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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 -
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 -
Annals of Indian Academy of Neurology 2018This sign is observed in atypical parkinsonism mainly in Progressive Supranuclear Palsy. The exact mechanism of this sign is not clear but the contraction of the...
This sign is observed in atypical parkinsonism mainly in Progressive Supranuclear Palsy. The exact mechanism of this sign is not clear but the contraction of the Corrugator Supercilii muscle is the most important factor for the generation of vertical forehead creases. Though the wrinkling of forehead is a complex phenomenon involving multiple muscles but the 'Corrugator sign' would be a better term to describe this phenomenon. Despite the controversies regarding the mechanism and nomenclature, the 'Procerus sign' remains an important clinical clue for early Progressive Supranuclear palsy.
PubMed: 30122846
DOI: 10.4103/aian.AIAN_408_17 -
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 Surgery Journal Oct 2017Glabellar frown lines are a common aesthetic concern, and minimally invasive techniques to treat frown lines have become popular.
BACKGROUND
Glabellar frown lines are a common aesthetic concern, and minimally invasive techniques to treat frown lines have become popular.
OBJECTIVES
The authors developed a technique to minimize frown lines by means of percutaneous myotomy with a small needle-knife and lipoinjection.
METHODS
Sixty-nine patients underwent treatment of the glabellar frown lines in a prospective study. Percutaneous myotomy of the corrugator supercilii and procerus was conducted with a small needle-knife, and autologous fat was transferred to the glabellar region. Two independent investigators assessed improvement of the glabellar frown lines by applying the Merz Facial Wrinkle Scale preoperatively and 6 months postoperatively. Improvement by ≥1 point was regarded as a response to treatment. Patients also conducted a self-assessment based on the Global Aesthetic Improvement Scale.
RESULTS
The mean follow-up period was 8 months. The evaluators determined that the glabellar frown lines of 62 patients (89.9%) responded to treatment. For 4 patients (5.8%), the frown lines were partially improved, and the frown lines did not improve for 3 patients (4.3%). In a self-assessment, 64 patients (92.8%) perceived improvement in their frown lines 6 months postoperatively. No serious complications were recorded.
CONCLUSIONS
Treatment of glabellar frown lines by percutaneous myotomy with a small needle-knife and lipoinjection is reliable and minimally invasive.
LEVEL OF EVIDENCE
4.
Topics: Adipose Tissue; Adult; Cosmetic Techniques; Esthetics; Facial Muscles; Female; Forehead; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Myotomy; Needles; Patient Satisfaction; Prospective Studies; Self-Assessment; Skin Aging; Transplantation, Autologous
PubMed: 29044361
DOI: 10.1093/asj/sjx072 -
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 -
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 -
Aesthetic Plastic Surgery Apr 2017The senior author introduced the transpalpebral approach for the first time during the ASPS meeting in 1993. He has made some refinements in the technique and has...
The senior author introduced the transpalpebral approach for the first time during the ASPS meeting in 1993. He has made some refinements in the technique and has developed newer indications for this procedure. These refinements, indications and the related new video are the subject of this report. The modifications in the technique are as follows: After elevation of the skin and the orbicularis muscle and dissection under the muscle, a thin layer of the depressor supercilii muscle overlying the darker and more friable corrugator supercilii muscle is removed. A fairly constant branch of the supraorbital nerve piercing this muscle medially is first identified on the surface and followed deep in the muscle using a mosquito hemostat. The muscle is then lifted, and then, the same nerve branch is identified above the periosteum. The segment of the muscle lateral to this nerve is then isolated and removed by first transecting it medially and then lateral to the nerve. A cephalic segment is isolated and removed using the coagulation power of the cautery to minimize the postoperative bleeding. The rest of the muscle is then removed in a piecemeal fashion as thoroughly as possible, including a lateral segment of the procerus muscle, the end point being visualization of the subcutaneous fat. If the intention of the surgery is to treat frontal migraine headaches, the supratrochlear and supraorbital arteries are also removed. If the nerve and vessel pass through a foramen, a foraminotomy is carried out on patients with migraine headaches. Two to three cc of fat is injected in the glabellar and corrugator sites in most patients to avoid any depression and to restore the lost glabellar volume. Beyond patients with male pattern baldness, those with a long forehead and those with overactive frown muscles but optimal eyebrow positions, this technique is now being used for those with proptosis, exophthalmos and those with eyelid ptosis who would not undergo ptosis correction to prevent elevation of the eyebrows, which exaggerates the proptosis or makes the eyelid ptosis more discernible. Additionally, a common indication for this surgery is in patients with frontal migraine headaches. This report highlights the refinements in the transpalpebral corrugator resection that have been implemented over the last 25 years and offers additional indications for its utilization. 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: Blepharoplasty; Blepharoptosis; Cosmetic Techniques; Dissection; Eyelids; Facial Muscles; Forehead; Humans
PubMed: 28233129
DOI: 10.1007/s00266-017-0780-8 -
Surgical and Radiologic Anatomy : SRA Aug 2017The aim of this study was to clarify the anatomical relationship of the procerus with the nose, especially focusing on the transverse part of the nasalis, the nasal ala,...
PURPOSE
The aim of this study was to clarify the anatomical relationship of the procerus with the nose, especially focusing on the transverse part of the nasalis, the nasal ala, and the levator labii superioris alaeque nasi (LLSAN).
MATERIALS AND METHODS
The 53 faces from Korean cadavers were examined anatomically.
RESULTS
The procerus originated from the superficial and deep layers in all specimens. Some fibers of the lateral part of the superficial layer extended to connect to the transverse part of the nasalis, while other such fibers extended to attach to the skin of the upper nasal ala in all specimens. The superficial and deep layers of the procerus merged and then intermingled with the frontalis. The anatomical relationship between the superficial layer of the procerus and the LLSAN was classified into the following two categories according to their connections. Some medial originating fibers of the LLSAN extended superomedially to blend in the area between the superficial layer of the procerus and the depressor supercilii (13.5%). And, some medial originating fibers of the LLSAN extended superomedially and then constituted the lateral portion of the superficial layer of the procerus (7.7%).
CONCLUSION
This study has yielded crucial data for understanding the anatomical relationships and functions of the procerus in relation to the nose. They will be helpful when designing effective therapies involving botulinum toxin type A, performing various types of rhinoplasty and facial surgeries, and in electromyography analyses.
Topics: Adult; Aged; Aged, 80 and over; Anatomic Landmarks; Cadaver; Dissection; Facial Muscles; Female; Humans; Male; Middle Aged; Nose; Republic of Korea
PubMed: 28132092
DOI: 10.1007/s00276-017-1817-z -
Aesthetic Plastic Surgery Dec 2016The purpose of this study is to establish a relationship between the skin lines on the upper third of the face in cadavers, which represent the muscle activity in life... (Review)
Review
Anatomy of Forehead, Glabellar, Nasal and Orbital Muscles, and Their Correlation with Distinctive Patterns of Skin Lines on the Upper Third of the Face: Reviewing Concepts.
BACKGROUND
The purpose of this study is to establish a relationship between the skin lines on the upper third of the face in cadavers, which represent the muscle activity in life and the skin lines achieved by voluntary contraction of the forehead, glabellar, and orbital muscles in patients.
METHODS
Anatomical dissection of fresh cadavers was performed in 20 fresh cadavers, 11 females and 9 males, with ages ranging from 53 to 77 years. Subcutaneous dissection identified the muscle shape and the continuity of the fibers of the eyebrow elevator and depress muscles. Subgaleal dissection identified the cutaneous insertions of the muscles. They were correlated with skin lines on the upper third of the face of the cadavers that represent the muscle activity in life. Voluntary contraction was performed by 20 voluntary patients, 13 females and 7 males, with ages ranging from 35 to 62 years. Distinct patterns of skin lines on the forehead, glabellar and orbital areas, and eyebrow displacement were identified.
RESULTS
The frontalis exhibited four anatomical shapes with four different patterns of horizontal parallel lines on the forehead skin. The corrugator supercilii showed three shapes of muscles creating six patterns of vertical glabellar lines, three symmetrical and three asymmetrical. The orbicularis oculi and procerus had single patterns. The skin lines exhibited in voluntary contraction of the upper third of the face in patients showed the same patterns of the skin lines achieved in cadavers.
CONCLUSIONS
Skin lines in cadavers, which are the expression of the muscle activity in life, were similar to those achieved in the voluntary contraction of patients, allowing us to assert that the muscle patterns of patients were similar to those identified in cadavers.
NO LEVEL ASSIGNED
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
Topics: Aged; Cadaver; Dissection; Facial Muscles; Female; Forehead; Humans; Male; Middle Aged; Oculomotor Muscles; Rhytidoplasty; Sensitivity and Specificity
PubMed: 27743084
DOI: 10.1007/s00266-016-0712-z