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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 -
Internal Medicine (Tokyo, Japan) 2007To evaluate the efficacy and tolerability of Botulinum Toxin Type A (BoNT-A) for migraine prophylaxis. (Clinical Trial)
Clinical Trial
OBJECTIVE
To evaluate the efficacy and tolerability of Botulinum Toxin Type A (BoNT-A) for migraine prophylaxis.
METHODS
Nineteen Japanese adult patients (50 +/- 10 years old), who met the International Classification of Headache Disorders 2nd Edition (ICHD II) criteria for migraine and had five or more migraine attacks a month, were enrolled in this open-label prospective study. A total of 50 units of BoNT-A were injected in 19-fixed sites of the muscles including procerus, corrugator, frontalis, temporalis and occipitalis. All participants were advised to stop taking preventive medicine from one month before and three months after BoNT-A injection. Migraine disability assessment (MIDAS), migraine questionnaire and headache diary were used for the evaluation of efficacy. Seven patients received repeated injection combined with prophylactic medication.
RESULT
We excluded five patients from the analysis because four patients had medication overuse headache and one continued preventive medicine. Mean MIDAS score decreased significantly two months after the injection. Thirteen of 14 patients stated subjective improvement after the injection on the migraine questionnaire. The amount of analgesics consumption or headache frequency did not change after injection, but the frequency of severe migraine attacks decreased significantly. No serious adverse event was reported. Repeated injections also showed significant reduction in MIDAS score three months after the second and third injections.
CONCLUSION
BoNT-A injection was an effective and safe treatment for migraine prophylaxis among the Japanese population. A randomized placebo control trial is necessary to confirm its efficacy.
Topics: Adult; Botulinum Toxins, Type A; Disability Evaluation; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Japan; Male; Middle Aged; Migraine Disorders; Neuromuscular Agents; Pain Measurement; Probability; Prospective Studies; Risk Assessment; Severity of Illness Index; Single-Blind Method; Statistics, Nonparametric; Treatment Outcome
PubMed: 17603233
DOI: 10.2169/internalmedicine.46.6416 -
Rinsho Shinkeigaku = Clinical Neurology Nov 2006The goal of medical therapy for primary dystonia is conservative. While botulinum toxin (BTX) therapy is a first choice for blepharospasm and cervical dystonia, medical... (Review)
Review
The goal of medical therapy for primary dystonia is conservative. While botulinum toxin (BTX) therapy is a first choice for blepharospasm and cervical dystonia, medical therapy is selected as such for other types of dystonia. As oral medications, trihexyphenidyl and benzodiazepines are most frequently used. Muscle relaxants are also commonly used, but dopamine antagonists are not recommended because of the risk of inducing tardive dyskinesia. For childhood-onset generalized dystonia, levodopa should be considered to rule out levodopa-responsive dystonia. Mexiletine is reported to be effective not only for bleharospasm and cervical dystonia but for focal limb dystonia. To improve the therapeutic performance of BTX therapy for blepharospasm, it is recommended that corrugator supercilii and procerus muscles, as well as orbicularis oculi muscle, be added as target muscles. To improve the therapeutic performance of BTX therapy for cervical dystonia, it is recommended that this therapy be started as early as possible, especially within one year of illness, and that levator scapulae muscle be added as target if necessary. To improve usefulness of medical therapy for dystonia, its strategy must be standardized, and more useful therapies must be positively adopted. Algorithm for treatment of dystonia must also be established and generalized.
Topics: Blepharospasm; Botulinum Toxins; Dystonia; Humans; Torticollis
PubMed: 17432235
DOI: No ID Found -
HNO Mar 2007Endoscopic forehead lifting is a widely accepted treatment for brow ptosis. The procedure safely and effectively corrects horizontal forehead rhytids, brow ptosis, upper... (Review)
Review
Endoscopic forehead lifting is a widely accepted treatment for brow ptosis. The procedure safely and effectively corrects horizontal forehead rhytids, brow ptosis, upper eyelid dermatochalasis and periorbital crow's feet. The result is a refreshed and more open facial expression. A thorough understanding of basic facial anatomy is the key to successful cosmetic surgery. The procedure is based on a subperiostal and preperiosteal mobilisation of the temporal and frontal soft tissues and a detachment of the periosteum of the orbital rim. An upper eyelid blepharoplasty and selective incomplete or complete myotomies of the corrugator and procerus muscles may be incorporated in the operation. Most surgeons prefer to fixate the elevated soft tissue planes to the calvarium by sutures, titanium or resorbabale polyglactid anchors. While initial enthusiasm for this procedure seems to be declining in several countries, few ENT-surgeons are familiar with this technique in Europe. This article reviews the surgical anatomy of the forehead and temporoparietal region by means of cadaver dissection and describes the surgical procedure for German speaking readers.
Topics: Blepharoplasty; Blepharoptosis; Endoscopy; Forehead; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians'; Plastic Surgery Procedures
PubMed: 17294146
DOI: 10.1007/s00106-006-1524-2 -
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 -
Facial Plastic Surgery : FPS May 2006Age-related changes to the upper third of the face manifest, typically, as brow ptosis and the development of deep skin furrows. Depression of the brow evolves as... (Review)
Review
Age-related changes to the upper third of the face manifest, typically, as brow ptosis and the development of deep skin furrows. Depression of the brow evolves as gravity and the action of the corrugator supercilli, procerus, and orbicularis draw on the progressively inelastic forehead skin. Facial mimetic muscle action reveals itself over time via the development of deep forehead rhytids. Facial plastic surgeons have at their disposal several effective surgical, and recently, medical interventions to address these changes. Each technique has merits and suitable applications. This review examines the history of rejuvenation of the upper face, details the pertinent treatment modalities, and evaluates the context in which each is applicable.
Topics: Botulinum Toxins, Type A; Eyebrows; Face; Facial Muscles; Forehead; Humans; Neuromuscular Agents; Rejuvenation; Rhytidoplasty; Skin Aging
PubMed: 16847799
DOI: 10.1055/s-2006-947714 -
The Journal of Craniofacial Surgery May 2006The aim of this study is to elucidate innervation of the procerus muscle, which is attributed mainly to transverse lines on the radix nasi and indirectly to glabella...
The aim of this study is to elucidate innervation of the procerus muscle, which is attributed mainly to transverse lines on the radix nasi and indirectly to glabella frown line. Twenty-three hemifaces of Korean adult cadavers were dissected. In all specimens, the procerus muscle was supplied by the buccal branch of the facial nerve, which coursed infraorbitally. The number of the buccal branches varied: three in 47.8%, two in 47.8%, and one in 4.4% of the specimens. The buccal branch crosses the intercanthal line (nasion to the medial canthus) at approximately lateral one third. The nerve entrance was within a circle with a diameter of 5 mm and its center located 9 mm lateral and 10 mm superior from nasion. It was about a midpoint of lateral half of intercanthal line and lower one third between the intercanthal line and tangential line of the supraorbital rim. The anatomical knowledge might be contributive to depletion of transverse lines on the nasal bridge and function of the procerus muscle.
Topics: Adult; Cadaver; Eyelids; Facial Muscles; Facial Nerve; Forehead; Humans; Nose; Orbit
PubMed: 16770185
DOI: 10.1097/00001665-200605000-00016 -
Journal of Plastic, Reconstructive &... 2006Elimination of glabellar frown lines by direct denervation of the corrugator and procerus muscles has proven elusive. Furrows often persist after the frontal branch of...
BACKGROUND
Elimination of glabellar frown lines by direct denervation of the corrugator and procerus muscles has proven elusive. Furrows often persist after the frontal branch of the facial nerve has been divided. In order to find an explanation for these observations and to provide an anatomic basis for future surgical strategies, the pattern of innervation of these muscles was studied.
METHODS
Two separate investigations were performed: (1) cadaveric anatomical dissection in 18 fresh cadaver hemi-faces utilizing loupe magnification, operating microscope, and template tracings; and (2) electrophysiologic testing performed in 12 healthy volunteers utilizing a Viking Ile nerve stimulator (Nicolet, Madison, WI).
RESULTS
The corrugator was found to have a dual nerve supply with contributions from branches of the frontal, zygomatic and buccal branches of the facial nerve. The frontal branch passes deep to the orbicularis at the level of the eyebrow; and the buccal branch, after receiving a contribution from the zygomatic, forms the angular nerve, which then passes superiorly in front of the medial canthus to supply both corrugator and procerus. The procerus muscle was found to receive contributions from the angular nerve exclusively.
CONCLUSIONS
Procedures designed to denervate the corrugator should be directed at both components of its redundant nerve supply, the frontal branch as well as the angular nerve. Division of the angular nerve will also denervate the procerus muscle. Both frontal nerve branches and angular nerve components are accessible through an upper blepharoplasty incision.
Topics: Cadaver; Dissection; Eyebrows; Facial Muscles; Facial Nerve; Forehead; Humans; Neural Conduction
PubMed: 16756251
DOI: 10.1016/j.bjps.2005.09.011 -
Archives of Dermatology Mar 2006To investigate the efficacy and safety of 2 injection site patterns (3- and 5-injection patterns [30 and 50 U]) of botulinum toxin A (Dysport; Ipsen Pharma, Ettlingen,... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy and safety of 3- and 5-injection patterns (30 and 50 U) of botulinum toxin A (Dysport) for the treatment of wrinkles in the glabella and the central forehead region.
OBJECTIVE
To investigate the efficacy and safety of 2 injection site patterns (3- and 5-injection patterns [30 and 50 U]) of botulinum toxin A (Dysport; Ipsen Pharma, Ettlingen, Germany), in the treatment of glabellar and central forehead wrinkles.
DESIGN
Multicenter, double-blind, placebo-controlled, randomized, 16-week trial.
SETTING
Twenty-three German dermatologic centers.
PATIENTS
Two hundred twenty-one patients with moderate or severe glabellar wrinkles when frowning maximally. Intervention Centers were randomly assigned to the 3-injection site pattern (3 injections of 10 U of botulinum toxin A or placebo) or 5-injection site pattern (5 injections of 10 U of botulinum toxin A or placebo). All centers used 3 sites in the procerus and corrugator muscles; the 2 additional sites were approximately 1-cm cranial from the corrugator sites.
MAIN OUTCOME MEASURE
Wrinkle severity was graded by 4 independent experts blinded to the treatment received using digital photographs and a standardized clinical scale (range, 0 [no wrinkles] to 3 [severe wrinkles]). A reduction of at least 1 point between weeks 0 and 4 was considered a therapeutic success (responder).
RESULT
One hundred ten patients (73 receiving botulinum toxin A vs 37 receiving placebo) received 3 injections; 111 patients (73 receiving botulinum toxin A vs 38 receiving placebo) received 5 injections. After 4 weeks, the proportions of responders were 86.1% vs 18.9% and 86.3% vs 7.9%, respectively (P<.001 for both). No major adverse effects were observed.
CONCLUSIONS
The 3 central injection sites are essential for the treatment of glabellar wrinkles. The 2 additional injection sites in the forehead region, targeting the frontalis muscle, did not significantly improve efficacy.
Topics: Adolescent; Adult; Aged; Botulinum Toxins, Type A; Cosmetic Techniques; Double-Blind Method; Facial Muscles; Female; Forehead; Humans; Injections, Intramuscular; Male; Middle Aged; Neuromuscular Agents; Patient Satisfaction; Skin Aging
PubMed: 16549707
DOI: 10.1001/archderm.142.3.320 -
Dermatologic Surgery : Official... Jan 2006This 44-year-old healthy white male was referred to our office for the treatment of a recurrent basal cell carcinoma clinically involving the left inferior forehead...
This 44-year-old healthy white male was referred to our office for the treatment of a recurrent basal cell carcinoma clinically involving the left inferior forehead extending down to the left glabellar region of the face. The preoperative size of the tumor was 1.5 x 1.5 cm (Figure 1). The lesion had been present since 1998 and had undergone previous liquid nitrogen treatment and, subsequently, excisional surgery. The patient had no significant medical history, and the only medication he had been taking was ibuprofen as needed. The patient did not smoke, nor did he have a history of diabetes. After discussing the various treatment options with the patient, he opted to undergo Mohs micrographic surgery. After two stages, the tumor was fully removed, and the defect measured 2.0 3 2.3 cm (Figure 2). The postoperative defect extended through the frontalis muscle superiorly and the procerus muscle inferomedially, down to the periosteum. The left corrugator supercilli muscle was spared from removal. How would you manage this wound?
Topics: Adult; Carcinoma, Basal Cell; Facial Neoplasms; Forehead; Humans; Male; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Surgical Flaps
PubMed: 16393611
DOI: 10.1111/1524-4725.2006.32016