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American Journal of Clinical Dermatology 2003Botox Cosmetic (Botox) is a formulation of the neuromuscular blocking agent botulinum toxin type A (BTX-A). When injected into hyperactive corrugator superciliaris... (Review)
Review
Botox Cosmetic (Botox) is a formulation of the neuromuscular blocking agent botulinum toxin type A (BTX-A). When injected into hyperactive corrugator superciliaris and/or procerus muscles of the face that predominantly control frowning, Botox produces a transient (3- to 6-month), dose-dependent localized muscle weakness, resulting in a temporary improvement in glabellar frown lines ('brow furrows'). After a decade of successful 'off-label' use, the efficacy and tolerability of Botox (total dose 20 biological units) in the treatment of glabellar frown lines have been demonstrated in two identical, large, multicenter, randomized, double-blind, placebo-controlled pivotal trials in a total of 537 subjects, mostly women, with moderate or severe glabellar lines during facial animation. Based both on subjects' and physicians' assessments, the improvement in glabellar lines with Botox was superior to that with placebo at each visit during the 120-day post-injection follow-up period, beginning on day 7 post-injection. The peak effect was seen on day 30 post-injection when 80% of subjects in the two studies combined had the severity of their lines at maximum frown reduced to mild or none, as assessed by their physician, and 89% had at least a moderate (> or =50%) improvement in the appearance of their glabellar lines, as rated by themselves. In a noncomparative extension of these trials, there was a tendency for a higher proportion of subjects to respond to Botox injections after a second and third treatment session. Botox injections for glabellar lines are well tolerated. Headache, the most common adverse event, occurred with a similar frequency to placebo in the two pivotal studies (13% vs 18%). Temporary blepharoptosis occurred in 3.2% of Botox recipients; however, the incidence of this adverse event tended to decrease with repeated treatment sessions. In summary, Botox injections offer a convenient, effective, and well tolerated treatment for improving glabellar frown lines. Repeated injections are necessary to maintain a long-term effect; however, this technique clearly represents an attractive option for individuals who wish to avoid a more major procedure.
Topics: Botulinum Toxins, Type A; Forehead; Humans; Neuromuscular Agents; Skin Aging
PubMed: 14507232
DOI: 10.2165/00128071-200304100-00005 -
Electromyography and Clinical... 1976
Topics: Action Potentials; Adult; Electromyography; Emotions; Facial Muscles; Female; Humans; Male; Movement
PubMed: 964201
DOI: No ID Found -
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 -
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 -
Annales de Chirurgie Plastique Et... Oct 2004As usual, the face at rest is analysed before btx injection. But the interest of the analysis of the face dynamically, in a functional way, with the help of the... (Review)
Review
As usual, the face at rest is analysed before btx injection. But the interest of the analysis of the face dynamically, in a functional way, with the help of the palpation, is demonstrated. A key point is to decide to favor the high position of the highbrow more than to totally fade the frontal wrinkles. To perform this, a new functional segmentation of the frontalis muscle is described. The role of the procerus muscle as antagonist of the frontalis muscle, inferior medial part, is explained. To elevate the medium third of the eyebrow, the lateral part of the corrugator muscle is injected with a specific technique. This technique decreases the risk of weakening the overlying frontalis muscle and the underlying levator palpebrae muscle. To achieve a higher elevation of the eyebrow tail, and to totally fade the upper and medium crow's foot, different points of injection on the lateral orbital rim are described, without the risk of migration to the oculo motor muscles. Fading the tear trough with the injection of the superior malar part of the orbicularis oculi muscle is explained. Thanks to the use of the functional analysis of the face and to the comprehension of the fabulous possibilities of the botulinum toxin A, it is now justified to switch from a "ready to wear" way of injection to a "haute couture" way, that is to say adapted to each patient.
Topics: Botulinum Toxins, Type A; Face; Humans; Movement; Muscle Weakness; Muscle, Skeletal; Neuromuscular Agents; Rhytidoplasty; Risk Factors; Skin Aging
PubMed: 15518952
DOI: 10.1016/j.anplas.2004.08.012 -
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 -
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 -
The Journal of Craniofacial Surgery Nov 2013The aim of this study was to introduce a technique of dividing forehead depressor muscles with a subbrow excision for improvement of brow ptosis or redundant upper...
The aim of this study was to introduce a technique of dividing forehead depressor muscles with a subbrow excision for improvement of brow ptosis or redundant upper eyelid skin and glabella wrinkles. Upper incisions were designed at the lower limit of the eyebrow with a lateral extension along the eyebrow curvature. After measuring the redundant upper eyelid skin, the excess skin was excised. The orbital part of the orbicularis oculi muscle was identified and split longitudinally. The forehead depressor muscles (depressor supercilii, oblique and transverse head of corrugator, and medial part of orbicularis oculi) in the brow fat pad were identified and avulsed. In the patients who have a lowered brow, the brow was elevated and fixed to the underlying periosteum about 1 cm above the superior orbital rim after subgaleal dissection. During the dissection, the supraorbital nerve was preserved. Preaponeurotic fat was transferred and sutured between the cut stumps of the corrugator and procerus. The 78 patients (19 men, 60 women; age range, 41-72 years [mean, 52.0 ± 7.1 years]) were operated on. The follow-up periods ranged from 3 to 48 months. Preoperative and postoperative photographs were taken, and the following evaluations were conducted by 1 surgeon via a Likert scale (1 = not improved, 2 = slightly improved, 3 = somewhat improved, 4 = much improved, 5 = markedly improved). The mean score for improvement of the glabella frowns in contraction was 3.7 ± 1.6. The mean score for the improvement of the glabella frowns in relaxation was 4.1 ± 1.3. The mean score for improvement of drooping eyelids was 4.7 ± 0.5. The mean score for the improvement of forehead wrinkles was 4.8 ± 0.7. We improved brow ptosis, redundant upper eyelid skin, and glabella wrinkles simultaneously using a subbrow excision and depressor muscle division while preserving the superficial branch of the supraorbital nerve.
Topics: Adult; Aged; Blepharoptosis; Cosmetic Techniques; Eyebrows; Facial Muscles; Female; Forehead; Humans; Male; Middle Aged
PubMed: 24220387
DOI: 10.1097/SCS.0b013e3182a28bc8 -
Biology of Mood & Anxiety Disorders 2014It has long been suggested that feedback signals from facial muscles influence emotional experience. The recent surge in use of botulinum toxin (BTX) to induce temporary...
BACKGROUND
It has long been suggested that feedback signals from facial muscles influence emotional experience. The recent surge in use of botulinum toxin (BTX) to induce temporary muscle paralysis offers a unique opportunity to directly test this "facial feedback hypothesis." Previous research shows that the lack of facial muscle feedback due to BTX-induced paralysis influences subjective reports of emotional experience, as well as brain activity associated with the imitation of emotional facial expressions. However, it remains to be seen whether facial muscle paralysis affects brain activity, especially the amygdala, which is known to be responsive to the perception of emotion in others. Further, it is unknown whether these neural changes are permanent or whether they revert to their original state after the effects of BTX have subsided. The present study sought to address these questions by using functional magnetic resonance imaging to measure neural responses to angry and happy facial expressions in the presence or absence of facial paralysis.
RESULTS
Consistent with previous research, amygdala activity was greater in response to angry compared to happy faces before BTX treatment. As predicted, amygdala activity in response to angry faces was attenuated when the corrugator/procerus muscles were paralyzed via BTX injection but then returned to its original state after the effects of BTX subsided. This preliminary study comprises a small sample size and no placebo condition; however, the A-B-A design affords the present sample to serve as its own control.
CONCLUSIONS
The current demonstration that amygdala responses to facial expressions were influenced by facial muscle paralysis offers direct neural support for the facial feedback hypothesis. Specifically, the present findings offer preliminary causal evidence that amygdala activity is sensitive to facial feedback during the perception of the facial expressions of others. More broadly, these data confirm the utility of using BTX to address the effect of facial feedback on neural responses associated with the perception, in addition to the experience or expression of emotion.
PubMed: 25694806
DOI: 10.1186/2045-5380-4-11 -
Plastic and Reconstructive Surgery Oct 2005Approaches for exposure of the muscles of brow depression include transpalpebral, endoscopically assisted, and open coronal techniques. The purpose of this anatomical... (Comparative Study)
Comparative Study
BACKGROUND
Approaches for exposure of the muscles of brow depression include transpalpebral, endoscopically assisted, and open coronal techniques. The purpose of this anatomical study was to compare the capacity for visualization and amount of brow depressor muscle resection with each technique.
METHODS
The corrugator supercilii, depressor supercilii, medial orbicularis oculi, and procerus muscles were studied by gross anatomical dissection carried out on 24 sides of 12 cadaver heads. First, all visible corrugator and depressor supercilii muscles were resected by means of an upper blepharoplasty incision. Subsequently, a subgaleal endoscopic approach was used to evaluate the extent of resection performed and remove the remaining muscle after transpalpebral corrugator resection. This was followed by coronal exposure to assess the anatomical location and extent of muscle resection accomplished by the two previously mentioned techniques.
RESULTS
In all dissections, endoscopy demonstrated that up to one-third of the lateral aspect of the transverse heads of the corrugator supercilii remained following transpalpebral resection. Oblique corrugator head resections were complete, without significant residual muscle following transpalpebral corrugator resection. The procerus muscle was able to be blindly transected by means of the transpalpebral incision but exposed and ablated in all 12 specimens using endoscopy. Coronal exposure demonstrated that no significant amount of corrugator, depressor supercilii, or procerus muscle remained in any of the 12 heads following endoscopically assisted exposure and resection. The medial head of the orbital portion of the orbicularis oculi was visualized and accessible regardless of the technique used.
CONCLUSIONS
In 24 anatomical dissections, transpalpebral corrugator resection failed to remove up to one-third of the transverse head of the corrugator muscle. Removal of the brow depressor muscles was accomplished with the endoscopic approach, as confirmed by coronal exposure.
Topics: Dissection; Endoscopy; Eyebrows; Facial Muscles; Female; Forehead; Humans; Male; Scalp
PubMed: 16217498
DOI: 10.1097/01.prs.0000182649.14511.52