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The Journal of Craniofacial Surgery Nov 2005The aim of the study is to elucidate the precise anatomy and histologic structure of frontalis muscle relating to blepharoptosis repair. Five Korean adult cadavers were...
The aim of the study is to elucidate the precise anatomy and histologic structure of frontalis muscle relating to blepharoptosis repair. Five Korean adult cadavers were used. The soft tissues of the lower forehead, including muscle and periosteum, were dissected at different sagittal planes and then observed histologically and photographed. Masson's trichrome was used for staining the section specimens. The frontalis muscle passed through and inserted into the bundles of the orbicularis oculi muscle on the superior border of the eyebrow at middle and medial side of the upper eyelid. However, at the lateral side it inserted about 0.5 cm below the superior border of eyebrow. At the medial side of the eyelid, the most distal frontalis muscle was located deep to the procerus muscle and superficial to the corrugator muscle. A knowledge of the distal insertion of the frontalis muscle is referred to the muscle transfer procedure for blepharoptosis repair.
Topics: Aged; Azo Compounds; Blepharoptosis; Cadaver; Coloring Agents; Eosine Yellowish-(YS); Eyebrows; Eyelids; Facial Muscles; Fascia; Female; Forehead; Humans; Male; Methyl Green; Middle Aged; Orbit; Periosteum
PubMed: 16327540
DOI: 10.1097/01.scs.0000198623.69372.22 -
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 -
Survey of Ophthalmology 1989Essential blepharospasm is an idiopathic disorder of progressive involuntary spasms of the orbicularis oculi and upper facial (corrugator, procerus) muscles.... (Review)
Review
Essential blepharospasm is an idiopathic disorder of progressive involuntary spasms of the orbicularis oculi and upper facial (corrugator, procerus) muscles. Blepharospasm literally means spasm of the eyelids; however, most patients with blepharospasm also have or will develop squeezing in the lower face and neck muscles (Meige's syndrome, orofacial dystonia, or oromandibular dystonia). Some patients develop dystonic, uncontrolled movements in areas outside the facial nerve distribution (segmental cranial dystonia or craniocervical dystonia). Chronic, forceful squeezing by the periocular muscles becomes debilitating for the patient and leads to functional and cosmetic eyelid deformities. Treatment has included a variety of modalities and oral medications that are of limited efficacy. Botulinum-A toxin injections have delivered the best temporary relief from this disorder, while the periorbital myectomy operation has been shown to give the best long-term results.
Topics: Blepharospasm; Botulinum Toxins; Diagnosis, Differential; Dystonia; Eyelid Diseases; Facial Muscles; Female; Humans; Male; Middle Aged
PubMed: 2686056
DOI: 10.1016/0039-6257(89)90040-4 -
The Annals of Pharmacotherapy Mar 2021PrabotulinumtoxinA-xvfs (Jeuveau), a botulinum toxin type A, was approved by the Food and Drug Administration for the temporary improvement in the appearance of...
OBJECTIVE
PrabotulinumtoxinA-xvfs (Jeuveau), a botulinum toxin type A, was approved by the Food and Drug Administration for the temporary improvement in the appearance of moderate-to-severe glabellar lines in February 2019. This article will review phase II and III clinical trials to assess the efficacy, safety, and clinical application of this novel, aesthetic-only drug.
DATA SOURCES
A systematic literature review was performed using the terms "glabellar lines AND prabotulinumtoxinA" in the PubMed database. ClinicalTrials.gov was searched to identify nonpublished studies.
STUDY SELECTION AND DATA EXTRACTION
Articles written in English between November 2019 and June 2020 discussing phase II and phase III clinical trials were evaluated.
DATA SYNTHESIS
By the primary efficacy end point on day 30, more patients achieved a greater than 2-point improvement on the Glabellar Line Scale (GLS) at maximum frown compared with baseline on day 0. The proportions of participants who responded to treatment with prabotulinumtoxinA were 67.5% and 70.4% versus 1.2% and 1.3% in placebo groups across 2 identical clinical trials ( < 0.001). Patients receiving prabotulinumtoxinA experienced greater improvement in GLS at maximum frown on day 30 (87.2%) compared with onabotulinumtoxinA (82.8%) and placebo (4.2%; < 0.001). PrabotulinumtoxinA was well tolerated across all studies.
RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE
This review provides a detailed analysis of the safety and efficacy of prabotulinumtoxinA-xvfs and includes special considerations to help guide patients and clinicians.
CONCLUSION
PrabotulinumtoxinA is a safe and effective new addition to the repository of available treatments for the appearance of glabellar lines.
Topics: Botulinum Toxins, Type A; Double-Blind Method; Female; Forehead; Humans; Male; Treatment Outcome
PubMed: 32698599
DOI: 10.1177/1060028020943527 -
Archives of Otolaryngology--head & Neck... Mar 1998To determine if the medial brow can be elevated following administration of botulinum toxin type A (Botox, Allergan, Irvine, Calif).
OBJECTIVE
To determine if the medial brow can be elevated following administration of botulinum toxin type A (Botox, Allergan, Irvine, Calif).
DESIGN
A before-after interventional study comparing pretreatment and posttreatment brow height. Objective measurements and subjective comparisons of pretreatment and posttreatment slides were made by 7 independent observers unaware of treatment status. All measurements and observations were based on standardized photographs taken with identical lens settings.
SETTING
Private facial plastic surgery practice. All injections were performed in office examination rooms without anesthesia or sedation.
PATIENTS
Thirty adult patients electively seeking improvement of glabellar frown lines or low-positioned medial brows (angry appearance).
INTERVENTION
Twenty units of botulinum toxin type A was injected into the corrugator supercilli and procerus muscles. An electromyographic needle was used for the initial 10 injections, and a 30-gauge needle was used for the remainder.
OUTCOME MEASURES
In the objective arm, change in brow height was measured from the medial canthus and midpupil directly vertical to the brow hairs; the change in interbrow distance was also measured. In the subjective arm, the number of patients who were found to have an elevated medial brow by the independent observers was noted. Objective and subjective findings were correlated.
RESULTS
Objective measurements yielded a raise in the medial brow in 8 (32%) of 25 patients from the medial canthus and in 12 (48%) of 25 from the midpupil and an increase in interbrow distance in 17 (59%) of 29 patients. Subjective comparison found 18 (62%) of the 29 patients to have higher medial brows after treatment.
CONCLUSIONS
Botulinum toxin type A treatment can create a chemical browlift. Further studies with more specific selection criteria are needed to better evaluate this effect.
Topics: Adult; Botulinum Toxins, Type A; Cosmetic Techniques; Female; Forehead; Humans; Injections; Male; Middle Aged; Rhytidoplasty; Skin Aging
PubMed: 9525518
DOI: 10.1001/archotol.124.3.321 -
Annals of Plastic Surgery May 1979The author presents a study of 280 cases of frontal face lift out of 2,934 cases of rhytidectomy, and his personal technique for correction of frontal and glabellar...
The author presents a study of 280 cases of frontal face lift out of 2,934 cases of rhytidectomy, and his personal technique for correction of frontal and glabellar wrinkles. The anatomical and physiological aspects of the facial musculature, especially the procerus and corrugator muscles, are described. Emphasis is placed on the technique of vertical and horizontal cuts in the aponeurosis of the frontal region.
Topics: Adult; Aged; Aging; Face; Facial Muscles; Fasciotomy; Female; Humans; Male; Middle Aged; Skin; Surgery, Plastic
PubMed: 543606
DOI: 10.1097/00000637-197905000-00009 -
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 -
HNO Oct 2012Endoscopic surgical techniques have greatly increased in popularity with the advent of modern endoscopes. Endoscopic brow lifting has largely replaced older, more...
Endoscopic surgical techniques have greatly increased in popularity with the advent of modern endoscopes. Endoscopic brow lifting has largely replaced older, more invasive procedures. With this technique a skilled surgeon can identify and treat a ptotic eyebrow by addressing the relevant anatomy, including the frontalis, corrugator, procerus and orbicularis oculi muscles. The frontalis muscle can then be permanently fixed into a predesignated position using titanium screws and permanent sutures. This approach has allowed facial plastic surgeons to address the ptotic brow with decreased rates of edema, hematoma, hypesthesia, alopecia and scarring.
Topics: Dermatologic Surgical Procedures; Endoscopy; Eyebrows; Humans; Plastic Surgery Procedures
PubMed: 23052234
DOI: 10.1007/s00106-012-2576-0 -
Internal Medicine (Tokyo, Japan) Dec 2002
Topics: Aged; Brain Diseases; Facial Muscles; Facies; Female; Humans; Magnetic Resonance Imaging; Neurologic Examination
PubMed: 12521221
DOI: 10.2169/internalmedicine.41.1217 -
Neurology Jun 2002
Topics: Facial Expression; Facial Muscles; Humans; Supranuclear Palsy, Progressive
PubMed: 12088015
DOI: No ID Found