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Singapore Medical Journal Oct 2017This study describes the physician experience relating to the effectiveness of incobotulinumtoxinA and patient satisfaction with its use for the treatment of glabellar... (Observational Study)
Observational Study
INTRODUCTION
This study describes the physician experience relating to the effectiveness of incobotulinumtoxinA and patient satisfaction with its use for the treatment of glabellar frown lines (GFLs).
METHODS
A total of 17 patients from six dermatological clinics, aged > 18 years and with mild to very severe GFLs at maximum frown, were included. Patients were excluded if they had treatment with resorbable fillers and botulinum toxins in the preceding six months, or non-resorbable fillers or surgery in the treatment area. Injection sites (range 3-5) were chosen depending on their severity (dose range 12-20 U), covering corrugators and procerus muscles. Physicians assessed improvements to GFLs using the Merz scale on Days 4 and 14 after treatment. Patients completed a self-reported questionnaire on their facial wrinkles on Days 2 and 4 after treatment.
RESULTS
Most (76.5%) patients were women. The mean age of the patients was 46.9 ± 10.0 years. Mean severities (on the Merz scale) for at-rest and dynamic (with expression) GFLs at baseline were 1.3 ± 1.10 and 3.4 ± 0.38, respectively, and decreased on Day 14 (p < 0.05). Treatment response rates (> 1-point improvement) for at-rest and dynamic (with expression) GFLs on Day 4 were 40% and 100%, respectively. All patients reported being satisfied or very satisfied, and 64.3%-71.4% indicated that their facial wrinkles had improved on Day 2.
CONCLUSION
IncobotulinumtoxinA was fast acting with visible improvements by Day 4 and all patients expressed satisfaction with their treatment after two days. GFLs saw the most improvement among the facial characteristics measured.
Topics: Adult; Botulinum Toxins, Type A; Dermatology; Facial Expression; Female; Forehead; Humans; Male; Middle Aged; Neurotoxins; Patient Satisfaction; Prospective Studies; Severity of Illness Index; Skin Aging; Surveys and Questionnaires; Time Factors; Treatment Outcome
PubMed: 27357317
DOI: 10.11622/smedj.2016112 -
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 -
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 -
The Journal of Craniofacial Surgery Jun 2015This study was designed to investigate the effects of open technique rhinoplasty on facial nerve terminal branches more concerned with mimicry via electroneurography...
OBJECTIVE
This study was designed to investigate the effects of open technique rhinoplasty on facial nerve terminal branches more concerned with mimicry via electroneurography (ENoG).
METHODS
Twenty patients ages between 24 and 36 years were included in the study. Five nasal mimicry muscles were used to evaluate axonal loss of the facial nerve: bilateral transverse nasal, levator labii superioris alaeque nasi (LLSAN), and procerus muscles of all patients were evaluated preoperatively and postoperative third month by ENoG. The patients that have abnormalities regarding the amplitude and latency at third month were reevaluated at sixth month postoperatively.
RESULTS
Mean latencies of the facial nerve were calculated to be increased for all muscles at third postoperative month, but this increase was significant only for left LLSAN (P = 0.002). Amplitudes of the facial nerve decreased in all of the groups, but this decrease was not significant (P > 0.05). Two patients with exceptionally long latency facial nerve response of transverse nasal muscle and 11 muscle recordings with abnormal low amplitudes of the facial nerve at the third month was reevaluated at sixth postoperative month and the values were improved.
CONCLUSIONS
This study demonstrated that facial nerve integrity is minimally affected after rhinoplasty, yet all affected muscles were recovered on the long term.
Topics: Adult; Electromyography; Facial Expression; Facial Muscles; Facial Nerve; Female; Humans; Male; Postoperative Period; Rhinoplasty; Young Adult
PubMed: 26080192
DOI: 10.1097/SCS.0000000000001731 -
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 -
Annali Italiani Di Chirurgia 2014The aim of this study is to prove the therapeutic effectiveness of nerve decompression, performed endoscopically for frontal migraine and by open surgery for occipital...
AIM
The aim of this study is to prove the therapeutic effectiveness of nerve decompression, performed endoscopically for frontal migraine and by open surgery for occipital migraine.
MATERIALS AND METHODS
Twenty patients were enrolled and underwent surgery for endoscopic resection of the glabellar muscle group, including the corrugator supercilii, depressor supercilii, and procerus muscles, while the occipital decompression was performed in open surgery through decompression of occipital nerves from occipital, semispinalis capitis, trapezius and sternocleidomastoid muscles. Every patient was diagnosed with: migraine without aura, chronic tensiontype headache and new daily persistent headache, refractory to medical management.
RESULTS
Analyzing the answers given by the patients to validated questionnaires, 9 referred alleviation of migraine symptoms (45%), 8 described elimination of their migraine headaches (40%) while 3 didn't report any improvement.
DISCUSSION
Our data confirmed the results of previous studies, pointing out the effectiveness of trigeminal branches and occipital nerves (trigger points) decompression from the surrounding muscles. Moreover, our technique has the same results but it's less invasive and has less collateral effects.
CONCLUSIONS
Our results highlight migraine surgery as an effective treatment for patients with migraine headaches who do not tolerate or do not wish to continue medical interventions.
KEY WORDS
Endoscopic surgery, Headache migraine.
Topics: Endoscopy; Facial Muscles; Female; Forehead; Humans; Male; Migraine Disorders; Surveys and Questionnaires; Treatment Outcome
PubMed: 25711848
DOI: No ID Found -
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 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2015To determine the efficacy of type A botulinum toxin (lantox) in the treatment of chronic migraine.
OBJECTIVE
To determine the efficacy of type A botulinum toxin (lantox) in the treatment of chronic migraine.
MATERIAL AND METHODS
Authors examined 22 patients with chronic migraine at baseline and 4 and 12 weeks after the introduction of 150 U of lantox in head and cervical muscles using "follow the pain method". The drug was introduced into the following muscles: m. corrugator, m. procerus, m. frontalis, m. temporalis and m. оccipitalis. Clinical/neurological examinations, a study of the emotional sphere (anxiety and depression), daily activities, quality-of-life, patient's completion of questionnaires on the subjective satisfaction with treatment were carried out.
RESULTS AND CONCLUSION
There was a significant positive effect of treatment on the frequency of headache attacks that was important for reverse transformation of chronic pain to episodic headache. Barriers in compliance may be overcome by solving psychological problems, in particular, overcoming depression. The prescription of the drug with no side-effects and fast results allows to support the adherence of the patient to treatment.
Topics: Activities of Daily Living; Botulinum Toxins, Type A; Chronic Pain; Depression; Drug Prescriptions; Humans; Migraine Disorders; Patient Compliance; Quality of Life; Surveys and Questionnaires; Treatment Outcome
PubMed: 26978496
DOI: 10.17116/jnevro201511511270-73 -
Dermatologic Surgery : Official... Jan 2015Various preparations of botulinum toxin type A (BTX-A) are used to reduces glabellar (frown) lines. However, dose-related safety and efficacy of intramuscular injections... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Various preparations of botulinum toxin type A (BTX-A) are used to reduces glabellar (frown) lines. However, dose-related safety and efficacy of intramuscular injections of a widely used, locally produced BTX-A in China has not been established.
OBJECTIVE
Assessment of dose-dependent safety and efficacy of Chinese botulinum toxin type A (Hengli BTX-A [HBTX-A]) intramuscular injections on glabellar lines.
METHODS
Four hundred eighty-eight BTX-A-naive participants were included in the double-blind trial and randomly divided into placebo (n = 122), low-dose (n = 183), and high-dose (n = 183) treatment groups for injection with saline solution, 10 units and 20 units of HBTX-A, respectively, at 4 sites in the corrugator muscle and 1 site in the procerus muscle. Outcomes were recorded before treatment and after 7, 30, 60, and 120 days, including glabellar line severity at maximum contraction and relaxation.
RESULTS
Significantly greater improvement was observed in both HBTX-A groups in comparison with the placebo group (p < .05). Better efficacy was obtained in the high-dose treatment group. More participants developed adverse events after treatment with HBTX-A doses, than with the placebo (p < .05).
CONCLUSION
Twenty-unit HBTX-A provided optimal improvement in glabellar lines, and its use might minimize injection frequency while maintaining acceptable safety.
Topics: Adult; Blepharoptosis; Botulinum Toxins, Type A; Dizziness; Double-Blind Method; Female; Forehead; Headache; Humans; Injections, Intramuscular; Male; Neuromuscular Agents; Patient Satisfaction; Skin Aging; Treatment Outcome
PubMed: 25548846
DOI: 10.1097/DSS.0000000000000265 -
Plastic and Reconstructive Surgery.... Jun 2014Magnetic resonance imaging (MRI) has not yet been established systematically to detect structural muscular changes after facial nerve lesion. The purpose of this pilot...
BACKGROUND
Magnetic resonance imaging (MRI) has not yet been established systematically to detect structural muscular changes after facial nerve lesion. The purpose of this pilot study was to investigate quantitative assessment of MRI muscle volume data for facial muscles.
METHODS
Ten healthy subjects and 5 patients with facial palsy were recruited. Using manual or semiautomatic segmentation of 3T MRI, volume measurements were performed for the frontal, procerus, risorius, corrugator supercilii, orbicularis oculi, nasalis, zygomaticus major, zygomaticus minor, levator labii superioris, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis, as well as for the masseter and temporalis as masticatory muscles for control.
RESULTS
All muscles except the frontal (identification in 4/10 volunteers), procerus (4/10), risorius (6/10), and zygomaticus minor (8/10) were identified in all volunteers. Sex or age effects were not seen (all P > 0.05). There was no facial asymmetry with exception of the zygomaticus major (larger on the left side; P = 0.012). The exploratory examination of 5 patients revealed considerably smaller muscle volumes on the palsy side 2 months after facial injury. One patient with chronic palsy showed substantial muscle volume decrease, which also occurred in another patient with incomplete chronic palsy restricted to the involved facial area. Facial nerve reconstruction led to mixed results of decreased but also increased muscle volumes on the palsy side compared with the healthy side.
CONCLUSIONS
First systematic quantitative MRI volume measures of 5 different clinical presentations of facial paralysis are provided.
PubMed: 25289366
DOI: 10.1097/GOX.0000000000000128