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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 -
The Journal of Craniofacial Surgery May 2006The aim of this study is to elucidate innervation of the procerus muscle, which is attributed mainly to transverse lines on the radix nasi and indirectly to glabella...
The aim of this study is to elucidate innervation of the procerus muscle, which is attributed mainly to transverse lines on the radix nasi and indirectly to glabella frown line. Twenty-three hemifaces of Korean adult cadavers were dissected. In all specimens, the procerus muscle was supplied by the buccal branch of the facial nerve, which coursed infraorbitally. The number of the buccal branches varied: three in 47.8%, two in 47.8%, and one in 4.4% of the specimens. The buccal branch crosses the intercanthal line (nasion to the medial canthus) at approximately lateral one third. The nerve entrance was within a circle with a diameter of 5 mm and its center located 9 mm lateral and 10 mm superior from nasion. It was about a midpoint of lateral half of intercanthal line and lower one third between the intercanthal line and tangential line of the supraorbital rim. The anatomical knowledge might be contributive to depletion of transverse lines on the nasal bridge and function of the procerus muscle.
Topics: Adult; Cadaver; Eyelids; Facial Muscles; Facial Nerve; Forehead; Humans; Nose; Orbit
PubMed: 16770185
DOI: 10.1097/00001665-200605000-00016 -
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 -
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 -
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 -
Aesthetic Plastic Surgery Feb 2022The procerus is the main muscle across the radix that needs to be operated during rhytidectomy, however, it is unclear whether transecting it can morphologically affect...
Can Procerus Transection Alter the Radix Morphology and Influence the Nasal Length? A Study of Photogrammetric Assessments and Anthropometric Measurements on Asian Patients.
BACKGROUND
The procerus is the main muscle across the radix that needs to be operated during rhytidectomy, however, it is unclear whether transecting it can morphologically affect the nose.
METHODS
A retrospective study of Asian patients who underwent procerus transection during rhytidectomy in our single institution was performed to assess whether the radix profile had any change postoperatively. The procerus was transected at a plane above the nasion.
RESULTS
Ninety-four patients were included. All of them were female with an average age of 50.7 ± 5.2 years and a mean follow-up time of 7.8 ± 3.2 months. Twenty-seven (28.7%) had moderate horizontal wrinkles preoperatively, and sixty-seven (71.3%) had severe rhytides. Different degrees of wrinkle improvement were seen on 91 (96.8%) patients, and no improvement occurred to 3 (3.2%) patients after procerus transection. The anthropometric measurements on these patients did not find any significant difference between the preoperative and postoperative nasal heights, radix projections, nasal lengths, or nasofrontal angles (all p >0.05).
CONCLUSIONS
Procerus transection primary contributes to wrinkle improvement. The morphological change of the radix following this operation is too subtle to be observed. This conclusion should be further verified on large samples as well as on other ethnic cohorts in a long-term follow-up.
LEVEL OF EVIDENCE IV
This journal requires that authors 10 assign a level of evidence to each article. For a full 11 description of these Evidence-Based Medicine ratings, 12 please refer to the Table of Contents or the online 13 Instructions to Authors www.springer.com/00266 .
Topics: Anthropometry; Asian People; Facial Muscles; Female; Humans; Middle Aged; Nose; Photogrammetry; Retrospective Studies; Treatment Outcome
PubMed: 34491414
DOI: 10.1007/s00266-021-02435-9 -
JAMA Facial Plastic Surgery Sep 2019Glabellar wrinkling is a critical component of upper facial aging. (Comparative Study)
Comparative Study
IMPORTANCE
Glabellar wrinkling is a critical component of upper facial aging.
OBJECTIVE
To compare the long-term outcomes on the wrinkle lines of the glabella and forehead following browlifts with vs without corrugator and procerus muscle resection.
DESIGN, SETTING, AND PARTICIPANTS
A prospective cohort comparative trial was conducted of 23 patients who underwent browlift procedures by a single surgeon at a single institution (16 with glabellar muscle resection and 7 without muscle resection) between May 1, 2016, and July 1, 2017. All analysis took place between May 1, 2016, and May 14, 2018. The mean follow-up period was 16 months (range, 12-21 months). Sixteen of the 23 patients underwent a browlift with muscle resection procedure alone or in combination with other facial rejuvenation procedures to the brow, midface, jowl, and neck. Four of the 23 patients underwent browlifts only, and 19 had browlifts with other procedures. Seven of the 23 patients had browlift procedures without muscle resection and were designated as controls.
INTERVENTIONS
Endoscopic browlift surgery was performed either with procerus and corrugator muscle resection or without muscle resection.
MAIN OUTCOMES AND MEASURES
Neutral gaze and dynamic photographs of the upper face obtained preoperatively and after the 1-year postoperative mark were reviewed and scored in a blinded fashion by 2 physicians not affiliated with the study team using a modified Fitzpatrick Wrinkle Assessment score (FWA; from 0 [no wrinkling] to 5 [deep wrinkling with redundant skin]).
RESULTS
The 23 study patients had a mean age of 60 years (range, 48-74 years); 21 were women, and 2 were men. There was a significant difference between the myectomy and control groups in the 12-month postoperative improvement in dynamic glabellar FWA scores (2.56 vs 1.07, P = .01). There was a difference between the myectomy and control groups in the improvements in resting glabellar FWA scores at 12-month follow-up, but it did not reach statistical significance (1.28 vs 1.00, P = .38). The 12-month postoperative improvements in dynamic (1.19 vs 1.29, P = .86) and resting forehead (1.0 vs 1.1, P = .70) FWA scores were not significantly different.
CONCLUSIONS AND RELEVANCE
In this study, the use of procerus and corrugator myectomy techniques appeared to achieve a superior long-term reduction in glabellar wrinkles vs forehead rejuvenation techniques without muscle resection.
LEVEL OF EVIDENCE
3.
Topics: Aged; Endoscopy; Facial Muscles; Female; Forehead; Humans; Male; Middle Aged; Rhytidoplasty
PubMed: 31046060
DOI: 10.1001/jamafacial.2018.2084