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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 -
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 -
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 -
Plastic and Reconstructive Surgery Jun 1996Treatment of eyebrow ptosis to enhance the cosmetic effect from blepharoplasty is commonly done with a forehead lift using a coronal incision approach. The coronal scalp...
Treatment of eyebrow ptosis to enhance the cosmetic effect from blepharoplasty is commonly done with a forehead lift using a coronal incision approach. The coronal scalp incision is associated with the annoying sequelae of frontoparietal scalp numbness, itching, and paresthesias, all of which can be permanent. A forehead lift technique with temporal scalp incisions only 4.5 to 5.0 cm in length can produce a result comparable with that of the coronal incision approach when combined with transpalpebral resection of the corrugator supercilii muscles and transection of the procerus muscle. This eyebrow elevation technique, like the endoscopic approach, minimizes the risk of permanently injuring the supraorbital nerve branches that innervate the frontoparietal scalp. Unlike the approach using only endoscopy, however, this technique can effectively treat cases of advanced eyebrow ptosis. The appropriate area of eyelid skin for excision may be difficult to assess when a forehead lift and upper blepharoplasty are done concomitantly. The described forehead lift incorporates a method to determine this area. This forehead lift technique, combined with a technique for protecting against overresecting upper eyelid skin, is described as used effectively on 140 blepharoplasty cases followed for 3 months to 4 years.
Topics: Eyebrows; Eyelids; Facial Muscles; Forehead; Humans; Rhytidoplasty; Treatment Outcome
PubMed: 8643715
DOI: 10.1097/00006534-199606000-00002 -
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 -
Eye (London, England) Jul 2009Severe cases of blepharospasm resistant to botulinum toxin represent a challenging clinical problem. Over the last 10 years, we have adopted a staged surgical management...
PURPOSE
Severe cases of blepharospasm resistant to botulinum toxin represent a challenging clinical problem. Over the last 10 years, we have adopted a staged surgical management of these cases with an initial upper lid orbicularis myectomy (combined with myectomy of procerus and corrugator supercilius as appropriate) and then 4-6 months later a brow suspension with autologous fascia lata. The aim of this study was to assess the outcome of this staged surgical approach.
MATERIALS AND METHODS
A questionnaire was sent to all patients who had undergone the procedure and the clinical records reviewed.
RESULTS
Fourteen patients had undergone the procedure of which 13 were alive. They were sent a questionnaire and 10 of them responded. All had both procedures. Eight of the 10 reported great benefit from the surgery, one some benefit, and one was worse off. All patients still required botulinum toxin injections after the surgery.
CONCLUSIONS
Majority, but not all, of the patients in our series greatly benefitted from this staged surgical approach.
Topics: Aged; Blepharospasm; Eyelids; Fascia Lata; Female; Follow-Up Studies; Humans; Male; Middle Aged; Oculomotor Muscles; Patient Satisfaction; Surveys and Questionnaires; Transplantation, Autologous
PubMed: 18927593
DOI: 10.1038/eye.2008.314 -
JAMA Facial Plastic Surgery 2013To review the single-stage forehead flap for patient selection, technique, and main outcome measures.
OBJECTIVE
To review the single-stage forehead flap for patient selection, technique, and main outcome measures.
METHODS
Patients undergoing nasal reconstruction between January 1, 1995, and June 30, 2000, were reviewed from medical records, photographs, and personal communication. All work was performed in an academic medical center.
RESULTS
Fifty-one patients had a forehead flap for nasal reconstruction, of which 10 (20%) were repaired in a single stage. All patients had no evidence of small vessel disease, eg, hypertension, diabetes mellitus, or tobacco use. Nasal defects were limited to the upper two-thirds of the nose. The technique is modified from the original description by creating a unilateral, subcutaneous pedicle, wide undermining, and partial resection of the procerus muscle. One patient had superficial epidermolysis at the distal tip of the flap. The remaining 9 patients maintained complete viability with satisfactory outcomes. One debulking procedure was performed to the glabellar area for aesthetic reasons. The average interval for returning to work was 6.6 days compared with the minimal 3 weeks for conventional interpolated flaps.
CONCLUSION
In select cases, a single-stage, island midline forehead flap can be used safely as an advantageous alternative to the conventional interpolated forehead flap.
Topics: Forehead; Humans; Outcome Assessment, Health Care; Rhinoplasty; Surgical Flaps
PubMed: 23787760
DOI: 10.1001/jamafacial.2013.1 -
Der Ophthalmologe : Zeitschrift Der... Sep 2007The use of botulinum toxin A for the treatment of wrinkles is increasing. Botulinum toxin A inhibits exocytosis of acetylcholine from 3 to 12 months, depending on the...
The use of botulinum toxin A for the treatment of wrinkles is increasing. Botulinum toxin A inhibits exocytosis of acetylcholine from 3 to 12 months, depending on the target tissue. Low-dose botulinum toxin A is used to smooth hyperkinetic facial lines. This is especially successful in the upper facial parts, since the target muscles (procerus, corrugator supracilii, frontalis, orbicularis oculi) all directly overlie the osseous structures of the face. This is not the case for the lower facial parts, and more side effects are encountered when treating, for example, wrinkles around the mouth. Contraindications to the use of botulinum toxin A are diseases affecting neuromuscular signal transduction, allergic reactions to components of the solution, therapy with aminoglycosides or acetylsalicylic acid prior to treatment, infections in the planned treatment area, and pregnancy and lactation. Alternative and complementary treatments include erbium-YAG or CO2 laser, as well as augmentation and surgical plastic procedures.
Topics: Adult; Animals; Botulinum Toxins, Type A; Combined Modality Therapy; Contraindications; Esthetics; Face; Facial Muscles; Female; Haplorhini; Humans; Injections, Intramuscular; Lactation; Laser Therapy; Lethal Dose 50; Middle Aged; Neuromuscular Agents; Posture; Pregnancy; Rhytidoplasty; Skin Aging; Surgery, Plastic; Time Factors; Treatment Outcome
PubMed: 17823803
DOI: 10.1007/s00347-007-1614-x -
Journal of the American Academy of... Dec 2006Different formulations of botulinum toxin type A can behave differently. There has been little clinical research directly comparing formulations. (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Different formulations of botulinum toxin type A can behave differently. There has been little clinical research directly comparing formulations.
OBJECTIVE
We sought to compare the efficacy and tolerability of two botulinum toxin type A formulations-BoNTA1 and BoNTA2-in the treatment of moderate and severe glabellar lines.
METHODS
Sixty-two patients with moderate or severe glabellar lines at maximum contraction were randomly assigned to receive 20 U of BoNTA1 or 50 U of BoNTA2 (20% in the procerus muscle, 80% in the corrugator muscles).
RESULTS
The incidence of 1-grade improvement or greater in glabellar line severity at maximum contraction was as follows: 77% (BoNTA1) versus 59% (BoNTA2) at week 12, 53% versus 28% at week 16. The estimated incidence of relapse was 23% (BoNTA1) versus 40% (BoNTA2) at week 16. Both formulations were similarly well tolerated.
LIMITATIONS
Few male and non-Caucasian subjects were studied.
CONCLUSION
BoNTA(1) offered more prolonged efficacy than BoNTA2 in the treatment of glabellar lines at the dose ratio of 2.5:1 (BoNTA2:BoNTA1) used in this study.
Topics: Adult; Botulinum Toxins, Type A; Chemistry, Pharmaceutical; Dose-Response Relationship, Drug; Double-Blind Method; Facial Muscles; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Neuromuscular Agents; Patient Satisfaction; Recurrence; Skin Aging; Time Factors; Treatment Outcome; White People
PubMed: 17097394
DOI: 10.1016/j.jaad.2006.07.006 -
The Journal of Craniofacial Surgery Mar 2009A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal...
A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal branch of the ophthalmic artery which is anastomosed to the terminal branch of the facial artery. The flap includes the skin, subcutaneous tissue, and procerus muscle. Ten patients, aged 50 to 86 years, have been reconstructed with this flap for defects in the nose (in 4 cases), midface (in 4 cases) and lower eyelids (in 2 cases). The mean flap size was 17 x 23 mm (range: 15 x 20 to 20 x 27 mm). All flaps fully survived. Additional complications and morbidity were not observed. The donor sites were closed a primarily closure in all cases. Follow-up ranged from 3 to 12 months (mean: 8.2 months). The radix nasi flap is a safe flap, has minimal donor site morbidity, and is especially suited for nasal and midface reconstruction in terms of attaining a suitable color and thickness.
Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cheek; Eyelid Neoplasms; Eyelids; Facial Muscles; Facial Neoplasms; Female; Follow-Up Studies; Graft Survival; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Ophthalmic Artery; Plastic Surgery Procedures; Skin Neoplasms; Skin Pigmentation; Skin Transplantation; Subcutaneous Tissue; Surgical Flaps; Tissue and Organ Harvesting; Wound Healing
PubMed: 19305249
DOI: 10.1097/SCS.0b013e3180f611c8