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Ohana O, Fezza JP, Sykes J, Yoelin SG, Lee JH, Fezza RM, Lee WW. The Platysma Contraction Pattern in Healthy Adults: A Vector Analysis Study. Plast Reconstr Surg 2024; 153:601-607. [PMID: 37171263 DOI: 10.1097/prs.0000000000010630] [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: 05/13/2023]
Abstract
BACKGROUND The platysma muscle's role in lower face dynamics is complex. Multiple insertion points to soft-tissue structures at various levels in the lower face create a multifaceted contraction pattern. To avoid adverse effects in cosmetic procedures when targeting the platysma, its anatomy and physiology must be understood. Clinical observations hint at a bidirectional contraction pattern. METHODS Eighteen healthy volunteers (13 women and five men) with a mean age of 44.2 ± 10.1 years were enrolled. Skin displacement vector analysis was used on maximal platysma contraction to characterize and calculate the movement of the neck and lower face skin. RESULTS In all of the participants, a bidirectional movement of the skin was observed: the skin of the lower face and inferior to the jawline moved caudally, whereas the skin of the lower neck moved cephalad. Both movements converged at a line situated at 54% ± 10% and 55% ± 8% of the length between the clavicle and the inferior base of the ear lobe in men and women, respectively ( P = 0.70). CONCLUSIONS The platysma is a bidirectional muscle with a line of convergence. Whereas the superior portion acts as lip depressor, the lower portion elevates the skin of the upper chest and lower neck. This transition can explain some of the clinically observed adverse effects of neuromodulation of the neck area. It can potentially direct neuromodulation injections to focus above the convergence line to better address lower face descent.
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Affiliation(s)
- Oded Ohana
- From the Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute
| | | | - Jonathan Sykes
- Facial Plastic and Reconstructive Surgery, University of California, Davis, Medical Center; and Roseville Facial Plastic Surgery
| | | | - James H Lee
- From the Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute
| | | | - Wendy W Lee
- From the Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute
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Gelezhe P, Frank K, Casabona G, Kaye KO, Kassirer S, Moelhoff N, Freytag DL, Gotkin RH, Alfertshofer M, Cotofana S. Safety considerations for treating the parotid and submandibular glands with neuromodulators for facial slimming. J Cosmet Dermatol 2023; 22:2957-2963. [PMID: 37602962 DOI: 10.1111/jocd.15973] [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: 07/16/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Neuromodulators have predominantly been used for the treatment of upper facial lines, but their use has expanded to include lower face and neck treatments. However, the injection sites for these treatments are based on skin surface landmarks, which may pose risks to nearby structures and result in undesired outcomes. OBJECTIVE To investigate the spatial relationship between the FDA-approved skin surface landmarks for neuromodulator injections in the parotid and submandibular glands and the topographical anatomy of critical facial structures such as the facial artery, facial vein, external carotid artery, and retromandibular vein. MATERIALS AND METHODS A cross-sectional retrospective analysis was conducted on contrast-enhanced cranial CT scans. The scans were analyzed for the morphology and location of the parotid and submandibular glands. Measurements were taken for gland volume, craniocaudal extent, anterior-posterior extent, and distances between the skin surface and gland capsule or nearby structures such as arteries. RESULTS The study sample consisted of 53 subjects, including 7 males and 46 females, with a mean age of 36.91 years and a mean BMI of 23.28 kg/m2 . The mean volume of the parotid gland was 31.9 ± 3.0 cc in males and 28.5 ± 3.6 cc in females with p < 0.001, while the mean volume of the submandibular gland was 18.2 ± 2.0 cc in males and 14.5 ± 3.4 cc in females with p < 0.001. The mean distances between skin surface and the gland capsule were 5.98 ± 2.2 and 8.84 ± 4.0 mm for the parotid and submandibular gland, respectively. This distance increased with higher age and higher BMI values in a statistically significant manner with p < 0.001. CONCLUSION The distances between FDA-approved skin surface landmarks and the parotid and submandibular glands varied significantly depending on gender, age, and BMI. Optimal injection depth and location for neuromodulator treatments cannot be generalized based on these landmarks alone, emphasizing the need for real-time ultrasound imaging guidance.
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Affiliation(s)
- Pavel Gelezhe
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | | | | | | | - Samuel Kassirer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicholas Moelhoff
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - David L Freytag
- Department of Plastic Surgery, Gemeinschaftsklinikum Havelhöhe, Berlin, Germany
| | | | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Dermatology, Erasmus Hospital, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
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Raman S, Yamamoto Y, Suzuki Y, Matsuka Y. Mechanism and clinical use of botulinum neurotoxin in head and facial region. J Prosthodont Res 2023; 67:493-505. [PMID: 36740263 DOI: 10.2186/jpr.jpr_d_22_00238] [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: 02/06/2023]
Abstract
PURPOSE Botulinum neurotoxin (BoNT) is a biological toxin produced by Clostridium botulinum. BoNT is a potent toxin extensively used in therapeutic interventions. This review provides an updated overview of the mechanisms of action and clinical applications of BoNT in head and facial region. STUDY SELECTION MEDLINE/PubMed searches were conducted using the terms "botulinum neurotoxin" and "dentistry" along with a combination of other related terms. In addition, studies were manually selected from reference lists of the selected articles. RESULTS The Food and Drug Administration in the United States initially approved BoNT to treat strabismus, blepharospasm, and hemifacial spasms. The use of BoNT in dermatology and cosmetics has been widely established and has created a revolution in these fields. Over the years, its applications in various medical specialties have expanded widely. Owing to its safety, efficacy, and long duration of action, it is well-accepted by patients. BoNT/A and BoNT/B are widely used in clinical practice. Several off-label uses of BoNT in the dental fraternity have yielded promising results. We have elaborated on the speculated mechanism of action, dosage, effective sites of injection, and adverse effects of each therapeutic application. The various clinical indications for BoNT include bruxism, myofascial pain, temporomandibular joint dislocation, hemifacial pain, orofacial dystonia, facial paralysis, chronic migraine, and trigeminal neuralgia. CONCLUSIONS BoNT is a safe treatment that can be used effectively, provided that the clinician has adequate knowledge regarding the mechanism, injection techniques, and local and systemic side effects and that it is administered cautiously and purposefully.
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Affiliation(s)
- Swarnalakshmi Raman
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yumiko Yamamoto
- Department of Bacteriology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yoshitaka Suzuki
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yoshizo Matsuka
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Li R, Chen X, Sun H, Hao L, Luo S. Application of 3-Dimensional Technology for Evaluating Muscular Type and Muscle-Fat Pad Mixed-Type Nasolabial Folds With Botulinum Toxin-A Treatment. Aesthet Surg J 2023; 43:NP271-NP282. [PMID: 36536480 DOI: 10.1093/asj/sjac341] [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] [Received: 10/12/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Botulinum toxin-A (BTX-A) is used in the treatment of nasolabial folds (NLFs). However, lighting and clinician subjectivity play a major role in evaluating the efficacy of this treatment. OBJECTIVES By applying 3-dimensional (3D) technology, this study aimed to quantitatively evaluate the effects of BTX-A injection on muscular (M) and muscle-fat pad mixed-type (MF) NLFs. METHODS BTX-A was injected into bilateral marked points on the NLFs, where the levator labii alaeque nasi, zygomaticus minor, and zygomaticus major pull the skin to form the NLF (2 U at each injection site). Pretreatment and posttreatment 3D facial images were captured with static and laughing expressions. The curvature, width, depth, and lateral fat volume of the NLFs were measured to compare the therapeutic efficacy for type M and MF NLFs. RESULTS Thirty-nine patients with type M and 37 with type MF NLFs completed the follow-up data. In these patients, the curvature, width, and depth of the NLF showed a significant reduction at 1 month and gradually recovered at 3 and 6 months after treatment, with more significant improvement when laughing than when static. Variations compared to the pretreatment values of type MF were greater than those of type M at each time point. The lateral fat volume of the type MF NLF was significantly reduced (P < .05). CONCLUSIONS 3D technology can quantitatively evaluate the effects BTX-A injection for treating type M and type MF NLFs. BTX-A is more effective on type MF than on type M NLFs. LEVEL OF EVIDENCE: 4
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A Novel 3-Point Injection Technique for OnabotulinumtoxinA in the Upper Depressor Anguli Oris. Dermatol Surg 2023; 49:259-265. [PMID: 36763899 DOI: 10.1097/dss.0000000000003695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the efficacy and safety of onabotulinumtoxinA (ONA) injections to the depressor anguli oris (DAO) to improve downturned mouth. PATIENTS AND METHODS/MATERIALS This prospective, placebo-controlled, study enrolled subjects aged 18 to 65 years. Injections were performed using a novel 3-point technique in the upper DAO (1.5 U/injection site). The primary end point was a DAO contraction scale 1-grade improvement. Subjective evaluation was performed using the Global Aesthetic Improvement Scale (GAIS). RESULTS Ten subjects received ONA and 10 placebo (saline) injections. In ONA-treated subjects, DAO scores showed significant improvements at Weeks 4 and 12 ( p < .001) compared with baseline. No significant difference between visits was observed for placebo-injected subjects. Global Aesthetic Improvement Scale scores showed that 100% of subjects were improved compared with baseline at Week 4% and 90% at Week 12. By contrast, 90% and 80% of placebo-treated subjects had "no change" in their DAO appearance at Weeks 4 and 12. Subject GAIS assessments matched the live evaluator at Week 4; 60% continued to report improvement at Week 12. Treatment was well tolerated. CONCLUSION OnabotulinumtoxinA injections to the DAO using a 3-point technique provide clinically meaningful improvements in appearance. Treatment was well tolerated and in most individuals lasted at least 12 weeks. IDENTIFIER ClinicalTrials.gov NCT04240535.
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Sun W, Ma H, Song T. The Underappreciated Role of the Platysma Muscle in the Perioral Expressions in Young Adults. Aesthet Surg J 2023; 43:195-201. [PMID: 35947469 DOI: 10.1093/asj/sjac222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The platysma is involved in lower face movement, yet limited information on its functional role when making perioral expressions is available. OBJECTIVES The aim of this study was to use 3-dimensional (3D) photogrammetry to analyze platysma activity when making expressions. METHODS Standardized frontal-view 3D images were obtained from 54 volunteers. Three perioral expressions were analyzed: a full smile, mouth corner depression, and a grimace to show the lower teeth. Positive volume change in the "heat map" of the neck skin surface-determined by the superimposed image subtraction technique-served as a sensitive indicator of platysma contraction. RESULTS When making the 3 expressions, the proportions of platysma contraction were 42.6%, 75.9%, and 92.6%, respectively. The platysma worked as a more critical dynamic force than expected. In most smiles involving the platysma, its upper portion contracted. With the laterally downward traction on the lower lip increasing, the upper and lower portions of the platysma contracted together and formed muscular bands. The platysma contracted extensively in the other 2 expressions. In some cases, platysma bands were observed to form due to vigorous contraction of muscle fibers. In addition, the platysma was found to be highly functionally active in young individuals. CONCLUSIONS This study introduced a simple method that can sensitively identify the functional status of the platysma. The results showed the platysma's highly active function in perioral expressions in young adults. These findings may assist surgeons in personalized decision-making toward platysma muscle-weakening strategies and work as an objective tool for outcome evaluation. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Weiyi Sun
- Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengyuan Ma
- Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Song
- Department One, Plastic Surgery Hospital, Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Houlton TMR, Jooste N, Steyn M, Hemingway J. Visualising trends in dentition to lip mouth morphology using geometric morphometrics. PLoS One 2022; 17:e0274127. [PMID: 36054122 PMCID: PMC9439251 DOI: 10.1371/journal.pone.0274127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Linear measurements taken from bony landmarks are often utilised in facial approximation (FA) to estimate and plan the placement of overlying soft tissue features. This process similarly guides craniofacial superimposition (CFS) practices. Knowledge of how hard and soft tissue features spatially relate around the mouth region is, however, limited. Geometric morphometric techniques have thus been used to investigate size and shape variation in dentition-to-lip mouth morphology in a South African population. Twenty landmarks (twelve dentition, eight lips) were digitised, using cone-beam CT images of the anterior craniofacial complex in a Frankfurt/Frankfort position, for 147 individuals aged between 20 and 75 years. Principal Component Analysis and Canonical Variate Analysis established that much shape variation exists. A two-way ANOVA identified significant (p < 0.0001) population and sex variation with mouth shape. Black individuals presented with thicker lips, with the oral fissure aligning closely to the dental occlusion. Oral fissure position for white individuals corresponded to the inferior one-quarter (females) or one-sixth (males) of the maxillary central incisor crowns. Males presented larger dimensions than females, but females had a greater lip-to-teeth height ratio than their male counterparts. A pooled within-group regression analysis assessed the effect of age on the dentition and lips and found that it had a significant (p < 0.0001) impact on mouth shape. Ageing was associated with a reduced lip and teeth height, increased mouth width, and a lowered oral fissure and cheilion placement. The generated mean shape data, with metric guides, offer a visual and numerical guide that builds on existing FA and CFS standards, enhancing our understanding of hard and soft tissue relationships.
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Affiliation(s)
- Tobias M. R. Houlton
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
- * E-mail:
| | - Nicolene Jooste
- Department of Human Anatomy and Physiology, University of Johannesburg, Doornfontein, Johannesburg, South Africa
| | - Maryna Steyn
- Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, University of the Witwatersrand, Medical School, Parktown, Johannesburg, South Africa
| | - Jason Hemingway
- Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, University of the Witwatersrand, Medical School, Parktown, Johannesburg, South Africa
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van der Sluis N, Gülbitti HA, van Dongen JA, van der Lei B. Lifting the Mouth Corner: A Systematic Review of Techniques, Clinical Outcomes, and Patient Satisfaction. Aesthet Surg J 2022; 42:833-841. [PMID: 35373812 PMCID: PMC9342679 DOI: 10.1093/asj/sjac077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Mouth corners are an essential part of the centrofacial area for perception of attractiveness and emotions. Downturned mouth corners are a result of aging or have a congenital origin. Different mouth corner lifting techniques are described in the literature. OBJECTIVES This review was performed to systematically assess and compare invasive and noninvasive mouth corner lifting techniques and their effectiveness, patient satisfaction, and adverse effects. METHODS MEDLINE (via PubMed), EMBASE (OvidSP), and the Cochrane Central Register of controlled trials databases were searched for clinical and observational studies published in peer-reviewed academic journals with abstracts available (searched from May 18, 2019, to December 18, 2021). Outcomes of interest were aesthetic mouth corner lifting techniques, the degree of lift as well as the longevity of the lifting effect, patient satisfaction, and adverse effects. Techniques were subdivided in invasive techniques and noninvasive techniques. RESULTS Out of 968 studies found from the search, 11 were included in the qualitative analysis. In general, surgical techniques seem to have a better mouth corner lifting effect than nonsurgical techniques; however, objective evidence is weak, and surgery inevitably results in a scar. Reported patient satisfaction was good for both surgical and nonsurgical techniques and no severe complications have been described. CONCLUSIONS Surgical techniques seem to have a better lifting effect on mouth corners than nonsurgical techniques. Nevertheless, objective evidence is weak, and a scar is inevitable. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Nanouk van der Sluis
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Haydar A Gülbitti
- Department of Dentistry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joris A van Dongen
- Department of Plastic, Reconstructive, and Hand Surgery, Utrecht University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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A Retrospective and Anatomical Study Describing the Injection of Botulinum Neurotoxins in the Depressor Anguli Oris. Plast Reconstr Surg 2022; 149:850-857. [PMID: 35139057 DOI: 10.1097/prs.0000000000008967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY The depressor anguli oris acts to lower the lateral corners of the mouth and can cause an individual to appear sad or angry and contribute to the development of the labiomental folds. Many patients can benefit from the injection of small amounts of botulinum neurotoxin into the depressor anguli oris to enable the lip elevators to reposition the corners of the mouth. Although effective, the procedure is off-label, and the proximity of the depressor anguli oris to the depressor labii inferioris, particularly inferiorly, can lead to inadvertent treatment of the latter, resulting in lip asymmetry. The authors have taken a threefold approach to establish a depressor anguli oris injection technique that provides optimal aesthetic outcomes with a low incidence of adverse events. This involved, first, reviewing the limited existing literature for studies discussing depressor anguli oris anatomy and botulinum neurotoxin treatment technique; second, supplementing information from the published literature with information from cadaver dissections to demonstrate the relationship between the depressor anguli oris and surrounding anatomical structures; and third, performing a retrospective chart review of 275 patients treated with the authors' three-point injection technique. Combining data from published studies, cadaver dissections, and clinical experience, the authors demonstrate that a three-point technique performed in the upper half of the depressor anguli oris is associated with good clinical outcome and avoids common side effects related to injection or spread of neurotoxin to adjacent muscles. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Releasing the Smile: Depressor Anguli Oris Excision in the Context of Managing Nonflaccid Facial Palsy. Plast Reconstr Surg 2022; 149:261e-269e. [PMID: 35077425 DOI: 10.1097/prs.0000000000008807] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nonflaccid facial palsy is a debilitating entity characterized by hypertonicity, synkinesis, and hypomobility. Patients with nonflaccid facial palsy often have smile asymmetry and restriction because of disruption of normal vector forces on the modiolus. Excision of the depressor anguli oris can lead to improved oral commissure excursion, smile angle, dental show, and symmetry. METHODS All depressor anguli oris resection cases between January 8, 2018, and December 26, 2019, were reviewed. Patients with postoperative photographs were included in this cohort study. Preoperative and postoperative photographs were analyzed using the Emotrics software program, and changes in oral commissure excursion, smile angle, and dental show were tracked. Clinician-graded facial palsy assessments and patient-reported outcome measures were compared preoperatively and postoperatively using the Electronic Facial Paralysis Assessment and Facial Clinimetric Evaluation Scale, respectively. RESULTS Forty-three patients were included in this study; 79 percent of patients underwent isolated depressor anguli oris resection. Depressor anguli oris resection led to a statistically significant increase in oral commissure median excursion, smile angle, and dental show [3.02 mm (p = 0.015), 1.70 degrees (p = 0.002), and 2.36 mm (p < 0.001), respectively]. Median Electronic Facial Paralysis Assessment and Facial Clinimetric Evaluation Scale instrument scores also improved [6.0 (p = 0.001) and 7.5 (p = 0.013), respectively]. Depressor anguli oris resection also led to more symmetric smiles. No correlation was seen between duration of follow-up and change in metrics. CONCLUSION Depressor anguli oris resection is a minimal-risk procedure that frequently results in improved smile dynamics, smile symmetry, and quality of life in patients with nonflaccid facial palsy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Kim ST, Jung JH, Ha R, Chang JS, Ryu J, Kang IG, Kang JG, Huynh T, Uhm CS, Rhyu IJ, Choi YH, Kwon TK. Oral Commissure Lift: A Retrospective Analysis of Complication Rates and Overall Outcomes. Aesthetic Plast Surg 2021; 45:2772-2780. [PMID: 34318343 DOI: 10.1007/s00266-021-02393-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Downward-turning oral commissures and sagging mouth corners can present an unfavorable impression. We introduced a new oral commissure lift procedure and investigated its effectiveness and complication rates. METHODS Patients who underwent oral commissure lift in the plastic surgery clinic between January 2010 and December 2017 were enrolled retrospectively. Pre-and postoperative photographs were evaluated to measure oral commissure angles and analyze surgical complications, including visible scarring, unnatural appearance, and asymmetry. Many patients underwent a oral commissure lift with a simultaneous facelift. To exclude potential bias, we compared angular changes between patients receiving both oral commissure lift and facelift, with those receiving only oral commissure lift. Moreover, oral commissure angles of patients only receiving facelift were also measured. Statistical significance was set at p < 0.05. RESULTS Oral commissure lift was performed in 51 patients. The mean ages and follow-up periods were 46.7 ± 11.9 years, and 25.2 ± 22.9 months, respectively. The preoperative mean angles of the right and left oral commissures measured - 3.1 ± 4.0° and - 3.4 ± 3.7°, respectively, and postoperative mean angles measured 3.6 ± 3.2° and 3.3 ± 3.5°, respectively. Postoperative changes in oral commissure angles were statistically significant (p < 0.05). The low complication rate included undercorrection in one patient, asymmetry in one patient, and visible scarring in three patients. We found no statistically significant differences in the studies excluding bias. CONCLUSIONS The new oral commissure lift procedure for correcting sagging oral commissures was simple, safe, and effective with a low complication rate. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Seon Tae Kim
- Department of Otolaryngology-Head & Neck Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Joo Hyun Jung
- Department of Otolaryngology-Head & Neck Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Ryun Ha
- Department of Otolaryngology-Head & Neck Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Jin Soon Chang
- Department of Otolaryngology-Head and Neck Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Junsun Ryu
- Department of Otolaryngology-Head & Neck Surgery, National Cancer Center, Gyeonggi-do, Republic of Korea
| | - Il Gyu Kang
- ENT Over Flower Clinic, Incheon, Republic of Korea
| | - Jae Goo Kang
- Department of Otolaryngology-Head and Neck Surgery, National Medical Center, Seoul, Republic of Korea
| | - Tien Huynh
- ICON Plastic Surgery, Hochiminh city, Vietnam
| | - Chang-Sub Uhm
- Department of Anatomy, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Im Joo Rhyu
- Department of Anatomy, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Yun Hee Choi
- AONE Plastic & Aesthetic Surgery, 18-6, Ihyeon-ro 29 beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, 16931, Republic of Korea
| | - Taek Keun Kwon
- AONE Plastic & Aesthetic Surgery, 18-6, Ihyeon-ro 29 beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, 16931, Republic of Korea.
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12
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A Validated Grading Scale for Downturned Oral Commisure in Asian Faces. Dermatol Surg 2021; 47:e200-e204. [PMID: 33941734 DOI: 10.1097/dss.0000000000003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Downturned oral commissures develop gradually with aging. Tools have been developed to evaluate the marionette line or the lower face. However, there is no validated and reproducible tool to evaluate the progress after oral commissure treatment in clinical practice. OBJECTIVE The authors aimed to develop a scoring system to evaluate therapeutic interventions for downturned oral commissures and to verify its reliability, reproducibility, and clinical significance. METHODS AND MATERIALS In the Scale Development Group, the Delphi method was used to establish a 5-graded scoring system to evaluate oral commissure position. The scoring system was applied to 50 participants. The authors recorded and compared the intrarater agreement, interrater agreement, and significance of the grade-dependent scale. RESULTS Delphi analysis of the scoring system verified the grade description adequacy. Intrarater agreement showed almost perfect agreement, and the intraclass correlation coefficient of the interrater agreement had a significantly higher agreement rate. The differences between the clinical grades were significant. CONCLUSION The Hugel Downturned Oral Commissure Scale is precise, reproducible, and reflective of the clinical differences for downturned oral commissure. Its novelty lies in the use of specific angles and ratio. This scale has clinical trial potential owing to its standardized and quantitative assessment.
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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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15
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Cohn JE, Greco TM. Advanced Techniques for the Use of Neurotoxins in Non-Surgical Facial Rejuvenation. Aesthetic Plast Surg 2020; 44:1788-1799. [PMID: 32239250 DOI: 10.1007/s00266-020-01691-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurotoxins initially were used to treat hyperfunctional rhytids of the face, but now have been expanded to improve facial shaping, correct facial asymmetry and even improve skin texture and tone. METHODS The clinical approach to non-surgical facial rejuvenation is approached into four anatomical regions: the upper face, midface, lower face and neck. RESULTS The key muscles of the upper face include frontalis, orbicularis oculi, corrugator supercilii, procerus, depressor supercilii and temporalis. The muscles in the midface to be discussed include the levator labii superioris, levator labii superioris alaeque nasi, depressor anguli oris, depressor septi nasi and nasalis. Treatment of the lower face focuses on the orbicularis oris, mentalis, depressor anguli oris and masseter muscles. Finally, treatment of the neck region will be reviewed with emphasis on platysmal bands and necklace lines as well as the Nefertiti lift. CONCLUSIONS Non-surgical facial rejuvenation using neurotoxins should be performed safely and effectively in order to avoid and treat complications. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic Reconstructive Surgery, Philadelphia College of Osteopathic Medicine, 4190 City Line Avenue, Philadelphia, PA, 19131, USA.
| | - Timothy M Greco
- Center of Excellence in Facial Cosmetic Surgery, 2 Bala Plaza, PL-15, Bala Cynwyd, PA, 19004, USA
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16
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Wollina U, Goldman A. Lip enhancement and mouth corner lift with fillers and botulinum toxin A. Dermatol Ther 2020; 33:e14231. [PMID: 32852076 DOI: 10.1111/dth.14231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
Beautiful lips are responsible for facial attractiveness and a youthful appearance. During aging process, lips become thinner and the red lips borders get poor defined. Downturn of the corners of the mouth suggests negative emotions. Lip surgery and underlying pathology may result in asymmetries and lip incontinence. Minor invasive procedures with hyaluronic acid fillers and botulinum toxin A are versatile tools to improve appearance of the lips, restore function and improve psycho-social well-being. In this review, we discuss anatomy, safety concerns, injections techniques as well as esthetic and medical indications.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Alberto Goldman
- Department of Plastic Surgery at Hospital São Lucas da PUCS, Porto Alegre, Brazil
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17
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Abstract
Abstract
Purpose of Review
To provide the reader with a clear overview of facial anatomy as it relates to injection of botulinum toxin.
Recent Findings
The review suggests the presentation of multiple combinations of facial musculature, with the forehead, glabellar, and nasal base areas as particular areas of variation. Differences in musculature result in different wrinkling patterns; with age, these changes first become apparent in the upper face, particularly in the forehead and glabellar area.
Summary
Botulinum toxin is well suited to achieve the optimal outcome: it is popular, safe, and non-invasive and presents with few adverse effects. Though limited, when adverse effects do arise these are primarily related to poor injection technique, often fuelled by poor anatomical knowledge. For clinicians to achieve the best outcomes with botulinum toxin use, an understanding of the facial muscles’ anatomy, actions, and interactions is key. This paper discusses the broad and intricate detail regarding the key target muscles of botulinum toxin, based on both literature review and cadaveric dissection carried out by the authors.
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18
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Pan B, Zhao R, Wu S, Lin H, Long Y, Hao G, Chen J, Nian F. A combined method of oral commissure lifting for perioral rejuvenation in Asians. J Plast Reconstr Aesthet Surg 2020; 73:2217-2224. [PMID: 32595087 DOI: 10.1016/j.bjps.2020.05.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/31/2020] [Accepted: 05/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND A drooping oral commissure shows an appearance of ageing and sadness. To improve it with less complications has become a rising aesthetic concern for Asians. OBJECTIVES To share our method for oral commissure lifting by a combined technique including skin resection, oral commissure suspension, and dissection of the depressor anguli oris muscle (DAO), and to present the follow-up outcomes. METHODS This was a retrospective study of patients who underwent oral commissure lifting between 10/2012 and 03/2019 at the Department of Plastic Surgery, Peking University Third Hospital. The patients were routinely followed at 1 week, 1 month, and over 6 months. After operation, cases with the cheilions (oral commissure points) located above the ipsilateral lateral thickening points were considered to be effective, with the points at the same level were considered to be mildly effective, and with the cheilions below the ipsilateral lateral thickening points were considered to be ineffective treatment. RESULTS Surgery took around an hour. Swelling subsided within 9.2±3.4 days. The red color of the scar disappeared within 3.7±1.5 months and the natural facial expression was restored within 7.9±2.6 weeks. Among the 159 cases, 125 (78.6%) were obviously effective, 21 (13.2%) were mildly effective, and 13 (8.2%) were ineffective. After the first operation, 112 patients (70.4%) were satisfied, 39 patients (24.5%) were basically satisfied, and eight patients (5.0%) were unsatisfied. CONCLUSIONS The combined technique for the oral commissure lifting displayed a significant effect with little complication in Asian patients.
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Affiliation(s)
- Bailin Pan
- Department of Plastic Surgery, Peking University Third Hospital.
| | - Runlei Zhao
- Department of Plastic Surgery, Peking University Third Hospital
| | - Siqiao Wu
- Department of Plastic Surgery, Peking University Third Hospital
| | - Hengju Lin
- Department of Plastic Surgery, Peking University Third Hospital
| | - Yan Long
- Department of Plastic Surgery, Guizhou Provincial People Hospital
| | - Guang Hao
- Department of Plastic Surgery, Peking University Third Hospital
| | - Jing Chen
- Department of Plastic Surgery, Peking University Third Hospital
| | - Fuhong Nian
- Department of Plastic Surgery, Peking University Third Hospital
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19
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Clevens RA, Khelemsky R, Sayal NR. The Corner of Lip Lift Technique. Facial Plast Surg Aesthet Med 2020; 22:389-390. [PMID: 32250643 DOI: 10.1089/fpsam.2020.0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ross A Clevens
- Facial Plastic and Reconstructive Surgery, Clevens Face and Body Specialists, Melbourne, Florida
| | - Renata Khelemsky
- Facial Plastic and Reconstructive Surgery, Clevens Face and Body Specialists, Melbourne, Florida
| | - Navdeep R Sayal
- Facial Plastic and Reconstructive Surgery, Clevens Face and Body Specialists, Melbourne, Florida
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20
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Bae GY, Na JI, Park KC, Cho SB. Nonsurgical correction of drooping mouth corners using monophasic hyaluronic acid and incobotulinumtoxinA. J Cosmet Dermatol 2019; 19:338-345. [PMID: 31125173 DOI: 10.1111/jocd.13010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nonsurgical correction of drooping of the corners of the mouth requires a multimodal approach combining botulinum toxin and soft tissue filler injections. OBJECTIVE To validate a nonsurgical therapeutic approach for correcting a "saddened" appearance characterized by drooping mouth corners, oral commissures, and/or marionette lines. METHODS In this prospective, evaluator-blinded study, monophasic hyaluronic acid (MHA) was infiltrated to correct drooping mouth corners in four steps, deep oral commissures in two steps, and/or deep marionette lines in two steps, in that order. Then, incobotulinumtoxinA was injected along the depressor anguli oris and mentalis muscles. RESULTS The total volumes of MHA used in steps 1-4 were 0.2 mL (interquartile range [IQR]: 0.19-0.3) for the right side of the face and 0.25 mL (IQR: 0.2-0.3) for the left side; total volumes in steps 5-8 were 0.18 mL (IQR: 0-0.4) for the right side and 0.15 mL (IQR: 0-0.33) for the left side. The total mean dose of incobotulinumtoxinA was 26.5 units (IQR: 24-28). The median degrees of drooping of the mouth corners were -4° (IQR: -7° to -2°) at baseline, -1° (IQR: -3° to 1°) at post-treatment 2 weeks, and -1° (IQR: -3° to 0°) at post-treatment 3 months. Median Global Aesthetic Improvement Scale scores were 3 (IQR: 2-3) at post-treatment 2 weeks and 3 (IQR: 2-3.75) at 3 months. CONCLUSION Our results demonstrated that nonsurgical treatment with MHA and incobotulinumtoxinA provides satisfactory therapeutic outcomes in patients with a saddened appearance by correcting drooping of the mouth corners, deep oral commissures, and/or deep marionette lines.
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Affiliation(s)
| | - Jung-Im Na
- Department of Dermatology, Seoul National University Bundang Hospital, Bundang, Korea
| | - Kyoung-Chan Park
- Department of Dermatology, Seoul National University Bundang Hospital, Bundang, Korea
| | - Sung Bin Cho
- Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.,Yonsei Seran Dermatology and Laser Clinic, Seoul, Korea
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21
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Snider CC, Amalfi AN, Hutchinson LE, Sommer NZ. New Insights into the Anatomy of the Midface Musculature and its Implications on the Nasolabial Fold. Aesthetic Plast Surg 2017; 41:1083-1090. [PMID: 28508263 DOI: 10.1007/s00266-017-0889-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prominent nasolabial fold is a distinct feature of the aging midface. As minimally invasive procedures have become mainstream, chemodenervation is a preferred method for treating dynamic facial rhytids. We therefore sought to identify relevant nasolabial fold and midfacial muscular anatomy to determine the ideal location of neuromodulation to improve the aesthetics of the midface and nasolabial fold without altering the upper lip and smile. METHODS Twelve hemifacial cadaveric dissections were performed to identify midface muscle origin, insertion, width, vector of pull, and neighboring structures. Attention was focused on the levator labii superioris alaeque nasi (LLSAN), levator labii superioris (LLS), nasalis, and orbicularis oculi. Measurements were obtained based on surface landmarks including the medial canthus for future neurotoxin injection. RESULTS The LLSAN inserts into the medial nasolabial fold and alar base, while the LLS inserts into the middle third of the nasolabial fold. The broadest portion of the superior LLSAN was on average 8.4 mm inferior and 4.6 mm medial to the medial canthus. A separate muscle obliquely oriented between the orbicularis oculi and LLSAN was identified and found to insert into the malar fat pad. This "malar levator" was present in all specimens and has implications on medial periorbital rhytids and the tear trough deformity. CONCLUSION This study further defines midfacial and nasolabial fold muscular anatomy and provides new insights into the use of neuromodulators for these areas without affecting upper lip position. The malar levator muscle appears to be a separate midfacial muscle with independent action. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Chelsea C Snider
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street, 3rd Floor, Springfield, IL, 62702, USA.
| | - Ashley N Amalfi
- Department of Plastic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Lauren E Hutchinson
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street, 3rd Floor, Springfield, IL, 62702, USA
| | - Nicole Z Sommer
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street, 3rd Floor, Springfield, IL, 62702, USA
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22
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Aguilera SB, Brown L, Perico VA. Aesthetic Treatment of Bruxism. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2017; 10:49-55. [PMID: 28670358 PMCID: PMC5479477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Bruxism is a diurnal or nocturnal parafunctional activity that includes unconscious clenching, grinding, or bracing of the teeth. An extensive medical history should be taken in these patients so proper diagnosis can be made. Habits such as biting the tongue, cheeks or lips, chewing gum or eating seeds for many hours per day, biting nails, and/or biting hard objects, will cause and/or exacerbate pre-existing bruxism. The etiology of bruxism is uncertain, but it is hypothesized to be associated with genetic, structural, and psychosocial factors. Over time, chronic clenching of the jaw leads to hypertrophy of masseters and temporalis musculature causing the face to take on a masculine and square appearance. Patients commonly present to dermatology cosmetic practices wishing to have a more slim, softer appearing face. This review is the first paper to discuss aesthetic treatment options for complications of bruxism including masseter and temporalis hypertrophy and the associated accelerated aging of the lower face.
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Affiliation(s)
- Shino Bay Aguilera
- Volunteer Professor, Nova Southeastern University College of Osteopathic Medicine, Department of Dermatology, Fort Lauderdale, Florida
| | - Liza Brown
- Dermatology Resident—PGY3, Larkin Community Hospital, Miami, Florida
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23
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Qian W, Zhang YK, Lv W, Hou Y, Cao Q, Fan JF. Application of Local Injection of Botulinum Toxin A in Cosmetic Patients with Congenital Drooping Mouth Corner. Aesthetic Plast Surg 2016; 40:926-930. [PMID: 27734116 DOI: 10.1007/s00266-016-0711-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to investigate the clinical application and efficacy of local injection of botulinum toxin A (BTX-A) at the depressor anguli oris in patients with congenital drooping mouth corner. METHODS From September 2013 to March 2015, 36 cosmetic patients received local injections of botulinum toxin A at the depressor anguli oris, with 1-3 injection sites in the moving region of the depressor anguli oris on each side. At each injection site, 2-4 U of BTX-A was injected, and the total dose for any unilateral treatment did not exceed 8 U. The change in the degree of drooping of the mouth corner before and after the injection was analyzed using statistical methods. The clinical efficacy, preservation time, and adverse reactions were observed. RESULTS The degree of drooping of the mouth corners of the cosmetic patients before the treatment was compared with that at 1 month after using a paired t test, and the difference was statistically significant, with P < 0.01. The treatment results were satisfactory, and the effect was preserved for 6-9 months. None of the 36 cosmetic patients had any complications of bruising, infection, dysfunction in opening and closing the mouth, smile asymmetry, drooling, or dysarthria after the injection. CONCLUSIONS The local injection of BTX-A at the depressor anguli oris can effectively lift a drooping mouth corner, thereby improving the depressed, stern, and aged appearance of the face. The performance of this treatment is simple, safe, and easy to perform in clinical applications. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Wei Qian
- Department of Plastic and Reconstructive Surgery, Beijing Chao-Yang Hospital, Capital Medical University, #8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Yan-Kun Zhang
- Department of Plastic and Reconstructive Surgery, Beijing Chao-Yang Hospital, Capital Medical University, #8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Wei Lv
- Department of Plastic and Reconstructive Surgery, Beijing Chao-Yang Hospital, Capital Medical University, #8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Ying Hou
- Department of Plastic and Reconstructive Surgery, Beijing Chao-Yang Hospital, Capital Medical University, #8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Qian Cao
- Department of Plastic and Reconstructive Surgery, Beijing Chao-Yang Hospital, Capital Medical University, #8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Ju-Feng Fan
- Department of Plastic and Reconstructive Surgery, Beijing Chao-Yang Hospital, Capital Medical University, #8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China.
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24
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Wanitphakdeedecha R, Ungaksornpairote C, Kaewkes A, Rojanavanich V, Phothong W, Manuskiatti W. The comparison between intradermal injection of abobotulinumtoxinA and normal saline for face‐lifting: a split‐face randomized controlled trial. J Cosmet Dermatol 2016; 15:452-457. [DOI: 10.1111/jocd.12289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Chanida Ungaksornpairote
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Arisa Kaewkes
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | | | - Weeranut Phothong
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Woraphong Manuskiatti
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
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25
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Abstract
The use of botulinum toxin in the lower face is more complex and less reliable than its use in the upper face. Use in the lower face is also fraught with more adverse events. The anatomy of the lower face is complex, as the muscles of this region are very close together and interface at different levels and depths to perform heterogeneous functions, such as talking, eating, drinking, and expressivity of the face. This article, based on the anatomical knowledge of each muscle of the lower face, provides recommendations and guidelines to perform botulinum toxin injection safely. The review of each muscle with its relevant anatomy and relationship of this three-dimensional anatomy with the cutaneous plane gives the exact position of injectable locations. For each muscle, the number of points related to the motor end plate location and the exact dose related to the muscular mass are indicated. Summary tables are provided.
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26
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Wollina U, Goldman A. [Esthetic dermatology for the elderly]. Hautarzt 2015; 67:148-52. [PMID: 26452352 DOI: 10.1007/s00105-015-3700-3] [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: 11/30/2022]
Abstract
Esthetic dermatology discovers older age. Methods and techniques which are useful in younger people need modifications to meet the special needs of the elderly. These aspects are discussed with a focus on the aging face. Esthetic dermatology is most successful when using principles of regenerative medicine.
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Affiliation(s)
- U Wollina
- Klinik für Dermatologie und Allergologie, Krankenhaus Dresden-Friedrichstadt, Städtisches Klinikum, Akademisches Lehrkrankenhaus der TU Dresden, Friedrichstr. 41, 01067, Dresden, Deutschland.
| | - A Goldman
- Clinica Goldman, Porto Alegre, RS, Brasilien
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27
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Anatomical Considerations Regarding the Location and Boundary of the Depressor Anguli Oris Muscle with Reference to Botulinum Toxin Injection. Plast Reconstr Surg 2014; 134:917-921. [DOI: 10.1097/prs.0000000000000589] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Descended mouth corner: an ignored but needed feature of facial rejuvenation. Arch Plast Surg 2013; 40:783-6. [PMID: 24286055 PMCID: PMC3840189 DOI: 10.5999/aps.2013.40.6.783] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 05/28/2013] [Accepted: 06/04/2013] [Indexed: 11/28/2022] Open
Abstract
For years, the gold standard in facial rejuvenation has been the face lift. However, exploring new, less complex procedures for achieving the same goal is currently drawing interest. Rejuvenation of the perioral area is a difficult task for plastic surgeons because of the minimal effect that face lift procedures have over this region and the lack of published material on the subject. In this article, the descended mouth corner anguloplasty technique is presented. It is a 20-minutes lift technique that can correct this typical feature of the ageing mouth. The authors have treated 71 patients using the technique with consistently good results, with just one requiring revision. They conclude that this procedure by itself and in combination with other small operations or even a full face lift can rejuvenate the ageing face.
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29
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Wollina U. Perioral rejuvenation: restoration of attractiveness in aging females by minimally invasive procedures. Clin Interv Aging 2013; 8:1149-55. [PMID: 24039412 PMCID: PMC3770626 DOI: 10.2147/cia.s48102] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lips and the perioral area are of outstanding importance in youthful appearance, attractiveness, and beauty. In contrast to younger and middle aged females, there is only scant published data on minimally invasive procedures to restore and revitalize lips and perioral soft tissue in elderly females. In this review we report the signs of aging in this particular region and the underlying anatomy. We review studies on lip restoration in younger females and present our techniques for elderly women. With an individually tailored approach, elderly females benefit from minimally invasive techniques.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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30
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Geister TL, Bleßmann-Gurk B, Rzany B, Harrington L, Görtelmeyer R, Pooth R. Validated assessment scale for platysmal bands. Dermatol Surg 2013; 39:1217-25. [PMID: 23650974 DOI: 10.1111/dsu.12240] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Marked platysmal bands in the neck are an unwelcome sign of aging. Botulinum neurotoxin type A has been used successfully to treat this indication, but there is a need for a validated tool for accurate assessment of dynamic platysmal bands to evaluate treatment efficacy objectively. OBJECTIVE To develop a scale for objective assessment of dynamic platysmal bands and to validate its use in the clinical setting. METHODS A new 5-point photonumeric assessment scale for platysmal bands was developed. Ten experts experienced in aesthetic dermatology used the scale to rate frontal and lateral neck photographs of 50 subjects in two separate validation cycles. Inter- and intrarater reliability of the scale was assessed. RESULTS The scale comprises five ratings of platysmal band severity ranging from 0 (no relevant prominence of platysmal bands) to 4 (very severe prominence of platysmal bands). Interrater reliability was "almost perfect," with intraclass correlation coefficients of 0.81 for the first validation cycle and 0.82 for the second. Mean intrarater reliability was also high (0.89), with Pearson correlation coefficients ranging between 0.87 and 0.91. CONCLUSION The new 5-point dynamic platysmal band photonumeric assessment scale is a valuable tool for use in the aesthetic clinical setting.
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Affiliation(s)
- Thorin L Geister
- Research and Development HQ, MERZ Pharmaceuticals GmbH, Frankfurt, Germany.
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31
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32
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Braz AV, Louvain D, Mukamal LV. Combined treatment with botulinum toxin and hyaluronic acid to correct unsightly lateral-chin depression. An Bras Dermatol 2013; 88:138-40. [PMID: 23539022 PMCID: PMC3699948 DOI: 10.1590/s0365-05962013000100024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 06/13/2012] [Indexed: 11/21/2022] Open
Abstract
With aging, anatomical changes are observed in the face. In the lower third, these changes are expressed as ptosis of the angle of the mouth, lip enhancement groove mentalis; decrease in concavity between the jaw and neck and very noticeable platysmal banding. The repeated contraction of muscles of the lateral-chin together with the band platysmal side form what are called a marionette groove. Treating the whole lateral-chin area can result in a more harmonious aspect of the face when compared with treatment of a marionette groove in isolation. In this paper we describe combined treatment of the lateral chin area using botulinum toxin and fillers.
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Affiliation(s)
- André Vieira Braz
- Dermatology Division, Policlínica Geral do Rio de Janeiro (PGRJ), Rio de Janeiro, RJ, Brazil.
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33
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Wollina U, Goldman A, Naoum C. [Side effects in aesthetic medicine. Spectrum, management and avoidance]. Hautarzt 2013; 64:155-62. [PMID: 23430168 DOI: 10.1007/s00105-012-2484-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aesthetic medicine has become increasingly popular in the last two decades. The same trend has occurred in dermatology. Aesthetic dermatology prefers minimally invasive procedures. Nevertheless, even these procedures are not free of possible adverse effects. The spectrum of possible adverse effects, their management and prevention are discussed for four popular procedures in aesthetic dermatology, i.e. chemical peels, mesotherapy, botulinum toxin, and dermal fillers. Aesthetic procedures should only be performed by well-educated, well-trained medical doctors with an excellent medical background, never by lay persons.
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Affiliation(s)
- U Wollina
- Klinik für Dermatologie und Allergologie, Krankenhaus Dresden-Friedrichstadt - Städtisches Klinikum, Akademisches Lehrkrankenhaus der TU Dresden, Friedrichstr. 41, 01067 Dresden.
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Wollina U, Goldman A. Minimally invasive aesthetic procedures in young adults. Clin Cosmet Investig Dermatol 2011; 4:19-26. [PMID: 21673871 PMCID: PMC3108279 DOI: 10.2147/ccid.s17467] [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: 03/24/2011] [Indexed: 11/23/2022]
Abstract
Age is a significant factor in modifying specific needs when it comes to medical aesthetic procedures. In this review we will focus on young adults in their third decade of life and review minimally invasive aesthetic procedures other than cosmetics and cosmeceuticals. Correction of asymmetries, correction after body modifying procedures, and facial sculpturing are important issues for young adults. The implication of aesthetic medicine as part of preventive medicine is a major ethical challenge that differentiates aesthetic medicine from fashion.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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