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Mitra R, Raja VBKK, Panneerselvam E. Comparison of Wrinkle Patterns Generated by Intradermal and Intramuscular Botulinum Toxin Injections by Clinical Evaluation. J Maxillofac Oral Surg 2024; 23:670-675. [PMID: 38911405 PMCID: PMC11189854 DOI: 10.1007/s12663-024-02141-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/18/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Botulinum toxin has played a remarkable role in management of forehead wrinkles. Most used is intramuscular technique due to its deposition into the muscles, however, with adverse effects like brow ptosis. This study has been designed for the evaluation of efficacy for intradermal v/s intramuscular route of botulinum toxin injections for forehead wrinkles using clinical correlation. Methods This study included a clinical trial of 32 facial halves divided equally into intradermal and intramuscular injection technique groups, receiving total dose of 8 U. Results were assessed by clinical examination upto 2 weeks and 4 weeks with parameters; objective wrinkle rate, eyebrow height, eyebrow movement, pain, and satisfaction after treatment. Result Results showed least mean for objective wrinkle rate in intramuscular group, showing statistically significant improvement. Overall improvement in eyebrow height and eyebrow movement were slightly more for intramuscular group. Pain was lesser for intradermal group, whereas satisfaction of patient of patient post treatment is similar for both the groups. Conclusion Among intradermal and intramuscular botulinum toxin injection technique, the effect and potency were better for intramuscular technique, whereas the patient comfort and compliance were better for intradermal technique.
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Affiliation(s)
- Rituparna Mitra
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, 600089 India
| | - V. B. Krishna Kumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, 600089 India
| | - Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, 600089 India
- Present Address: SRM Dental College, Bharathi Salai, Ramapuram, Chennai, Tamil Nadu 600089 India
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de Sanctis Pecora C, Pateo BV, Nunes GJDB, Queiroz AEML, da Silveira BRL, Van Loghen J. A Combined Approach Using IncobotulinumtoxinA and CPM-Hyaluronic Acid Injections for the Periorbital Complex Improvement: A Pilot Study. Aesthet Surg J Open Forum 2024; 6:ojae027. [PMID: 38938924 PMCID: PMC11210074 DOI: 10.1093/asjof/ojae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background Previous reports have objectively demonstrated the efficacy of botulinum toxin for brow elevation. No previous clinical trial has reported a combined approach to botulinum toxin A injection with hyaluronic acid (HA) injection in the upper face for periorbital region beautification focusing on eyebrow reshaping. Objectives To evaluate the effect of IncobotulinumtoxinA injection using the ONE21 technique combined with HA injection (CPM technology) to redefine brow shape and position. Methods A prospective pilot study was designed to evaluate the effect of IncobotulinumtoxinA injection using the ONE21 technique-with a preestablished scheme of doses and injection-site distribution-combined with HA injection (CPM technology) periosteally into the palpebromalar groove and subdermally in the anterior temporal region, to redefine brow shape and position. Objective eyebrow measurements were taken by an independent investigator using the Merz Aesthetic Scale (MAS) for brow positioning. Patient satisfaction was also evaluated. Some patients were also assessed using the Vectra System (Canfield Scientific, Parsippany, NJ). Results Eleven females, aged 29 to 55 years, were included in this prospective pilot study. The totality of patients (11/100%) had at least ≥1-point improvement in the MAS brow positioning. All patients (100%) reported significant aesthetic improvement of their periorbital region and appearance, with 82% of the patients much improved. Mild side effects, such as ecchymosis and transient temporal edema, were reported. Conclusions The combined technique improved the appearance of the orbital area by uplifting the lateral eyebrow and creating an almond-shaped eye effect, which characterizes the trending marketing term Foxy eyes. Further studies, including more cases, are needed to obtain a statistically significant outcome. Level of Evidence 4
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Affiliation(s)
- Carla de Sanctis Pecora
- Corresponding Author: Dr Carla de Sanctis Pecora, Avenida Dr Cardoso de Melo, 1308, 04548-004 São Paulo, Brazil. E-mail:
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Bertucci V, Huang C. Neuromodulator Assessment and Treatment for the Upper Face: An Update. Dermatol Clin 2024; 42:51-62. [PMID: 37977684 DOI: 10.1016/j.det.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Neuromodulator treatment of the upper face has been extensively studied and serves as an excellent tool to enhance facial appearance, non-verbal communication, and social functioning. Optimal outcomes are best achieved when health care providers take an individualized approach, based on knowledge of structural and functional anatomy, thorough facial assessment, and customized injection techniques and patterns.
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Affiliation(s)
- Vince Bertucci
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Private Practice, 100-8333 Weston Road, Woodbridge, Ontario L4L 8E2, Canada.
| | - Christina Huang
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Bertucci V, Green JB, Fezza JP, Brown J, Gallagher CJ, Solish N. Impact of Glabellar Injection Technique With DaxibotulinumtoxinA for Injection on Brow Position. Aesthet Surg J 2023; 43:S10-S18. [PMID: 36322141 PMCID: PMC10638665 DOI: 10.1093/asj/sjac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Precise injection technique is vital for avoiding suboptimal eyebrow position when treating glabellar lines with botulinum toxin type A. OBJECTIVES The aim of this study was to evaluate the impact of glabellar injection technique on eyebrow position in patients treated with DaxibotulinumtoxinA for Injection (DAXI). METHODS This retrospective post hoc analysis involved 60 adults who received a single treatment with DAXI 40 U to the glabella and had standardized facial photography. Median vertical and horizontal displacement of the brows (at rest) at baseline and 2 weeks after glabellar injection were measured. Brow position outcomes were evaluated by an oculoplastic surgeon and expert anatomist. Investigators were interviewed to ascertain individual injection techniques. RESULTS Precise injection location and depth, and median resting brow position following treatment varied between investigators. Positive brow outcomes were achieved with deep DAXI injections into the medial corrugator, superficial lateral corrugator injections placed between the midpupil and lateral limbus, and deep midline procerus injections. Glabellar injection technique that more precisely targeted the corrugator muscles resulted in longer glabellar line treatment duration compared to a less targeted technique. Medial corrugator injections above the medial brow; lateral corrugator injections administered deeply or more medially, toward the medial third of the brow; and procerus injections superior to the inferomedial brow tended to be associated with suboptimal outcomes that were more apparent during dynamic expression. CONCLUSIONS Aesthetically pleasing brow outcomes and greater duration of efficacy can be achieved with an injection pattern that precisely treats the anatomic location of the corrugator supercilii and procerus muscles, avoiding the frontalis. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | - Jessica Brown
- Corresponding Author: Dr Jessica Brown, Medical Affairs, Revance Therapeutics, Inc., 1222 Demonbreun St, Nashville, TN, 37203, USA. E-mail:
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Bertucci V, Carruthers JD, Sherman DD, Gallagher CJ, Brown J. Integrative Assessment for Optimizing Aesthetic Outcomes When Treating Glabellar Lines With Botulinum Toxin Type A: An Appreciation of the Role of the Frontalis. Aesthet Surg J 2023; 43:S19-S31. [PMID: 36322138 PMCID: PMC10638666 DOI: 10.1093/asj/sjac267] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Despite the perception that treatment of glabellar lines with botulinum toxin A is straightforward, the reality is that the glabellar region contains a number of interrelated muscles. To avoid adverse outcomes, practitioners need to appreciate how treatment of 1 facial muscle group influences the relative dominance of others. In particular, practitioners need to understand the independent role of the frontalis in eyebrow outcomes and the potential for negative outcomes if the lower frontalis is unintentionally weakened by botulinum toxin A treatment. In addition, practitioners must recognize how inter-individual variation in the depth, shape, and muscle fiber orientation among the upper facial muscles can affect outcomes. For optimal results, treatment of the glabellar complex requires a systematic and individualized approach based on anatomical principles of opposing muscle actions rather than a one-size-fits-all approach. This review provides the anatomical justification for the importance of an integrated assessment of the upper facial muscles and eyebrow position prior to glabellar treatment. In addition, a systematic and broad evaluation system is provided that can be employed by practitioners to more comprehensively assess the glabellar region in order to optimize outcomes and avoid negatively impacting resting brow position and dynamic brow movement. LEVEL OF EVIDENCE: 5
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Affiliation(s)
| | | | | | | | - Jessica Brown
- Corresponding Author: Dr Jessica Brown, Medical Affairs, Revance Therapeutics, Inc., 1222 Demonbreun St, Nashville, TN, 37203, USA. E-mail:
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Walker B, Hand M, Chesnut C. Forehead Movement Discrepancies After Botulinum Toxin Injections: A Review of Etiology, Correction, and Prevention. Dermatol Surg 2022; 48:94-100. [PMID: 34537780 DOI: 10.1097/dss.0000000000003218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Forehead rhytides are a popular target for botulinum toxin injections, but neuromodulation of the frontalis can be fraught with complications because of its anatomic complexity and integral role in brow position and expressivity. OBJECTIVE This article explores common forehead movement discrepancies that can occur after neuromodulation of the frontalis, as well as how to correct and prevent them. METHODS A review of the literature was conducted and combined with clinical experience to examine underlying forehead anatomy, etiology and correction of forehead movement discrepancies, and important factors to consider before injecting the frontalis with botulinum toxin. RESULTS AND CONCLUSION Variable anatomy from person to person necessitates an individualized treatment approach to achieve the best cosmetic results and prevent the occurrence of forehead movement discrepancies.
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Affiliation(s)
- Bridget Walker
- Department of Dermatology, Geisinger Health System, Danville, Pennsylvania
| | - Matthew Hand
- University of Washington School of Medicine, Seattle, Washington
- Chesnut MD Cosmetic Surgery Fellowship, Spokane, Washington
| | - Cameron Chesnut
- University of Washington School of Medicine, Seattle, Washington
- Chesnut MD Cosmetic Surgery Fellowship, Spokane, Washington
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Glogau R, Kontis TC, Liu Y, Gallagher CJ. Progressive Improvement in Static Glabellar Lines After Repeated Treatment With DaxibotulinumtoxinA for Injection. Dermatol Surg 2021; 47:1579-1584. [PMID: 34417396 PMCID: PMC8612903 DOI: 10.1097/dss.0000000000003211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND DaxibotulinumtoxinA for Injection (DAXI) is a novel botulinum toxin in development that has demonstrated efficacy on dynamic glabellar lines. OBJECTIVE To evaluate the effect of repeated DAXI treatment on static glabellar lines. METHODS This post hoc analysis included adults with moderate or severe dynamic glabellar lines who were treated with 40U DAXI in the SAKURA clinical program. Glabellar line severity was evaluated through validated subject and investigator scales. RESULTS Overall, 568 subjects received 3 DAXI treatments. Most subjects were White (92.3%) and female (85.7%). At baseline, 9.0% and 27.3% of subjects had no static glabellar lines based on subject and investigator assessment, respectively. Four weeks after DAXI Treatment Cycle 1, the proportion of subjects with no static glabellar lines increased to 57.9% and 64.8% based on subject and investigator assessment, respectively. At Week 4 after DAXI Treatment Cycles 2 and 3, the proportion further increased to 68.7% and 71.5%, respectively, based on subject assessment and 75.0% and 77.6% based on investigator assessment. CONCLUSION Subjects who received repeated DAXI treatment showed progressive improvement in their static glabellar lines. The extended duration of therapeutic benefit with DAXI on dynamic glabellar lines likely provides a long period of muscle inactivity/hypoactivity, during which dermal remodeling can occur.
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Affiliation(s)
- Richard Glogau
- Department of Dermatology, University of California at San Francisco, San Francisco, California
| | - Theda C. Kontis
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Yan Liu
- Revance Therapeutics, Inc, Newark, California
| | - Conor J. Gallagher
- Department of Dermatology, University of California at San Francisco, San Francisco, California
- Revance Therapeutics, Inc, Newark, California
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Norman S. Lifting effect of onabotulinumtoxinA in patients treated for glabellar and crow's feet rhytids. J COSMET LASER THER 2021; 22:232-238. [PMID: 33944656 DOI: 10.1080/14764172.2021.1918341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OnabotulinumtoxinA injection can enhance the appearance of the eyes. This study evaluated the lifting effect of onabotulinumtoxinA treatment of the eye area. A retrospective, single-center audit of patients treated for glabellar and crow's feet rhytids was undertaken. Standardized photographs taken before and 2-4 weeks after treatment were assessed. Computer-based measurements were made of the height of the visible superior tarsal plate (STP) and brow (measured from upper eyelid lash edge to eyebrow base) at rest and maximum frown. One hundred patients were included (96 females; mean age: 46.2 ± 8.8 years). Mean onabotulinumtoxinA doses were 14.95 ± 0.61 units (glabella) and 17.83 ± 2.74 units (crow's feet). There were significant post-treatment increases in mean STP height at rest (left side, 0.76 ± 0.99 mm, p = .02; right side, 0.79 ± 0.94 mm, p = .01) and maximum frown (left, 2.25 ± 1.52 mm, p < .0001; right, 1.87 ± 1.34 mm, p < .0001), and mean brow height at rest (left side, 1.54 ± 1.49 mm, p = .0006; right side, 1.47 ± 1.84 mm, p = .0009) and maximum frown (left, 4.37 ± 2.29 mm, p < .0001; right, 4.16 ± 1.88 mm, p < .0001). OnabotulinumtoxinA injection is effective for elevating brow position and increasing STP show.
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Affiliation(s)
- Sarah Norman
- Aesthetic Practitioner, Private Practice, Cheshire, UK
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Abstract
When one considers the avalanche of new indications and uses for botulinum toxins, it is truly surprising that this has all happened in such a short time. And the safety and dependability of these products are profound, when used appropriately. There is still much to be discovered about the potential of this agent when you contemplate the profound non-cosmetic benefits reported by clinicians and scientists from around the world. The mechanism of action has been studied in depth, and yet the benefits appreciated by people with chronic migraine or major depressive disorder, for instance, are unlikely to be explained by our current mechanistic understanding. Given that these toxins control acetylcholine at the motor end plates, and given that acetylcholine is central to practically every cell in the body, it will not be surprising to find that botulinum toxin researchers will be enjoying many decades of fruitful studies. The advent of the non-surgical aesthetic physician has helped push the clinical utilization of botulinum toxins well beyond its original adoption by oculoplastic surgeons in their patients with blepharospasm. We can expect that the next edition of this book to have a dozen or more new indications which will surprise us all.
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Lapa T, Mandavia R, Gentile R. Botulinum Toxin for the Head and Neck: a Review of Common Uses and Recent Trends. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wanitphakdeedecha R, Kantaviro W, Suphatsathienkul P, Tantrapornpong P, Yan C, Apinumtham C, Srinoulprasert Y. Association Between Secondary Botulinum Toxin A Treatment Failure in Cosmetic Indication and Anti-Complexing Protein Antibody Production. Dermatol Ther (Heidelb) 2020; 10:707-720. [PMID: 32445175 PMCID: PMC7367960 DOI: 10.1007/s13555-020-00397-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Botulinum toxin A (BoT/A) treatment failure (BTF) affects patients subjected to repeated BoT/A exposure for cosmetic indications. BoT/A’s general formulation contains core BoT/A and complexing proteins. BTF may be caused by antibody-induced treatment failure. Antibodies against core BoT/A can occur; however, anti-complexing protein antibodies have never been demonstrated, and tools for anti-complexing protein antibody detection have not been developed. The aim of this study was to evaluate immune involvement in BoT/A-nonresponsive patients. Methods Patients suspected of nonresponsiveness to BoT/A for cosmetic indications were recruited. All volunteers were categorized as BoT/A-responsive or BoT/A-tolerant according to frontalis testing with onabotulinumtoxinA (onaA). Twenty-two BoT/A-tolerant volunteers were recruited separately for frontalis testing with incobotulinumtoxinA (incoA). Anti-BoT/A and anti-complexing protein antibodies were quantified by special ELISA using sera from blood sampled before and after frontalis testing. Results Significantly higher levels of IgG against complexing protein were detected in onaA-tolerant sera but not in onaA-responders, leading to proposals that anti-complexing protein antibodies could cause onaA unresponsiveness. Some onaA-tolerant patients according to frontalis test with incoA were responsive to incoA. Newly developed absorption ELISA confirmed that incoA-responsive sera predominantly contained IgG against complexing proteins, whereas incoA-tolerant sera contained significant levels of IgG against core BoT/A. The presence of anti-complexing protein antibodies higher than 90.75% in sera of onaA-tolerant patients could respond to incoA. The ELISA technique might be employed as a tool to predict incoA responsiveness. Our frontalis testing after incoA treatment showed that anti-incoA IgG levels were not increased by incoA. Conclusions BoT/A-exposed patients may develop antibodies against core botulinum toxin and complexing proteins. Our study is the first to demonstrate that anti-complexing protein antibodies cause BTF. High levels of antibodies against complexing proteins can cause onaA unresponsiveness, although some patients were still incoA-responsive. Our developed ELISA to detect anti-complexing protein antibodies can determine whether onaA-tolerant patients respond to incoA without incoA frontalis testing.
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Affiliation(s)
| | - Watsachon Kantaviro
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panittra Suphatsathienkul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ploypailin Tantrapornpong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalermkwan Apinumtham
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yuttana Srinoulprasert
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Ultrasonographic and Three-Dimensional Analyses at the Glabella and Radix of the Nose for Botulinum Neurotoxin Injection Procedures into the Procerus Muscle. Toxins (Basel) 2019; 11:toxins11100560. [PMID: 31554222 PMCID: PMC6832436 DOI: 10.3390/toxins11100560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022] Open
Abstract
Botulinum neurotoxin (BoNT) injections are widely used for facial rejuvenation procedures, and the procerus muscle is a major target in cases of glabellar transverse lines or rhytids. Although there have been many cadaveric studies of the procerus, its depth and thickness have not been investigated thoroughly. The aim of this study was to measure the depth and thickness of the procerus and identify the location of the intercanthal vein using ultrasonographic (US) imaging and the three-dimensional scanning method, which is needed to know to avoid side effects during BoNT injections. The morphology of the procerus was classified into two types based on the US images obtained at the glabella. The procerus was located deeper below the skin surface at the glabella than the sellion (3.8 ± 0.7 mm versus 2.7 ± 0.6 mm). The width of the procerus in US images increased from the sellion (10.9 ± 0.2 mm) to the glabella (14.5 ± 4.6 mm), whereas its thickness decreased (from 1.6 ± 0.6 mm to 1.1 ± 0.5 mm). The intercanthal vein was located 5.1 ± 4.0 mm superior to the sellion and 3.0 ± 0.6 mm below the skin’s surface. The present findings provide anatomical knowledge as well as the reference location information for use when injecting BoNT into the procerus.
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Long-Term Cumulative Effects of Repeated Botulinum Toxin Type A Injections on Brow Position. Dermatol Surg 2019; 46:1252-1254. [PMID: 31517662 DOI: 10.1097/dss.0000000000002142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schlager S, Kostunov J, Henn D, Stark BG, Iblher N. A 3D Morphometrical Evaluation of Brow Position After Standardized Botulinum Toxin A Treatment of the Forehead and Glabella. Aesthet Surg J 2019; 39:553-564. [PMID: 30124769 DOI: 10.1093/asj/sjy205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Botulinum toxin treatment for forehead wrinkles has been extensively studied and found to be a safe and reproducible procedure. However, the effect on the position of the eyebrows, which relies on the dynamic positioning of the treated muscles, has received less attention and has not been studied with 3-dimensional (3D) technology. OBJECTIVES The authors sought to evaluate the changes of eyebrow position after standardized botulinum toxin treatment of glabella or glabella and frontalis muscles with 3D imaging. METHODS In a prospective study, 2 groups of adult females were treated with botulinum toxin A at the glabella only (G) or at the glabella and the frontalis muscle (F/G). The brow position was measured at 5 positions with 3D photography before injection and 2 weeks, 3 months, and 6 months after injection. Results were statistically analyzed and related to patient age. RESULTS In the F/G group, the brow descended significantly almost across the whole brow length after 2 weeks. The descent lessened after 3 months and moved medially. No clear trend was evident in the G group. There was no significant change attributed to patient age in both groups. CONCLUSIONS Botulinum toxin treatment of the glabella and frontalis muscle impacts the position and configuration of the eyebrow. The degree of change is affected by the amount of frontalis weakening rather than by treatment of the glabella. While age in general is not a reliable predictor, individual factors play the major role in how pronounced a change of the brow can be expected. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Stefan Schlager
- Department of Biological Anthropology, University of Freiburg, Freiburg, Germany
| | - Jana Kostunov
- Department of Plastic and Hand Surgery, Freiburg University Medical Center, Freiburg, Germany
| | - Dominic Henn
- Department of Plastic, Hand, and Reconstructive Surgery, BG Trauma Center, Ludwigshafen, Germany
| | - Bjoern G Stark
- Department of Plastic and Hand Surgery, Freiburg University Medical Center, Freiburg, Germany
| | - Niklas Iblher
- Department of Plastic and Hand Surgery, Freiburg University Medical Center, Freiburg, Germany
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15
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The Impact of Upper Face Botulinum Toxin Injections on Eyebrow Height and Forehead Lines. Plast Reconstr Surg 2018; 142:1212-1217. [DOI: 10.1097/prs.0000000000004836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jabbour S, Awaida C, Kechichian E, Rayess Y, Abdelmassih Y, Noel W, Hachem LE, Nasr M. Botulinum Toxin for Eyebrow Shaping: A Systematic Review. Dermatol Surg 2017; 43 Suppl 3:S252-S261. [PMID: 33065951 DOI: 10.1097/dss.0000000000001410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Currently, there is no standardized approach for eyebrow shaping with botulinum toxin, and controversies still exist regarding this subject. OBJECTIVE The objective of this systematic review is to summarize and compare all the published data regarding eyebrow shaping with botulinum toxin. METHODS On March 10, 2017, an online search of published articles in the Medline, Embase, and Cochrane databases were conducted. All articles that used objective measurements to quantify the eyebrow changes after botulinum toxin injection were included in this review. RESULTS Eleven studies were selected for inclusion with a total of 585 patients. All the included studies used onabotulinumtoxin A. Seven studies injected both the lateral and the medial eyebrow depressors, 2 studies injected the lateral depressors alone, and 2 studies injected the medial depressors alone. The highest elevation was observed in the lateral brow (0.4-4.8 mm). Bruising and headache were the most frequently reported complications, and only 5 cases of eyelid ptosis were noted. CONCLUSION Botulinum toxin injection for eyebrow shaping is a noninvasive, safe, and reproducible procedure. Eyebrow reshaping can be achieved by targeting different muscle groups. However, further randomized controlled trials are warranted.
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Affiliation(s)
- Samer Jabbour
- Departments of *Plastic and Reconstructive Surgery, †Dermatology, and ‡Ophthalmology, Faculty of Medicine, Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon; §Department of Plastic and Reconstructive Surgery, Saint-Joseph Hospital, Paris, France; ‖Department of Obstetrics and Gynecology, Lebanese American University Medical Center, Beirut, Lebanon
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Giordano CN, Matarasso SL, Ozog DM. Injectable and topical neurotoxins in dermatology: Indications, adverse events, and controversies. J Am Acad Dermatol 2017; 76:1027-1042. [PMID: 28522039 DOI: 10.1016/j.jaad.2016.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022]
Abstract
The use of neuromodulators for therapeutic and cosmetic indications has proven to be remarkably safe. While aesthetic and functional adverse events are uncommon, each anatomic region has its own set of risks of which the physician and patient must be aware before treatment. The therapeutic usages of botulinum toxins now include multiple specialties and multiple indications. New aesthetic indications have also developed, and there has been an increased utilization of combination therapies to combat the effects of global aging. In the second article in this continuing medical education series, we review the prevention and treatment of adverse events, therapeutic and novel aesthetic indications, controversies, and a brief overview of combination therapies.
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Affiliation(s)
| | - Seth L Matarasso
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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Bentivoglio AR, Di Stasio E, Mulas D, Cerbarano ML, Ialongo T, Laurienzo A, Petracca M. Long-Term Abobotulinumtoxin A Treatment of Cervical Dystonia. Neurotox Res 2017; 32:291-300. [DOI: 10.1007/s12640-017-9737-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 12/17/2022]
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Consensus Recommendations for Combined Aesthetic Interventions in the Face Using Botulinum Toxin, Fillers, and Energy-Based Devices. Dermatol Surg 2017; 42:586-97. [PMID: 27100962 DOI: 10.1097/dss.0000000000000754] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aging process is a complex interplay of intrinsic and extrinsic factors across multiple layers of the face. Accordingly, combining aesthetic interventions targeting different manifestations of aging often leads to better results than single modalities alone. However, no guidelines for a pan-facial approach using multiple interventions have been published to date. OBJECTIVE To develop consensus recommendations for the optimal combination and ideal sequence of botulinum toxin (BoNT), hyaluronic acid, calcium hydroxylapatite, and microfocused ultrasound with visualization (MFU-V) in persons of all Fitzpatrick skin types. METHODS AND MATERIALS Fifteen specialists convened under the guidance of a certified moderator. Consensus was defined as approval from 75% to 94% of all participants, whereas agreement of ≥95% denoted a strong consensus. RESULTS Optimal aesthetic treatment of the face begins with a thorough patient assessment and an individualized treatment plan. Spacing consecutive treatments 1 to 2 weeks apart allows for resolution of side effects and/or to assess results. For same-day treatments, BoNT and fillers may be performed together in either sequence, whereas MFU-V is recommended before injectable agents. CONCLUSION Expert consensus supports a combination approach using multiple modalities in specific sequence for the safe and effective treatment of the aging face.
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Abstract
The authors aim to determine the periorbital soft tissue anthropometric norms for Turkish young adults for right and left eyes using a noninvasive two-dimensional photogrammetric analysis. Anthropometric measurements of the periorbital soft tissue were taken from 172 female and 56 male Turkish adults aged between 18 and 24 years. The periorbital soft tissue profiles (ocular and palpebral) for males and females were digitally analyzed using linear measurements made with standardized photographic records, taken in a natural head position. Statistically significant differences were found for ocular soft tissue measurements according to gender except inner intercanthal distance (P = 0.125) and right horizontal palpebral aperture (P = 0.240). Statistically significant differences were found for palpebral soft tissue measurements according to gender except right pretarsal skin height (P = 0.112) and left pretarsal skin height (P = 0.056). Results were compared with other ethnic groups. Normal periorbital soft tissue measurements are fundamental anatomical parameters utilized in ophthalmology, optometry, ophthalmic industry, oculoplastic surgery, clinical genetics, dermatocosmetology. Further, normal anthropometric measurements generate reference data for studies in craniofacial dysmorphology, oculoplastic surgery, dermatocosmetology, and comparative physical anthropology.
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Aesthetic Applications of Botulinum Toxin A in Asians: An International, Multidisciplinary, Pan-Asian Consensus. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e872. [PMID: 28293488 PMCID: PMC5222633 DOI: 10.1097/gox.0000000000000507] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 08/04/2015] [Indexed: 01/23/2023]
Abstract
Background: Botulinum toxin type A remains the most popular nonsurgical aesthetic treatment worldwide. Previous consensus statements have focused on Caucasians and on Koreans as generally representative of Asians. However, indications and dosages vary among different ethnic groups. This publication reports the results of a multidisciplinary, pan-Asian consensus focusing on incobotulinumtoxinA. Methods: A consensus group of plastic surgeons and dermatologists from Asia, Europe, and the United States convened for a live meeting in Asia, followed by a questionnaire-based Delphi procedure. Treatment of Asians in both their native countries and countries of migration was discussed. Results: For most items, the group achieved a majority consensus. A number of treatment indications, strategies, and dosages were identified in Asians, which are distinct to those previously described for Caucasians due to differences in facial morphotypes, anatomy, and cultural expectations. The group also formulated position statements for intradermal botulinum toxin type A (“mesotoxin”), body shaping with the calves as a paradigm, and reduction of parotid glands. While Asians have previously been considered a homogeneous group for the purposes of aesthetic treatment, this publication considers regional variations. A new classification of Asian facial morphotypes is proposed to aid treatment planning and implementation. Conclusions: This is the first pan-Asian consensus for aesthetic use of botulinum toxin type A. Its unique objective is to optimize treatment safety and efficacy for patients of complete or part-Asian ancestry in all regions. The recommendations for incobotulinumtoxinA may be extended with care to other botulinum toxin formulations.
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Carruthers A, Carruthers J, Fagien S, Lei X, Kolodziejczyk J, Brin MF. Repeated OnabotulinumtoxinA Treatment of Glabellar Lines at Rest Over Three Treatment Cycles. Dermatol Surg 2016; 42:1094-101. [PMID: 27427996 PMCID: PMC5414762 DOI: 10.1097/dss.0000000000000704] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND OnabotulinumtoxinA has demonstrated the ability to eliminate mild glabellar lines at rest; however, less is known regarding the effect of repeat treatment on more severe lines at rest. OBJECTIVE To assess the effect of repeated onabotulinumtoxinA treatment for reduction of glabellar lines at rest. METHODS Subjects 18 to 75 years old with at least mild glabellar lines at rest, as assessed by the validated Facial Wrinkle Scale (FWS) with photonumeric guide (score ≥ 1), received 3 treatments of 20 U onabotulinumtoxinA 4 months apart (N = 225). "Response" was defined as elimination of glabellar lines at rest (FWS score = 0) at any time point (Days 7, 30, 60, 90, and 120). Effect of treatment cycle on response was analyzed using repeated measures logistic regressions (p < .05). RESULTS Most subjects were female (85%) and white (88%) (age range: 35-54 years). The likelihood of significant response was as follows: for all subjects combined (odds ratio [OR]: 1.31), for subjects with mild resting lines at baseline (OR: 1.49), and for older women (≥55 years) with mild resting lines at baseline (OR: 2.22). Of all subjects, 76% responded after 1 treatment, and 45% responded in all 3 cycles. CONCLUSION Subjects repeatedly treated with onabotulinumtoxinA showed progressive improvement in glabellar lines at rest.
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Affiliation(s)
| | - Jean Carruthers
- Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Xiaofang Lei
- Department of Clinical Development, Allergan plc, Irvine, California
| | | | - Mitchell F. Brin
- Department of Clinical Development, Allergan plc, Irvine, California
- Department of Neurology, University of California, Irvine, California
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Abstract
Botulinum toxin type A (BTA) can be used for facial aesthetics. The 3 currently available BTA types include onabotulinumtoxinA (Botox; Botox Cosmetic, Allergan, Irvine, CA), abobotulinumtoxinA (Dysport; Ipsen, Ltd, Berkshire, UK), and incobotulinumtoxinA (Xeomin; Merz Pharmaceuticals, Frankfurt, Germany). The mechanism of action and clinical uses for treatment of dynamic lines of the forehead, brow, glabella, lateral orbit, nose, and lips are presented, as well as treatment of masseter hypertrophy, platysmal bands, and improvements of the perioral region. Specific BTA injection sites and suggested doses are presented.
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A Comparative Assessment of Three Formulations of Botulinum Toxin Type A for Facial Rhytides: A Systematic Review with Meta-Analyses. Plast Reconstr Surg 2016; 137:1125-1140. [PMID: 27018668 DOI: 10.1097/prs.0000000000002004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Three formulations of botulinum toxin are available for facial rhytides. It is unclear which formulation offers the greatest balance of benefits and harms. The objective of this study was to conduct a systematic review with meta-analyses to compare formulations of botulinum toxin for reduction of facial rhytides at the glabella. METHODS The authors' protocol was registered with the International Prospective Register of Systematic Reviews (CRD4201200377). A systematic literature search was performed identifying double-blind studies. The authors assessed 1-, 3-, and 4-month follow-up. The authors performed pairwise meta-analyses using random effects models to compare response rates among the three botulinum formulations and a network meta-analysis. RESULTS A total of 18 studies (3082 patients) were included. At 30-, 90-, and 120-day follow-up, all medications with available data showed statistically significantly increased treatment response versus placebo. Only high-dose onabotulinum toxin (compared to standard-dose onabotulinum toxin) offered additional benefit at 30 days. Exploratory analysis using network meta-analysis mostly suggested insufficient evidence of incremental benefits when comparing specific formulations. CONCLUSIONS Evidence supporting benefits versus placebo of the different formulations was clear over time. Comparisons between active formulations were rare and typically based on single trials of small to moderate sample size. The data suggest some gains with high-dose onabotulinum toxin (relative to standard dose), whereas exploratory indirect comparisons between active formulations were largely associated with inconclusive findings. Future studies should undertake head-to-head comparisons of the different formulations and ensure longer follow-up to best inform the accumulating evidence base. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Carruthers J, Carruthers A. Non-operative facial rejuvenation. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sneath J, Humphrey S, Carruthers A, Carruthers J. Injecting Botulinum Toxin at Different Depths Is Not Effective for the Correction of Eyebrow Asymmetry. Dermatol Surg 2015; 41 Suppl 1:S82-7. [DOI: 10.1097/dss.0000000000000159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The cosmetic use of botulinum toxin (BoNT) is the most common cosmetic procedure performed in the world today. Common adverse events seen in the aesthetic use of the BoNT include swelling, localized bruising, headaches, injection site discomfort, excessive muscle weakness, and unintended paresis of adjacent muscles. BoNT has a wide array of cosmetic uses, including treatment of glabellar lines, chemical browlift, forehead wrinkles, periorbital, and perioral lines. The future formulations and applications of BoNT type A will be plentiful, and are exciting to consider.
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Affiliation(s)
- Andrew Dorizas
- Sadick Research Group, 911 Park Avenue, New York, NY 10075, USA.
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Hanke CW, Moy RL, Roenigk RK, Roenigk HH, Spencer JM, Tierney EP, Bartus CL, Bernstein RM, Brown MD, Busso M, Carruthers A, Carruthers J, Ibrahimi OA, Kauvar ANB, Kent KM, Krueger N, Landau M, Leonard AL, Mandy SH, Rohrer TE, Sadick NS, Wiest LG. Current status of surgery in dermatology. J Am Acad Dermatol 2013; 69:972-1001. [PMID: 24099730 DOI: 10.1016/j.jaad.2013.04.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 02/08/2023]
Abstract
An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.
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Lee D, Kang S, Feneran A, Youn C, Kim J, Cho S, Won C, Chang S, Lee M, Choi J, Moon K. RimabotulinumtoxinB vs. onabotulinumtoxinA for the treatment of forehead lines: an evaluator-blind, randomized, pilot study. J Eur Acad Dermatol Venereol 2012; 27:e1-7. [DOI: 10.1111/j.1468-3083.2012.04681.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maas C, Kane MAC, Bucay VW, Allen S, Applebaum DJ, Baumann L, Cox SE, Few JW, Joseph JH, Lorenc ZP, Moradi A, Nestor MS, Schlessinger J, Wortzman M, Lawrence I, Lin X, Nelson D. Current aesthetic use of abobotulinumtoxinA in clinical practice: an evidence-based consensus review. Aesthet Surg J 2012; 32:8S-29S. [PMID: 22941910 DOI: 10.1177/1090820x12455192] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The amount and complexity of scientific and clinical evidence for aesthetic use of botulinum neurotoxin type A (BoNT-A) has expanded rapidly in recent years, especially for abobotulinumtoxinA, necessitating reassessment of current knowledge about aesthetic use of abobotulinumtoxinA and other BoNT-A preparations. A committee of 13 plastic surgeons, facial plastic surgeons, and dermatologists engaged in a live discussion of information from a systematic literature review and an Internet-based survey of their beliefs and practices. The committee achieved consensus on most issues. It was concluded that doses of different BoNT-A preparations cannot be interconverted with a fixed ratio. The size of the "field of effect" is difficult to measure, and comparisons between preparations have yielded equivocal results. Nonresponse due to neutralizing antibodies appears exceedingly rare with currently available BoNT-A preparations and of little concern clinically. BoNT-A dose, injection depth, and injection technique should be adjusted according to the anatomic area being treated and each patient's individual characteristics and goals. Aesthetic use of BoNT-A has a good safety profile. Most adverse events are minor and related to the trauma of injection, although special care is needed in certain anatomic areas. Detailed recommendations for treatment of different anatomic areas are presented. BoNT-A products are often used in conjunction with other treatment modalities (eg, fillers and resurfacing), but little agreement was reached on best practices. The findings reported in this consensus document may serve as a practical guide for aesthetic practitioners as they apply the latest knowledge about BoNT-A in providing their patients with optimal care.
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Affiliation(s)
- Corey Maas
- University of California-San Francisco, CA 94115, USA
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de Almeida ART, da Costa Marques ERM, Banegas R, Kadunc BV. Glabellar contraction patterns: a tool to optimize botulinum toxin treatment. Dermatol Surg 2012; 38:1506-15. [PMID: 22804914 DOI: 10.1111/j.1524-4725.2012.02505.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Botulinum toxin is a well-established treatment for dynamic glabellar lines. A previous study evaluated the existence of glabellar contraction "patterns," according to the predominance of eyebrow approximation, depression, or elevation movements, namely "U," "V," "convergent arrows," "omega," and "inverted omega." OBJECTIVES To confirm contraction patterns in the adult population for a better treatment approach and to verify whether changes occur after repeated treatment. METHODS Pairs of photographs-at rest and under contraction-from two groups were retrospectively analyzed: 334 adult volunteers with a predominance of specific movements, being verified and 36 previously treated individuals when they returned for re-injections. RESULTS The five glabellar contraction patterns were confirmed. Each individual's initial pattern reappeared upon waning of the toxin effect. CONCLUSION Interpersonal differences in facial animation are observed. Classifying glabellar wrinkles allows accurate treatment with botulinum toxin, injecting the most commonly recruited muscles with higher doses or into more sites. Muscles not so recruited are spared or injected with lower doses for more-effective and -natural results. Although botulinum toxin blockade causes recruitment of adjacent muscles, the initial muscle contraction pattern is resumed when the effect wanes.
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Flynn TC, Carruthers A, Carruthers J, Geister TL, Görtelmeyer R, Hardas B, Himmrich S, Kerscher M, de Maio M, Mohrmann C, Narins RS, Pooth R, Rzany B, Sattler G, Buchner L, Benter U, Fey C, Jones D. Validated Assessment Scales for the Upper Face. Dermatol Surg 2012; 38:309-19. [DOI: 10.1111/j.1524-4725.2011.02248.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cartee TV, Monheit GD. An Overview of Botulinum Toxins: Past, Present, and Future. Clin Plast Surg 2011; 38:409-26, vi. [DOI: 10.1016/j.cps.2011.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Proebstle TM. Skin displacement analysis (SDA): a tool for the quantitative evaluation of skin movements elicited by underlying muscles in the face and neck area. Clin Cosmet Investig Dermatol 2011; 4:27-33. [PMID: 21673872 PMCID: PMC3108281 DOI: 10.2147/ccid.s18185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Quantitative numerical analysis of skin displacement triggered by muscles inserting the overlaying skin would be useful for monitoring the inhibition of mimetic muscles. METHODS By using removable grid markings and digital photographs, skin displacement analysis (SDA) was performed on 13 patients pre-treatment and on Days 1, 2, 3, and 7 after injection of 18 units of botulinum toxin type A (BoNT/A) in the fronto-glabellar area. RESULTS At baseline, amplitudes of horizontal skin displacement with fronto-glabellar contraction showed a linear increase along the eyebrow laterally from the midline; mean values (±standard deviation [SD]) 15 and 30 mm lateral to the midline were 3.2 ± 1.0 mm (range, 1.9-4.9 mm) and 6.5 ± 1.4 mm (range 4.0-8.5 mm), respectively. After injection of BoNT/A, maximum horizontal skin displacement 30 mm lateral to the midline showed a mean reduction (±SD) to 62% ± 23% at Day 2 and to 17% ± 16% at Day 7; corresponding values 15 mm lateral to the midline were 62% ± 29% and 15% ± 20%, respectively. In all cases, the reduction in horizontal skin displacement compared with pre-injection levels was statistically significant (P < 0.001). CONCLUSION SDA is a feasible method for the quantitative evaluation of skin movements elicited by muscles inserting the overlaying skin in the face and neck area.
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Hexsel C, Hexsel D, Porto MD, Schilling J, Siega C. Botulinum toxin type A for aging face and aesthetic uses. Dermatol Ther 2011; 24:54-61. [DOI: 10.1111/j.1529-8019.2010.01378.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Since its initial approval by the US Food and Drug Administration (FDA) 20 years ago for the treatment of strabismus, hemifacial spasm, and blepharospasm in adults, botulinum toxin (BTX) has become one of the most frequently requested products in cosmetic rejuvenation around the world. After years of clinical success and consistent safety in the upper face, the use of BTX has expanded and evolved to include increasingly complicated indications. In the hands of adept injectors, the focus has shifted from the treatment of individual dynamic rhytides to shaping, contouring, and sculpting, alone or in combination with other cosmetic procedures, to enhance the aesthetic appearance of the face. Although recent reports have questioned the safety of BTX, 25 years of therapeutic and over 20 years of cosmetic use has demonstrated an impressive record of safety and efficacy when used appropriately by experienced injectors.
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Mechanisms of Blepharoptosis following Cosmetic Glabellar Chemodenervation. Plast Reconstr Surg 2010; 126:248e-249e. [DOI: 10.1097/prs.0b013e3181ef822a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jaspers GWC, Pijpe J, Jansma J. The use of botulinum toxin type A in cosmetic facial procedures. Int J Oral Maxillofac Surg 2010; 40:127-33. [PMID: 20965695 DOI: 10.1016/j.ijom.2010.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 07/24/2010] [Accepted: 09/17/2010] [Indexed: 10/18/2022]
Abstract
Over the past decade, facial cosmetic procedures have become more commonplace in dentistry and oral and maxillofacial surgery. An increasing number of patients seek minimal invasive procedures. One of the most requested procedures is treatment with botulinum toxin type A (BoNTA). Treatment of dynamic rhytids and lines with BoNTA is effective and produces high rates of improvement with rapid onset and long duration of action (longer than 4 months for some patients) compared with placebo. This paper considers the history and pharmacology of this neurotoxin, and focusses on the literature concerning the treatment of different facial areas with BoNTA. It also presents clinical guidelines on the treatment of glabellar lines, the frontalis muscle, peri-orbital lines, gummy smile and masseter muscle hypertrophy. Knowledge about the mechanisms of action and the ability to use BoNTA as an adjunctive treatment are mandatory for those working in the field of cosmetic facial surgery.
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Affiliation(s)
- G W C Jaspers
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands.
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Trevidic P, Cauchois R, Ingallina F. [Facial anatomy and botulinum toxin: the muscular balances]. Ann Dermatol Venereol 2009; 136 Suppl 4:S61-6. [PMID: 19576487 DOI: 10.1016/s0151-9638(09)74529-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The muscular topographic anatomy of the face has long been known. The functional anatomy of the face has been studied by many neurologists, with Duchenne of Boulogne one of the first. The possibility of correcting not only wrinkles, but also certain regional balances gives botulinum toxin a certain number of advantages as well as limitations that should be well known by future injectors as well as the more experienced of practitioners who seek to treat the most difficult zones.
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Gassia V, Michaud T. Les techniques d’injection du haut du visage : front et glabelle, pattes d’oie, région péri-oculaire. Ann Dermatol Venereol 2009; 136 Suppl 4:S104-10. [DOI: 10.1016/s0151-9638(09)74536-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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A Validated Brow Positioning Grading Scale. Dermatol Surg 2008. [DOI: 10.1097/00042728-200811001-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Sa Earp AP, Marmur ES. The five D's of botulinum toxin: doses, dilution, diffusion, duration and dogma. J COSMET LASER THER 2008; 10:93-102. [PMID: 18569262 DOI: 10.1080/14764170701883660] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this review is to update cosmetic dermatologists and surgeons on the latest information about botulinum toxin injections for the treatment of the face and neck and to provide a practical guide to effective and safe technique. We review indications, recommended doses and dilutions, storage recommendations and injection techniques.
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Abstract
PURPOSE OF REVIEW Current cosmetic surgical practice for facial rejuvenation has undergone a significant change due to the introduction of technologies to improve the age-associated changes of the face. The most widely adopted methods of minimally invasive facial rejuvenation include the use of neuromuscular blocking agents and injectable fillers. The topic of minimally invasive procedures might include a variety of subjects including nutritional and hormonal modulation, light-based and laser-based therapies, minimal incision surgical procedures, as well as the use of botulinum toxin and fillers. The focus of this study will be on the minimally invasive facial rejuvenation efforts achieved by injection techniques. RECENT FINDINGS Botulinum A neurotoxin has been shown to be effective in the reduction of hyperfunctional lines in the upper and lower face. Anatomic areas that have been found to benefit include the glabella, the forehead, the periorbital area, lips, and the platysma muscle. The more recently introduced hyaluronic acid and other injectable fillers are receiving increasing usage. These temporary fillers have been found to improve creases and wrinkles, augment deep nasolabial folds, augment thin lips, and improve hollowing in the periorbital and other depressions and deformities. SUMMARY There has been a significant paradigm shift in the field of rejuvenation surgery. Injectable minimally invasive methods have been offered to remedy age-related and other acquired deformities of the head and neck region. These methods have provided temporary correction of undesirable characteristic that were traditionally approached with more invasive surgically oriented modalities.
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