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Aesthetic Plastic Surgery Feb 2022Currently, botulinum toxin (BoNT) injections are the most commonly performed non-invasive procedure for rejuvenation on the upper face. The therapeutic use of botulinum... (Review)
Review
BACKGROUND
Currently, botulinum toxin (BoNT) injections are the most commonly performed non-invasive procedure for rejuvenation on the upper face. The therapeutic use of botulinum toxin has generally been safe and well tolerated. Adverse effects are considered mild, transient, and self-limited. However, as with all other injectable procedures, this one is also susceptible to adverse events and complications. When the safety zones are respected, the chance of any of these complications is practically null. Thus, this review aims to describe the main complications of treatment with BoNT on the upper face and to present a practical guide based on current evidence on how to avoid them.
METHODS
The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles.
RESULTS
The main complications secondary to BoNT injections on the upper face are: ptosis of eyelid or eyebrow, eyebrow asymmetry, diplopia, Lakeophthalmos, Palpebral ectropion, and prominence of the palpebral bags. To avoid such complications, it is necessary to have knowledge of the anatomy of this region and adequate and individualized planning based on the existing patterns of the frontalis muscle, glabella, and crow's feet. This review presents the specificities of each of these regions and practical suggestions to obtain satisfactory results, avoiding complications.
CONCLUSION
Particularly on the upper face treatment with BoNT offers predictable results, has few adverse effects, and is associated with high patient satisfaction. However, it is suggested that the commented parameters and safety areas be incorporated into daily practice so that the possibilities of complications are minimized as much as possible.
LEVEL OF EVIDENCE III
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: Botulinum Toxins, Type A; Face; Forehead; Humans; Rejuvenation; Skin Aging
PubMed: 34341857
DOI: 10.1007/s00266-021-02483-1 -
Toxins Jan 2023Botulinum toxin (BoNT) is an anaerobic rod-shaped-neurotoxin produced by Clostridium botulinum, that has both therapeutic and lethal applications. BoNT injection is the... (Review)
Review
Botulinum toxin (BoNT) is an anaerobic rod-shaped-neurotoxin produced by Clostridium botulinum, that has both therapeutic and lethal applications. BoNT injection is the most popular cosmetic procedure worldwide with various applications. Patients with dynamic wrinkles in areas such as the glabella, forehead, peri-orbital lines, nasal rhytides, and perioral rhytides are indicated. Excessive contraction of muscles or hyperactivity of specific muscles such as bulky masseters, cobble stone chins, gummy smiles, asymmetric smiles, and depressed mouth corners can achieve esthetic results by targeting the precise muscles. Patients with hypertrophic submandibular glands and parotid glands can also benefit esthetically. There are several FDA-approved BoNTs (obabotuli-numtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, letibotulinumtoxinA, prabotulinumtox-inA, daxibotulinumtoxinA, rimbotulinumtoxinB) and novel BoNTs on the market. This paper is a narrative review of the consensus statements of expert practitioners and various literature on the injection points and techniques, highlighting both the Asian and Caucasian population separately. This paper can serve as a practical illustrative guide and reference for optimal, safe injection areas and effective doses for application of BoNT in the face and oral and maxillofacial area. The history of BoNT indications, contraindications, and complications, and the merits of ultrasonography (US)-assisted injections are also discussed.
Topics: Humans; Botulinum Toxins, Type A; Face; Forehead; Neurotoxins; Cosmetic Techniques; Esthetics; Neuromuscular Agents
PubMed: 36828397
DOI: 10.3390/toxins15020082 -
Annals of Agricultural and... Jun 2022Despite a significant increase in reported cases of frontal fibrosing alopecia (FFA) in literature, discussion about the possible role of environmental factors,... (Review)
Review
Despite a significant increase in reported cases of frontal fibrosing alopecia (FFA) in literature, discussion about the possible role of environmental factors, instruction for diagnosis and guideline for treatment, are limited. The review aims to provide a detailed synthesis of this condition that could be used by clinicians in their practise. Whether single-centre or multi-centre, studies of more than 60 cases less than 5 years old were mainly taken into consideration. Results obtained were that FFA affects mainly postmenopausal Caucasian women; the most common comorbidities are hyperlipidaemia, arterial hypertension, osteoporosis, hypothyroidism, depression, alongside dermatological disorders such as atopic dermatitis, rosacea, seborrheic dermatitis and androgenetic alopecia. Autoimmune, genetic, hormonal (e.g. estrogen deficiency, pregnancy, lactation, HRT and raloxifene) and environmental (e.g. daily use of facial sunscreens and less frequent use of hair dyes and shampoo) hypotheses were proposed for pathogenesis, as well as association with various predisposing factors (patient's health-social profile, disease's history and comorbidities). Clinical presentation of FFA can be divided into 3 specific patterns, each with a different prognosis. Diagnosis is usually made clinically with the use of trichoscopy; however, scalp biopsy remains the gold standard. The condition is regarded as a variant of lichen planopilaris (LPP) due to the similarity of the prominent histopathological findings, but the clinical image is distinct and therapeutic options vary. 5α-reductase inhibitors, intralesional steroids, and hydroxychloroquine provide the highest level of evidence for the treatment of FFA. The conclusion is that a better understanding of the disease is crucial for proper disease management.
Topics: Alopecia; Child, Preschool; Female; Forehead; Humans; Hydroxychloroquine; Lichen Planus; Scalp
PubMed: 35767748
DOI: 10.26444/aaem/141324 -
Toxins Apr 2022Botulinum neurotoxin injection for treating glabellar frown lines is a commonly used method; however, side effects, such as ptosis and samurai eyebrow, have been... (Review)
Review
Botulinum neurotoxin injection for treating glabellar frown lines is a commonly used method; however, side effects, such as ptosis and samurai eyebrow, have been reported due to a lack of comprehensive anatomical knowledge. The anatomical factors important for the injection of the botulinum neurotoxin into the corrugator supercilii muscle has been reviewed in this study. Current understanding on the localization of the botulinum neurotoxin injection point from newer anatomy examination was evaluated. We observed that for the glabellar-frown-line-related muscles, the injection point could be more accurately demarcated. We propose the injection method and the best possible injection sites for the corrugator supercilii muscle. We propose the optimal injection sites using external anatomical landmarks for the frequently injected muscles of the face to accelerate effective glabellar frown line removal. Moreover, these instructions would support a more accurate procedure without adverse events.
Topics: Botulinum Toxins; Botulinum Toxins, Type A; Eyebrows; Facial Muscles; Forehead; Neuromuscular Agents; Skin Aging
PubMed: 35448877
DOI: 10.3390/toxins14040268 -
Acta Dermatovenerologica Alpina,... Sep 2018Among several skin fillers developed in recent decades, hyaluronic acid (HA) fillers have become the material of choice. They are safe, long-lasting, not immunogenic,...
Among several skin fillers developed in recent decades, hyaluronic acid (HA) fillers have become the material of choice. They are safe, long-lasting, not immunogenic, and cost effective, and they can be removed with hyaluronidase. Unfortunately, early and delayed complications can also occur following HA filler injection. Here we report the case of a hyaluronic filler-related complication in a 50-year-old female patient. The locations affected were the forehead, glabella, and nose. Three days after HA filler application in the upper lip, glabellar region, and nasal root, with no immediate diverse reaction at the time of application, an erythematous, livedoid rash with a well-defined border occurred at the site of the injection in the glabellar region, including the area from the nasal root to the scalp and left upper eyelid. Because an infection or allergy was suspected, she was first given an antibiotic for 6 days p.o. and later also a corticosteroid systemically with good results. Two years later (in 2017) the patient decided to repeat the treatment with HA injections in the glabellar region and experienced no adverse reactions.
Topics: Cosmetic Techniques; Dermal Fillers; Exanthema; Female; Forehead; Humans; Hyaluronic Acid; Injections, Subcutaneous; Middle Aged; Nose
PubMed: 30244271
DOI: No ID Found -
Aesthetic Surgery Journal Apr 2022Botulinum toxin A (BoNT-A) injections are a popular non-surgical procedure for facial rejuvenation. Its increase in popularity and utilization is met with limited... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Botulinum toxin A (BoNT-A) injections are a popular non-surgical procedure for facial rejuvenation. Its increase in popularity and utilization is met with limited regulations, potentially posing a significant risk to patient safety and public health.
OBJECTIVES
The authors sought to assess the safety profile of cosmetic glabellar and forehead BoNT-A injections and evaluate BoNT-A type on complication rate.
METHODS
A systematic search of MEDLINE and EMBASE was performed for studies reporting complications after cosmetic BoNT-A in the glabellar or in the forehead region in the glabellar or in the forehead region. A random effects meta-analysis was carried out to assess complication rate. Where there were sufficient randomized-controlled trials, a network meta-analysis was performed.
RESULTS
Of 556 identified articles, 24 were included in the final quantitative analysis, with 4268 BoNT-A injection sessions and 1234 placebos. Frequently observed treatment-related complications in the BoNT-A intervention group included headache, local skin reactions, and facial neuromuscular symptoms. The overall BoNT-A complication rate was 16%. The odds ratio of developing complications from abobotulinum toxin injections compared with placebo was 1.62 (1.15, 2.27; P > 0.05) and that from onabotulinum toxin injections compared with placebo was 1.34 (0.52, 3.48; P > 0.05). In 30% of the studies, the injectors were doctors, whereas the training status of the practitioner was not reported in the remaining 70%.
CONCLUSIONS
Cosmetic BoNT-A injections in the glabellar and forehead region appear to be safe, and most complications are mild and transient. Nevertheless, the literature demonstrates heterogeneous reporting of complications and a lack of consistency of the definition of treatment-related complications.
Topics: Botulinum Toxins, Type A; Face; Forehead; Humans; Neuromuscular Agents; Skin Aging
PubMed: 35178552
DOI: 10.1093/asj/sjac036 -
Current Opinion in Otolaryngology &... Aug 2021Total nasal reconstruction is a unique plastic surgery challenge of the highest order. The history of nasal reconstruction dates back to ancient times and it remains a... (Review)
Review
PURPOSE OF REVIEW
Total nasal reconstruction is a unique plastic surgery challenge of the highest order. The history of nasal reconstruction dates back to ancient times and it remains a fundamental challenge today. This article reviews the historical context of nasal reconstruction, and highlights how the essential tenets of this art have been conserved over millennia.
RECENT FINDINGS
The disfiguring and brutal practice of nasal amputation created a demand for 'nosemakers' in India since 1500 BC. In 600 BC, Sushruta described the use of a leaf to make a template of the wound, and a cheek flap to supply tissue. In the 1400-1500s, the Italians relied on similar flap concepts, but employed a pedicled arm flap for soft tissue coverage. Eventually, the forehead flap, or 'Indian method' of nasal reconstruction, made its way to Europe in the 1800s. Its use has been a fundamental component of nasal reconstruction to this day.
SUMMARY
Knowledge of the unique history of nasal reconstruction permits appreciation of this surgical integration of art and science. The story of nasal reconstruction has been one of global contribution and creativity that has stood the test of time.
Topics: Forehead; Humans; Nose; Plastic Surgery Procedures; Rhinoplasty; Surgical Flaps
PubMed: 34074876
DOI: 10.1097/MOO.0000000000000730 -
Deutsches Arzteblatt International Feb 2020
Topics: Adult; Forehead; Humans; Magnetic Resonance Imaging; Male; Sinus Pericranii
PubMed: 32181738
DOI: 10.3238/arztebl.2020.0136a -
BMJ Case Reports Nov 2019
Topics: Adult; Diagnosis, Differential; Disease Progression; Forehead; Humans; Knee Joint; Male; Osteoarthropathy, Primary Hypertrophic; Wrist
PubMed: 31748366
DOI: 10.1136/bcr-2019-232238 -
Scientific Reports Apr 2023This article reviewed our experience of Chinese nasal reconstruction over 12 years and evaluated the effect of expanded forehead flap both aesthetically and... (Review)
Review
This article reviewed our experience of Chinese nasal reconstruction over 12 years and evaluated the effect of expanded forehead flap both aesthetically and functionally. The special skin type and other anatomic features of Chinese patients was understood thoroughly during the treatment. This article thus catered for the need of multiracial nasal reconstruction. We analyzed existing clinical data and demonstrated a typical case in detail. The postoperative result supported our strategy which advocated the extensive application of expanded forehead flap, together with flip scar flap as the internal lining. The features of Chinese patients also prompted the use of costal and auricular cartilage. Emerging technology like 3D-printing would benefit nasal reconstruction from more aspects.
Topics: Humans; Rhinoplasty; Forehead; Nose; Surgical Flaps; Nose Neoplasms
PubMed: 37015929
DOI: 10.1038/s41598-023-30245-3