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Surgical and Radiologic Anatomy : SRA Nov 2016The dynamic balance of the eyebrows is maintained by the frontal muscle which acts as a brow elevator, and the brow depressors include corrugator supercilii muscle...
The dynamic balance of the eyebrows is maintained by the frontal muscle which acts as a brow elevator, and the brow depressors include corrugator supercilii muscle (CSM), procerus, depressor supercilii, and orbicularis oculi muscles. The glabellar rhytids might appear as a result of negative emotions, such as anger, anxiety, fatigue, fear, or disapproval. For youthful and calmer eyes, CSM may restore the muscle balance more safely and effectively for the treatments of forehead rejuvenation. In 50 cadaver hemibrows, CSM was dissected to investigate the location, position, muscle patterns, and its relationships to other muscles. The location of the CSM was variable; five different CSM patterns were defined. Pattern 1: rectangular-shaped classical type was observed with the frequency of 42.5 %. Also, three bellies were present in 25 %, and duplicate muscle in 12.5 %. Irregular flat (15 %) and hypoplastic types (5 %) were introduced as previously unidentified patterns. In muscle specimens, 30 % had complete symmetry, 45 % complete asymmetry, and 25 % semi-assymetry. Mean CSM thickness, length, and width were measured as 1.62 ± 0.4, 29.24 ± 6.4, and 12.62 ± 3.3 mm, respectively. The distances of the medial origo of the CSM-midline and the lateral origo of the CSM-midline were measured as 5.54 ± 4.89 and 14.62 ± 4.17 mm. The different patterns of the CSM were undefined previously. The findings manifest the necessity of botox treatment peculiar to each individual. As, insertion points have been releasing fibres to the peripheral muscles, it is an evidence of its complicated structure. The muscles in the glabella are difficult to demarcate precisely from surface anatomy due to overlapped muscles with intermingled borders, where they are attached as individual patterns. Hence, it might be disadvantageous that different patterns may lead to the risk of asymmetry of the face and brow ptosis in the postinjection period.
Topics: Anatomic Variation; Cosmetic Techniques; Eyebrows; Facial Muscles; Humans; Middle Aged
PubMed: 27021220
DOI: 10.1007/s00276-016-1666-1 -
Diseases (Basel, Switzerland) Sep 2022Facial hemiplegia happens when the seventh cranial nerve is inflamed, causing a dysfunction of the facial nerve in specific regions. This case report brings a complex...
Facial hemiplegia happens when the seventh cranial nerve is inflamed, causing a dysfunction of the facial nerve in specific regions. This case report brings a complex case of facial hemiplegia, a non-temporary lesion caused by a traumatic accident, which had a more conservative approach, treating the patient with botulinum toxin. After explanation of treatment outcomes, the patient favored treatment on a unilateral side with botulinum toxin applied locally to the muscles. It was applied on her left side, in order to change the muscles tonus and improve the esthetic. The patient adhered to immediate and short-term instructions following the procedure, including movement limitation and skin exposure avoidance. At 2 weeks, the patient returned to follow-up, and the result was checked. After around 6-month follow-up, the patient was reassessed, and a new application was done. The patient tried to contract the procerus and corrugator muscles which were treated, and periorbicular region that was corrected. After contracting the frontal muscle, a satisfactory result was also seen in the frontal area. While limited to a single case presentation, botulinum toxin may be an effective short-term tool for treatment of facial hemiplegia to establish an effective esthetic result.
PubMed: 36278566
DOI: 10.3390/diseases10040067 -
Aesthetic Plastic Surgery Apr 2016Dorsal nasal augmentation is an essential part of injection rhinoplasty on the Asian nose. Aesthetic physicians require detailed knowledge of the nasal anatomy to...
BACKGROUND
Dorsal nasal augmentation is an essential part of injection rhinoplasty on the Asian nose. Aesthetic physicians require detailed knowledge of the nasal anatomy to accurately and safely inject filler.
METHODS
One hundred and thirty-five histological cross sections were examined from 45 longitudinal strips of soft tissue harvested from the midline of the nose, beginning from the glabella to the nasal tip. Muscles and nasal cartilage were used as landmarks for vascular identification.
RESULTS
At the nasal tip, a midline longitudinal columellar artery with a diameter of 0.21 ± 0.09 mm was noted in 14 cadavers (31.1 %). At the infratip, subcutaneous tissue contained cavernous tissue similar to that of the nasal mucosa. The feeding arteries of these dilated veins formed arteriovenous shunts, into which retrograde injection of filler may be possible. All of the nasal arteries present were identified as subcutaneous arteries. They coursed mainly in the superficial layer of the subcutaneous tissues, with smaller branches forming subdermal plexuses. A substantial arterial anastomosis occurred at the supratip region, in which the artery lay in the middle of the subcutaneous tissue at the level of the major alar cartilages. These arteries had a diameter ranging between 0.4 and 0.9 mm and were found in 29 of 45 specimens (64.4 %). This was at the level midway between the rhinion above the supratip and the infratip. This anastomotic artery also crossed the midline at the rhinion superficial to the origin of the procerus on the lower end of the nasal bone. Here the arterial diameter ranged between 0.1 and 0.3 mm, which was not large enough to cause arterial emboli. Fascicular cross sections of the nasalis muscle directly covered the entire upper lateral cartilage. The subdermal tissue contained few layers of fat cells along with the occasional small artery. The procerus arose from the nasal bone and was continuous with the nasalis in 16 cadavers (35.6 %). There was fatty areolar tissue between the procerus and the periosteal layer and no significant arteries present. The procerus ascended beyond the brow to insert into the frontalis muscle with very few cutaneous insertions. The supratrochlear vessels and accompanying nerve were occasionally found on the surface of the frontalis muscle.
CONCLUSION
Most nasal arteries found in the midline are subcutaneous arteries. Filler should be injected deeply to avoid vascular injury leading to compromised perfusion at the dorsum or filler emboli at the nasal tip.
LEVEL OF EVIDENCE V
This journal requires that the 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: Asian People; Cadaver; Humans; Nose; Rhinoplasty
PubMed: 26893278
DOI: 10.1007/s00266-016-0621-1 -
The Journal of Craniofacial Surgery Sep 2018Forehead aging is characterized by wrinkles, loss of skin elasticity, brow ptosis, and soft-tissue atrophy. For patients with prominent rhytids and marked brow ptosis,...
Forehead aging is characterized by wrinkles, loss of skin elasticity, brow ptosis, and soft-tissue atrophy. For patients with prominent rhytids and marked brow ptosis, forehead lift is still the most effective treatment with a persisting result. In order to eliminate the glabellar wrinkles, forehead lift usually requires the removal of the corrugator supercilii muscle and procerus, which can lead to glabellar flattening or depression. Instead of muscle removal, the corrugator supercilii muscle, procerus, and the underlying galea were dissected as a pedicled glabellar flap. Then reversed periosteum or dermal fat graft was used to cover the glabellar flap to restore the glabellar volume. From January 2005 to November 2014, a total of 164 coronal and 42 trichophytic forehead lifts were performed. Reversed periosteum was used to cover the glabellar flap in 191 patients while dermal fat graft was applied in 15 patients with a follow-up period ranging from 6 months to 10 years. There was no irregularity or depression in the glabellar region in the group of reversed periosteal flap. The take of dermal fat graft placed over the glabellar flap was minimal. Complications from surgical procedures occurred in 2.91% of the patients. There was 1 asymmetry, 4 patients with higher than desired frontal hairline for implantation of autologous follicular units, and 1 patient with scar hyperplasia. There was no hematoma or nerve injury, no permanent numbness, and no alopecia. The techniques are simple and effective to eliminate the glabellar wrinkles and maintain or restore the glabellar volume.
Topics: China; Facial Muscles; Female; Forehead; Humans; Male; Middle Aged; Rejuvenation; Rhytidoplasty; Skin Aging; Surgical Flaps; Treatment Outcome
PubMed: 29863552
DOI: 10.1097/SCS.0000000000004620 -
Aesthetic Plastic Surgery Oct 2020Neurotoxins initially were used to treat hyperfunctional rhytids of the face, but now have been expanded to improve facial shaping, correct facial asymmetry and even...
BACKGROUND
Neurotoxins initially were used to treat hyperfunctional rhytids of the face, but now have been expanded to improve facial shaping, correct facial asymmetry and even improve skin texture and tone.
METHODS
The clinical approach to non-surgical facial rejuvenation is approached into four anatomical regions: the upper face, midface, lower face and neck.
RESULTS
The key muscles of the upper face include frontalis, orbicularis oculi, corrugator supercilii, procerus, depressor supercilii and temporalis. The muscles in the midface to be discussed include the levator labii superioris, levator labii superioris alaeque nasi, depressor anguli oris, depressor septi nasi and nasalis. Treatment of the lower face focuses on the orbicularis oris, mentalis, depressor anguli oris and masseter muscles. Finally, treatment of the neck region will be reviewed with emphasis on platysmal bands and necklace lines as well as the Nefertiti lift.
CONCLUSIONS
Non-surgical facial rejuvenation using neurotoxins should be performed safely and effectively in order to avoid and treat complications.
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: Face; Facial Muscles; Humans; Lip; Neurotoxins; Rejuvenation
PubMed: 32239250
DOI: 10.1007/s00266-020-01691-5 -
Clinical, Cosmetic and Investigational... 2021Botulinum toxin type A is an effective treatment for glabellar dynamic wrinkles. As the muscular group involved in the contraction of the glabella varies among people,...
PURPOSE
Botulinum toxin type A is an effective treatment for glabellar dynamic wrinkles. As the muscular group involved in the contraction of the glabella varies among people, individualized treatment can achieve optimal results. This study evaluates a customized assessment for the treatment of glabellar lines with Incobotulinumtoxin-A, leading to an individualized points distribution and dosage.
PATIENTS AND METHODS
A single-center, evaluator-blinded, therapeutic cohort study enrolled 130 women with moderate or severe glabellar wrinkles. They underwent Incobotulinumtoxin-A injection following the standard 5-point injection at the glabellar muscles (n = 65) or an individualized assessment and scheme treatment based on anatomical references of contraction, the One21 technique (n = 65). All the patients were photographed under maximum contraction before treatment (T0) and after 4 weeks (T28). The photos were randomly assessed by two blinded, experienced raters to consensually grade the severity according to the Merz Aesthetics Scales (MAS). The primary clinical efficacy was defined as a 2-point reduction in the MAS score, on Day 28.
RESULTS
The groups were homogeneous regarding age, phototype, and baseline MAS scores. On Day 28 (T28), 64 (98.5%) patients from the One21 group and 52 (80%) from the 5-point group reduced the MAS score by at least two points ( < 0.01). When adjusted by age and phototype, both groups reduced the MAS score at T28 ( < 0.01); nevertheless, patients from the One21 group significantly performed better ( < 0.01), with a much higher rate response rate at T28, in comparison to the 5-point group. Of patients enrolled in the 5-point group, 83.1% utilized muscle groups other than the procerus and corrugator in glabellar wrinkle formation, and 17 (24.6%) presented asymmetrical contraction. Patients from the 5-point group with glabellar asymmetry and those who utilized the frontalis and orbicularis presented inferior performance ( < 0.05), reinforcing the importance of an individualized assessment and treatment plan.
CONCLUSION
The One21 technique yielded better results than the standard 5-point treatment in reducing glabellar dynamic lines with Incobotulinumtoxin-A, especially for asymmetric lines of the glabella or the involvement of muscle groups other than the procerus and corrugator.
PubMed: 33564254
DOI: 10.2147/CCID.S281901 -
Journal of Cosmetic Dermatology Jun 2022Injection of botulinum toxin for cosmetic purposes is a well-established practice. (Randomized Controlled Trial)
Randomized Controlled Trial
Evaluation of the safety and efficacy of a biosimilar abobotulinum toxin type A in treating moderate-to-severe glabellar lines: A non-inferiority double blinded randomized controlled trial.
BACKGROUND
Injection of botulinum toxin for cosmetic purposes is a well-established practice.
OBJECTIVES
This study was conducted to compare the safety and efficacy of Dyston (investigational biosimilar abobotulinumtoxinA) with Dysport (abobotulinumtoxinA, Ipsen) in the treatment of moderate-to-severe glabellar lines.
METHODS
Out of 193 screened subjects, 126 volunteers with moderate-to-severe glabellar lines fulfilling eligibility criteria were randomized in a 1:1 ratio to receive either an intramuscular injection of 40-60 units of Dyston or Dysport . The primary objective was to test the non-inferiority of Dyston compared with Dysport as measured by the percentage of volunteers who achieved no or mild glabellar lines at maximum frown assessed by the physicians based on the Glabellar Line Severity Score (GLSS) at Day 30. Secondary endpoints included the improvement in the glabellar lines at maximum frown and rest states at Days 14, 60, 90, and 120 as well as the side effects of the treatment.
RESULTS
Response rates at maximum frown were 75.44% (43/57) in the Dyston group and 76.67% (46/60) in the Dysport group on Day 30 (p value: 0.88, 95% CI: -14.24 to 16.70, diff: 1.23) as per-protocol set, and were 75.81% (47/62) and 76.19 (48/63) (p value: 0.96, 95% CI: -14.59 to 15.35, diff: 0.3) in the Dyston and the Dysport groups, respectively, based on modified intention to treat population. Adverse events were similar in both groups and mostly mild and well-tolerated.
CONCLUSION
Treatment of moderate-to-severe glabellar lines with Dyston was effective, tolerable, and non-inferior compared with Dysport .
Topics: Biosimilar Pharmaceuticals; Botulinum Toxins, Type A; Double-Blind Method; Forehead; Humans; Neuromuscular Agents; Skin Aging; Treatment Outcome
PubMed: 35340107
DOI: 10.1111/jocd.14939 -
The Journal of Craniofacial Surgery Jun 2015This study was designed to investigate the effects of open technique rhinoplasty on facial nerve terminal branches more concerned with mimicry via electroneurography...
OBJECTIVE
This study was designed to investigate the effects of open technique rhinoplasty on facial nerve terminal branches more concerned with mimicry via electroneurography (ENoG).
METHODS
Twenty patients ages between 24 and 36 years were included in the study. Five nasal mimicry muscles were used to evaluate axonal loss of the facial nerve: bilateral transverse nasal, levator labii superioris alaeque nasi (LLSAN), and procerus muscles of all patients were evaluated preoperatively and postoperative third month by ENoG. The patients that have abnormalities regarding the amplitude and latency at third month were reevaluated at sixth month postoperatively.
RESULTS
Mean latencies of the facial nerve were calculated to be increased for all muscles at third postoperative month, but this increase was significant only for left LLSAN (P = 0.002). Amplitudes of the facial nerve decreased in all of the groups, but this decrease was not significant (P > 0.05). Two patients with exceptionally long latency facial nerve response of transverse nasal muscle and 11 muscle recordings with abnormal low amplitudes of the facial nerve at the third month was reevaluated at sixth postoperative month and the values were improved.
CONCLUSIONS
This study demonstrated that facial nerve integrity is minimally affected after rhinoplasty, yet all affected muscles were recovered on the long term.
Topics: Adult; Electromyography; Facial Expression; Facial Muscles; Facial Nerve; Female; Humans; Male; Postoperative Period; Rhinoplasty; Young Adult
PubMed: 26080192
DOI: 10.1097/SCS.0000000000001731 -
Singapore Medical Journal Oct 2017This study describes the physician experience relating to the effectiveness of incobotulinumtoxinA and patient satisfaction with its use for the treatment of glabellar... (Observational Study)
Observational Study
INTRODUCTION
This study describes the physician experience relating to the effectiveness of incobotulinumtoxinA and patient satisfaction with its use for the treatment of glabellar frown lines (GFLs).
METHODS
A total of 17 patients from six dermatological clinics, aged > 18 years and with mild to very severe GFLs at maximum frown, were included. Patients were excluded if they had treatment with resorbable fillers and botulinum toxins in the preceding six months, or non-resorbable fillers or surgery in the treatment area. Injection sites (range 3-5) were chosen depending on their severity (dose range 12-20 U), covering corrugators and procerus muscles. Physicians assessed improvements to GFLs using the Merz scale on Days 4 and 14 after treatment. Patients completed a self-reported questionnaire on their facial wrinkles on Days 2 and 4 after treatment.
RESULTS
Most (76.5%) patients were women. The mean age of the patients was 46.9 ± 10.0 years. Mean severities (on the Merz scale) for at-rest and dynamic (with expression) GFLs at baseline were 1.3 ± 1.10 and 3.4 ± 0.38, respectively, and decreased on Day 14 (p < 0.05). Treatment response rates (> 1-point improvement) for at-rest and dynamic (with expression) GFLs on Day 4 were 40% and 100%, respectively. All patients reported being satisfied or very satisfied, and 64.3%-71.4% indicated that their facial wrinkles had improved on Day 2.
CONCLUSION
IncobotulinumtoxinA was fast acting with visible improvements by Day 4 and all patients expressed satisfaction with their treatment after two days. GFLs saw the most improvement among the facial characteristics measured.
Topics: Adult; Botulinum Toxins, Type A; Dermatology; Facial Expression; Female; Forehead; Humans; Male; Middle Aged; Neurotoxins; Patient Satisfaction; Prospective Studies; Severity of Illness Index; Skin Aging; Surveys and Questionnaires; Time Factors; Treatment Outcome
PubMed: 27357317
DOI: 10.11622/smedj.2016112 -
Journal of Cosmetic Dermatology Jan 2022The human face significantly affects the individuals' quality of life, attitude, and mental state. The study of anatomy would always be on the spotlight, as the beauty...
BACKGROUND
The human face significantly affects the individuals' quality of life, attitude, and mental state. The study of anatomy would always be on the spotlight, as the beauty of the face is desired by humans worldwide. However, age, stress, and negative emotions could lead to stimulation of the corrugator supercilii and procerus muscles in the glabellar region and, subsequently, to alterations in face's characteristics, which could be associated with isolation and avoidance of engaging in social contacts.
AIMS
Here, we aimed to examine the degree to which treatment with botulinum toxin type A (BoNT A) can affect patients' quality of life and mental state.
PATIENTS/METHODS
The data collection was performed using 11 questionnaires, which were filled by 83 individuals who underwent BoNT A treatment (sex, 95% female and 5% male; mean age, 48 years).
RESULTS
The results showed that the treatment with BoNT A improved the patients' social and psychological behavior, and their opinion regarding their appearance. This effect developed within 1 month following completion of the treatment. Moreover, the effect was higher in patients' social behavior and was better in patients aged 40-49 years compared to those aged <40 and ≥49 years.
CONCLUSIONS
Thus, BoNT A treatment could be considered as an important way to improve the social behavior and socialization of individuals by raising their psychology and self-esteem.
Topics: Botulinum Toxins, Type A; Facial Muscles; Female; Humans; Male; Mental Health; Middle Aged; Neuromuscular Agents; Quality of Life; Retrospective Studies; Social Behavior
PubMed: 34806297
DOI: 10.1111/jocd.14627