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The Journal of Craniofacial Surgery Nov 2017In rhinoplasty patients radix position profoundly impacts the appearance of the nasal profile by influencing dorsal length, contour, angulation, and height. The authors...
In rhinoplasty patients radix position profoundly impacts the appearance of the nasal profile by influencing dorsal length, contour, angulation, and height. The authors wanted to introduce a new perspective to radix, and decided to focus on subcutaneous tissues, especially procerus muscle. Actually resection of procerus and corrugator supercilii is a part of browlift and endoscopic facelift techniques, with which the authors are already familiar.In this short report and video, the authors wanted to present a new technique to lower radix area. This technique is based on face anatomy, and muscles under radix area, and takes its roots from facelift techniques. Before introducing the authors' technique the authors wanted to show the effect of soft tissues on radix with lateral nasal x-rays. With this maneuver the soft tissue thickness of radix area is thinned.
Topics: Facial Muscles; Humans; Nose; Rhinoplasty
PubMed: 28953161
DOI: 10.1097/SCS.0000000000004015 -
Journal of Cosmetic Dermatology Sep 2020The globally devastating effects of COVID-19 breach not only the realm of public health, but of psychosocial interaction and communication as well, particularly with the... (Review)
Review
BACKGROUND
The globally devastating effects of COVID-19 breach not only the realm of public health, but of psychosocial interaction and communication as well, particularly with the advent of mask-wearing.
METHODS
A review of the literature and understanding of facial anatomy and expressions as well as the effect of botulinum toxin on emotions and nonverbal communication.
RESULTS
Today, the mask has become a semi-permanent accessory to the face, blocking our ability to express and perceive each other's facial expressions by dividing it into a visible top half and invisible bottom half. This significantly restricts our ability to accurately interpret emotions based on facial expressions and strengthens our perceptions of negative emotions produced by frowning. The addition of botulinum toxin (BTX)-induced facial muscle paralysis to target the muscles of the top (visible) half of the face, especially the corrugator and procerus muscles, may act as a therapeutic solution by its suppression of glabellar lines and our ability to frown. The treatment of the glabella complex not only has been shown to inhibit the negative emotions of the treated individual but also can reduce the negative emotions in those who come in contact with the treated individual.
CONCLUSIONS
Mask-wearing in the wake of COVID-19 brings new challenges to our ability to communicate and perceive emotion through full facial expression, our most effective and universally shared form of communication, and BTX may offer a positive solution to decrease negative emotions and promote well-being for both the mask-wearer and all who come in contact with that individual.
Topics: Botulinum Toxins; COVID-19; Emotions; Facial Expression; Facial Muscles; Forehead; Humans; Masks; Nonverbal Communication; SARS-CoV-2
PubMed: 32592268
DOI: 10.1111/jocd.13569 -
Aesthetic Plastic Surgery Dec 2016The purpose of this study is to establish a relationship between the skin lines on the upper third of the face in cadavers, which represent the muscle activity in life... (Review)
Review
Anatomy of Forehead, Glabellar, Nasal and Orbital Muscles, and Their Correlation with Distinctive Patterns of Skin Lines on the Upper Third of the Face: Reviewing Concepts.
BACKGROUND
The purpose of this study is to establish a relationship between the skin lines on the upper third of the face in cadavers, which represent the muscle activity in life and the skin lines achieved by voluntary contraction of the forehead, glabellar, and orbital muscles in patients.
METHODS
Anatomical dissection of fresh cadavers was performed in 20 fresh cadavers, 11 females and 9 males, with ages ranging from 53 to 77 years. Subcutaneous dissection identified the muscle shape and the continuity of the fibers of the eyebrow elevator and depress muscles. Subgaleal dissection identified the cutaneous insertions of the muscles. They were correlated with skin lines on the upper third of the face of the cadavers that represent the muscle activity in life. Voluntary contraction was performed by 20 voluntary patients, 13 females and 7 males, with ages ranging from 35 to 62 years. Distinct patterns of skin lines on the forehead, glabellar and orbital areas, and eyebrow displacement were identified.
RESULTS
The frontalis exhibited four anatomical shapes with four different patterns of horizontal parallel lines on the forehead skin. The corrugator supercilii showed three shapes of muscles creating six patterns of vertical glabellar lines, three symmetrical and three asymmetrical. The orbicularis oculi and procerus had single patterns. The skin lines exhibited in voluntary contraction of the upper third of the face in patients showed the same patterns of the skin lines achieved in cadavers.
CONCLUSIONS
Skin lines in cadavers, which are the expression of the muscle activity in life, were similar to those achieved in the voluntary contraction of patients, allowing us to assert that the muscle patterns of patients were similar to those identified in cadavers.
NO LEVEL ASSIGNED
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
Topics: Aged; Cadaver; Dissection; Facial Muscles; Female; Forehead; Humans; Male; Middle Aged; Oculomotor Muscles; Rhytidoplasty; Sensitivity and Specificity
PubMed: 27743084
DOI: 10.1007/s00266-016-0712-z -
Aesthetic Surgery Journal Nov 2023Precise injection technique is vital for avoiding suboptimal eyebrow position when treating glabellar lines with botulinum toxin type A.
BACKGROUND
Precise injection technique is vital for avoiding suboptimal eyebrow position when treating glabellar lines with botulinum toxin type A.
OBJECTIVES
The aim of this study was to evaluate the impact of glabellar injection technique on eyebrow position in patients treated with DaxibotulinumtoxinA for Injection (DAXI).
METHODS
This retrospective post hoc analysis involved 60 adults who received a single treatment with DAXI 40 U to the glabella and had standardized facial photography. Median vertical and horizontal displacement of the brows (at rest) at baseline and 2 weeks after glabellar injection were measured. Brow position outcomes were evaluated by an oculoplastic surgeon and expert anatomist. Investigators were interviewed to ascertain individual injection techniques.
RESULTS
Precise injection location and depth, and median resting brow position following treatment varied between investigators. Positive brow outcomes were achieved with deep DAXI injections into the medial corrugator, superficial lateral corrugator injections placed between the midpupil and lateral limbus, and deep midline procerus injections. Glabellar injection technique that more precisely targeted the corrugator muscles resulted in longer glabellar line treatment duration compared to a less targeted technique. Medial corrugator injections above the medial brow; lateral corrugator injections administered deeply or more medially, toward the medial third of the brow; and procerus injections superior to the inferomedial brow tended to be associated with suboptimal outcomes that were more apparent during dynamic expression.
CONCLUSIONS
Aesthetically pleasing brow outcomes and greater duration of efficacy can be achieved with an injection pattern that precisely treats the anatomic location of the corrugator supercilii and procerus muscles, avoiding the frontalis.
Topics: Adult; Humans; Botulinum Toxins, Type A; Retrospective Studies; Skin Aging; Injections; Rhytidoplasty; Forehead; Neuromuscular Agents
PubMed: 36322141
DOI: 10.1093/asj/sjac002 -
Aesthetic Plastic Surgery Feb 2022
Invited Discussion on: Can Procerus Transection Alter the Radix Morphology and Influence the Nasal Length? A Study of Photogrammetric Assessments and Anthropometric Measurements on Asian Patients.
Topics: Facial Muscles; Humans; Nose; Photogrammetry
PubMed: 34580761
DOI: 10.1007/s00266-021-02495-x -
Aesthetic Plastic Surgery Apr 2017The senior author introduced the transpalpebral approach for the first time during the ASPS meeting in 1993. He has made some refinements in the technique and has...
The senior author introduced the transpalpebral approach for the first time during the ASPS meeting in 1993. He has made some refinements in the technique and has developed newer indications for this procedure. These refinements, indications and the related new video are the subject of this report. The modifications in the technique are as follows: After elevation of the skin and the orbicularis muscle and dissection under the muscle, a thin layer of the depressor supercilii muscle overlying the darker and more friable corrugator supercilii muscle is removed. A fairly constant branch of the supraorbital nerve piercing this muscle medially is first identified on the surface and followed deep in the muscle using a mosquito hemostat. The muscle is then lifted, and then, the same nerve branch is identified above the periosteum. The segment of the muscle lateral to this nerve is then isolated and removed by first transecting it medially and then lateral to the nerve. A cephalic segment is isolated and removed using the coagulation power of the cautery to minimize the postoperative bleeding. The rest of the muscle is then removed in a piecemeal fashion as thoroughly as possible, including a lateral segment of the procerus muscle, the end point being visualization of the subcutaneous fat. If the intention of the surgery is to treat frontal migraine headaches, the supratrochlear and supraorbital arteries are also removed. If the nerve and vessel pass through a foramen, a foraminotomy is carried out on patients with migraine headaches. Two to three cc of fat is injected in the glabellar and corrugator sites in most patients to avoid any depression and to restore the lost glabellar volume. Beyond patients with male pattern baldness, those with a long forehead and those with overactive frown muscles but optimal eyebrow positions, this technique is now being used for those with proptosis, exophthalmos and those with eyelid ptosis who would not undergo ptosis correction to prevent elevation of the eyebrows, which exaggerates the proptosis or makes the eyelid ptosis more discernible. Additionally, a common indication for this surgery is in patients with frontal migraine headaches. This report highlights the refinements in the transpalpebral corrugator resection that have been implemented over the last 25 years and offers additional indications for its utilization. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Blepharoplasty; Blepharoptosis; Cosmetic Techniques; Dissection; Eyelids; Facial Muscles; Forehead; Humans
PubMed: 28233129
DOI: 10.1007/s00266-017-0780-8 -
The British Journal of Dermatology Sep 2014The skin of the nasal dorsum and bridge is more forgiving in terms of reconstructive options. Individual differences in skin laxity, nasal length and sebaceous...
The skin of the nasal dorsum and bridge is more forgiving in terms of reconstructive options. Individual differences in skin laxity, nasal length and sebaceous composition impact on reconstructive choice as do the size, depth and exact location of the surgical defect. For many, if not all, defects in this area there are multiple different reconstructive options available all of which can result in equivalent and excellent results. Oftentimes there is no clear advantage of one repair over another and the choice becomes one of personal preference based on experience. No proscriptive approach or algorithm can be usefully applied in this setting. Key considerations include the location of the defect (distal vs. proximal nasal dorsum), the position of the defect (midline or off-centre) and the texture of the skin involved (sebaceous vs. non-sebaceous). Defects may be considered complex if they border on, or cross onto adjacent cosmetic units. Examples include defects extending onto the nasal tip, tip-ala junction, sidewall, nasal root-glabella and medial canthus. The adjacent reservoirs of tissue redundancy that can be utilized in flap reconstruction include the nasal sidewall, the nasal dorsum itself, the glabella, the midline/paramedian forehead and the medial cheek. Nearly all flaps on the nasal dorsum require subnasalis muscle dissection to effect sufficient movement and to ensure adequate flap vascularity and viability. The nasal bridge and glabella have much thicker skin and it is usually sufficient to dissect in the subcutaneous plane rather than disrupting the deeper procerus and corrugator muscles. Thick sebaceous skin is generally stiffer, moves less easily and closures may result in greater wound tension. These factors together with a tendency for sutures to tear through easily potentially increases the risk of complications. Greater consideration should be given to the exact type of flap or graft chosen in these patients.
Topics: Humans; Nose; Nose Diseases; Rhinoplasty; Surgical Flaps
PubMed: 25124308
DOI: 10.1111/bjd.13238 -
The Journal of Craniofacial Surgery May 2015Recent insights into the pathogenesis of migraine headache substantiate a neuronal hyperexcitability and inflammation involving compressed peripheral craniofacial...
Recent insights into the pathogenesis of migraine headache substantiate a neuronal hyperexcitability and inflammation involving compressed peripheral craniofacial nerves, and these trigger points can be eliminated by surgery. The aim of this study was to describe a modified, innovative, minimally invasive endoscopic technique to perform selective myotomies of corrugator supercilii, depressor supercilii, and procerus muscles, which turned out to be an effective therapy for migraine and tension-type headaches. Forty-three patients (18-75 years) who experienced 15 or more frontal migraine headaches without aura, tension-type headaches, or new daily persistent headaches each month were enrolled in the study between 2011 and 2013. Of 43 patients, 15 were followed for 2 years. Fourteen patients (93.3%) reported a positive response to the surgery: 5 (33.3%) observed complete elimination, 9 (60%) experienced significant improvement (at least 50% reduction in intensity or frequency), and 1 patient (6.6%) did not notice any change in their headaches. A statistically significant difference was found between our protocol compared with currently performed, more invasive technique (odds ratio, 1.9; 95% confidence interval, 1.151-3.13). According to our data, the modified endoscopic procedure leads to better results, compared to previous techniques, together with eliminating the need for general anesthesia, reducing the invasiveness of the procedure and the number of postoperative scars.
Topics: Adolescent; Adult; Aged; Endoscopy; Facial Muscles; Female; Headache Disorders; Humans; Male; Middle Aged; Rhytidoplasty; Young Adult
PubMed: 25887206
DOI: 10.1097/SCS.0000000000001353 -
Aesthetic Plastic Surgery Feb 2019Synkinesis is a recognized complication following peripheral facial nerve paralysis. Different types of synkinesis have been described, with oral-ocular and ocular-oral...
BACKGROUND
Synkinesis is a recognized complication following peripheral facial nerve paralysis. Different types of synkinesis have been described, with oral-ocular and ocular-oral synkinesis being the most common. Ocular-nasal synkinesis has been reported in two patients following cosmetic rhinoplasty. However, synkinesis between the orbicularis oculi and procerus muscles has not been reported by now.
METHODS
This is an interventional case report.
RESULTS
Two women, aged 42 and 37 years, presented with unilateral contraction of the medial eyebrow muscles (procerus) with spontaneous or voluntary blinking, 4 and 5 months after cosmetic rhinoplasty, respectively. Both were successfully treated with injection of botulinum toxin A.
CONCLUSIONS
Surgical trauma is inevitable during every procedure, including rhinoplasty, and may damage the fine structures including branches of the facial nerve innervating the muscles. Gentle tissue handling may minimize iatrogenic injury to the fine motor branches of the facial nerve and prevent subsequent aberrant innervation and synkinesis. Botulinum toxin A injection can effectively, yet temporarily, resolve the unintentional contractions and provide significant patient comfort.
LEVEL OF EVIDENCE V
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266 .
Topics: Adult; Botulinum Toxins, Type A; Eyelids; Facial Muscles; Female; Humans; Injections, Intralesional; Postoperative Complications; Prognosis; Rare Diseases; Recovery of Function; Rhinoplasty; Risk Assessment; Sampling Studies; Synkinesis; Treatment Outcome
PubMed: 30327854
DOI: 10.1007/s00266-018-1255-2 -
Annals of Plastic Surgery Jan 2020Full myectomy is recommended for benign essential blepharospasm (BEB) refractory to botulinum toxin (BT) treatment, but long-term swelling, scar contracture, hollow...
BACKGROUND
Full myectomy is recommended for benign essential blepharospasm (BEB) refractory to botulinum toxin (BT) treatment, but long-term swelling, scar contracture, hollow appearance, and unnatural contour of the eyelids are common postoperative complications. We present myotomy in situ to minimize these adverse outcomes.
METHODS
The redundant eyelid skin with its underlying muscle is resected first, and myotomy in situ is performed by completely cutting the residual orbicularis oculi muscles into multiple cubes and down to the subcutaneous layer, and then cutting the procerus and corrugator muscles down to the periosteum. Patient demographics, medical treatment history, BT injection history, blepharoptosis correction techniques, associated surgical procedures, and aesthetic outcomes were analyzed. Preoperative and postoperative BT injection dosage and frequency, as well as modified disability scores, were compared using paired Student t tests.
RESULTS
Twenty-five patients underwent this technique. Their average ± SD age was 64.4 ± 8.9 years, with average postoperative follow-up occurring 17.0 ± 8.0 months. Associated diseases included blepharoptosis (88%) and apraxia of lid opening (44%). There were no postoperative hematoma, seroma, scar contracture, and depressed hollow eyelid contours. Preoperative to postoperative assessments revealed improvements in mean BT injection interval (10.4 ± 2.1 to 14.6 ± 2.9 weeks, P < 0.001), BT injection dosage (44.4 ± 13.3 to 28.1 ± 6.7 units, P < 0.001), and modified disability score (15.3 ± 3.0 to 2.8 ± 2.2, P < 0.001). All patients were highly satisfied with functional and aesthetic surgical outcomes (4.5 ± 0.6 on Likert scale).
CONCLUSIONS
Myotomy in situ is effective for patients with BEB who are refractory to BT treatment, with therapeutic benefits similar to that of full myectomy with the ability to maintain favorable cosmetic results. Relative high incidence of blepharoptosis and apraxia of lid opening in patients with refractory BEB was reported. Simultaneous correction of the ptosis can further optimize outcomes.
Topics: Aged; Blepharoptosis; Blepharospasm; Botulinum Toxins; Humans; Middle Aged; Myotomy; Oculomotor Muscles; Ophthalmologic Surgical Procedures
PubMed: 31833891
DOI: 10.1097/SAP.0000000000002182