes.
OBJECTIVE
The objective of this study was to investigate the efficacy and safety profile of a refined 3-point injection technique targeting horizontal and vertical glabellar lines.
METHODS
A total of n=105 patients (27 males and 78 females) with a mean age of 40.90 ± 9.2 years were investigated. The injection technique relied on targeting the muscular origin of the procerus and the corrugator supercilii muscles exclusively. The time of effect onset and the injection-related outcome 120 days after the treatment was evaluated using the 5-point glabellar line severity scale.
RESULTS
The onset of the neuromodulator effect was on average 3.5 ± 1.5 days. There was no statistically significant difference in the amplitude of movement before or 14 days after the treatment with 2.99 ± 4.4 mm vs. 3.39 ± 3.6 mm (p = 0.149) for the medial head of the eyebrow and with 3.18 ± 4.7 mm vs. 3.33 ± 4.3 mm (p = 0.510) for the lateral head of the eyebrow, respectively.
CONCLUSION
Incorporating anatomic concepts into clinical practice for glabellar frown line neuromodulator treatments with the investigated 3-point injection technique resulted in the absence of adverse events like eyebrow ptosis, upper eyelid ptosis, medial eyebrow ptosis, and lateral frontalis hyperactivity. This technique demonstrated efficacy throughout the 4-month study period.
Topics: Adult; Eyebrows; Face; Facial Muscles; Female; Forehead; Humans; Male; Middle Aged; Neurotransmitter Agents
PubMed: 33817912
DOI: 10.1111/jocd.14133 -
Annales de Chirurgie Plastique Et... Oct 2017The goal of this article is to provide a systemic approach to forehead rejuvenation. Fillers, botulinic toxin injections, transpalpebral, endoscopic or bicoronal brow...
The goal of this article is to provide a systemic approach to forehead rejuvenation. Fillers, botulinic toxin injections, transpalpebral, endoscopic or bicoronal brow lift must be usual techniques for every plastic surgeon in overall facial rejuvenation. Achieving a long lasting and aesthetically pleasing forehead is possible only with surgical techniques when aging is obvious.
Topics: Adult; Aged; Aging; Botulinum Toxins; Cosmetic Techniques; Dermal Fillers; Forehead; Humans; Middle Aged; Rejuvenation; Rhytidoplasty
PubMed: 28943215
DOI: 10.1016/j.anplas.2017.07.016 -
Journal of Plastic, Reconstructive &... Sep 2022The primary goal of blepharoplasty for blepharoptosis and blepharochalasis is to elevate the upper eyelid to restore a full field of vision, although many surgeons also...
INTRODUCTION
The primary goal of blepharoplasty for blepharoptosis and blepharochalasis is to elevate the upper eyelid to restore a full field of vision, although many surgeons also aim to provide a better aesthetic outcome. Several facial configuration changes may occur following blepharoplasty. This study examined the effectiveness of vessel clips to preoperatively predict facial configuration alterations.
METHODS
We retrospectively enrolled 93 consecutive patients who underwent blepharoplasty correction for blepharoptosis and blepharochalasis with eyebrow elevation. Frontal portrait images were taken at the initial examination without load, preoperatively with vessel clips, and without load at 6 months postoperatively for evaluations of eyebrow height, forehead wrinkle length, and procerus area wrinkle length. Subjective outcomes were also surveyed by questionnaires and interviews at 6 months post-surgically.
RESULTS
No significant differences were detected between preoperative measurements with vessel clips and recordings at 6 months postoperatively. Significant correlations were identified among the addition/reduction values for preoperative and postoperative measurements (eyebrow height and forehead wrinkle length: r=0.402, p<0.001; eyebrow height and procerus area wrinkle length: r=-0.327, p<0.01; forehead wrinkle length and procerus area wrinkle length: r=-0.488, p<0.001). Women more frequently described notable changes in wrinkles than men.
CONCLUSIONS
Postoperative facial change outcomes for blepharoplasty may be predicted using the simple but effective vessel clip test. A better understanding of surgical results can relieve patient anxiety and contribute to increased satisfaction.
Topics: Blepharoplasty; Blepharoptosis; Eyebrows; Eyelids; Female; Humans; Male; Retrospective Studies
PubMed: 35752591
DOI: 10.1016/j.bjps.2022.04.066 -
Toxins Sep 2019Botulinum neurotoxin (BoNT) injections are widely used for facial rejuvenation procedures, and the procerus muscle is a major target in cases of glabellar transverse...
Botulinum neurotoxin (BoNT) injections are widely used for facial rejuvenation procedures, and the procerus muscle is a major target in cases of glabellar transverse lines or rhytids. Although there have been many cadaveric studies of the procerus, its depth and thickness have not been investigated thoroughly. The aim of this study was to measure the depth and thickness of the procerus and identify the location of the intercanthal vein using ultrasonographic (US) imaging and the three-dimensional scanning method, which is needed to know to avoid side effects during BoNT injections. The morphology of the procerus was classified into two types based on the US images obtained at the glabella. The procerus was located deeper below the skin surface at the glabella than the sellion (3.8 ± 0.7 mm versus 2.7 ± 0.6 mm). The width of the procerus in US images increased from the sellion (10.9 ± 0.2 mm) to the glabella (14.5 ± 4.6 mm), whereas its thickness decreased (from 1.6 ± 0.6 mm to 1.1 ± 0.5 mm). The intercanthal vein was located 5.1 ± 4.0 mm superior to the sellion and 3.0 ± 0.6 mm below the skin's surface. The present findings provide anatomical knowledge as well as the reference location information for use when injecting BoNT into the procerus.
Topics: Adult; Aged; Botulinum Toxins, Type A; Cosmetic Techniques; Facial Muscles; Female; Forehead; Humans; Imaging, Three-Dimensional; Injections; Male; Nose; Skin Aging; Ultrasonography
PubMed: 31554222
DOI: 10.3390/toxins11100560 -
Headache 2023The objective is to review the technique of onabotulinumtoxinA injection treatment in the glabellar and frontal regions using the PREEMPT (Phase III REsearch Evaluating... (Review)
Review
BACKGROUND
The objective is to review the technique of onabotulinumtoxinA injection treatment in the glabellar and frontal regions using the PREEMPT (Phase III REsearch Evaluating Migraine Prophylaxis Therapy) paradigm, with review of the aesthetic issues related to the procedure. OnabotulinumtoxinA is an effective medication for the prevention of chronic migraine. The PREEMPT injection paradigm has been validated in randomized clinical trials and real-world settings. This treatment includes injections in the forehead and glabella area. In addition, for aesthetic uses, glabella onabotulinumtoxinA injections are done in similar muscles specifically the procerus, corrugator supercilii, and frontalis muscles. Often patients who have been injected with onabotulinumtoxinA for chronic migraine have concerns about their appearance and will ask if they can see an aesthetic injector to improve this. This is a difficult issue as onabotulinumtoxinA should be injected with an interval of 10-12 weeks to avoid development of antibodies against onabotulinumtoxinA, so all injections (migraine and aesthetic) should ideally be done close together; however, if an aesthetic injection is done on the same day as a PREEMPT injection, the effect of the PREEMPT injection will not yet be visible as it takes time for onabotulinumtoxinA effects to be seen. Thus, there is a risk of a potential overdose in a particular area if aesthetic injections are done without input from the PREEMPT injector.
METHODS
This is a narrative review supported by photographic documentation showing the technique of onabotulinumtoxinA injection of the upper face, considering anatomical differences between patients, and combining the needs in neurology and aesthetic medicine fields.
RESULTS
Practitioners treating chronic migraine often modify some of the principles of the PREEMPT paradigm. Many practitioners are unsure about injections in the glabellar and frontal areas. The authors present a technique for using the PREEMPT protocol and adapting this to the individual patient's anatomy to prevent an unsightly appearance or ptosis. In addition, sites are provided where an aesthetic injector could inject to improve the patient's appearance without overlapping with the PREEMPT injection sites.
CONCLUSION
Adherence to the PREEMPT injection protocol provides an evidence-based approach to achieving clinical benefit for patients with chronic migraine. Aesthetic elements of the treatment of the glabella and forehead require additional attention. The authors provide practical considerations and recommendations regarding this.
Topics: Humans; Botulinum Toxins, Type A; Muscle, Skeletal; Facial Muscles; Migraine Disorders; Chronic Disease; Treatment Outcome
PubMed: 37366143
DOI: 10.1111/head.14588 -
Toxins May 2022Botulinum neurotoxin injection surrounding the nose area is frequently used in aesthetic settings. However, there is a shortage of thorough anatomical understanding that... (Review)
Review
Botulinum neurotoxin injection surrounding the nose area is frequently used in aesthetic settings. However, there is a shortage of thorough anatomical understanding that makes it difficult to treat wrinkles in the nose area. In this study, the anatomical aspects concerning the injection of botulinum neurotoxin into the nasalis, procerus, and levator labii superioris alaeque muscles are assessed. In addition, the present knowledge on localizing the botulinum neurotoxin injection point from a newer anatomy study is assessed. It was observed that, for the line-associated muscles in the nose region, the injection point may be more precisely defined. The optimal injection sites are the nasalis, procerus, and levator labii superioris alaeque muscles, and the injection technique is advised. We advise the best possible injection sites in association with anatomical standards for commonly injected muscles to increase efficiency in the nose region by removing the wrinkles. Similarly, these suggestions support a more precise procedure.
Topics: Botulinum Toxins; Facial Muscles; Injections; Nose; Skin Aging
PubMed: 35622589
DOI: 10.3390/toxins14050342 -
Journal of Cosmetic Dermatology Apr 2022When applying botulinum toxin in the upper third of the face, it is important to consider the balance between the elevator and depressor muscles of the eyebrows.... (Review)
Review
INTRODUCTION
When applying botulinum toxin in the upper third of the face, it is important to consider the balance between the elevator and depressor muscles of the eyebrows. Depressor supercilii muscle block leads to elevation of the medial portion of the eyebrow and correction of the oblique lines in the frown.
OBJECTIVES
The intention is to highlight the importance of the depressor supercilii muscle block as a useful tool to reposition the medial portion of the eyebrow.
PATIENTS AND METHODS
Three cases are presented, in whom botulinum toxin is applied conventionally and subsequently on the depressor supercilii muscle after the subjective sensation of flattening of the glabella and increasing distance between the eyebrows referred by the patients.
RESULTS
The application of botulinum toxin type A on the depressor supercilii muscle is an effective measure to facilitate the elevation of the medial portion of the eyebrow, after the conventional application in between the eyebrows treating the orbicularis, corrugator, and procerus muscles.
CONCLUSIONS
Depressor supercilii muscle block can be considered when applying botulinum toxin type A in the upper third of the face, in cases where there is loss of facial aesthetic harmony. This is given by the subjective perspective of the patient due to a change in the natural expression of their face with a sensation of flattening of the glabella and distancing of the medial portion of the eyebrows, occurring after the use of a conventional technique at that anatomical level, where patients may report a "feline" or "avatar" appearance.
Topics: Botulinum Toxins, Type A; Esthetics; Eyebrows; Facial Muscles; Forehead; Humans
PubMed: 35175677
DOI: 10.1111/jocd.14856