Background Currently, botulinum toxin (BoNT) injections are the most commonly performed non-invasive procedure for rejuvenation on the upper face. The therapeutic use of botulinum toxin has generally been safe and well tolerated. Adverse effects are considered mild, transient, and self-limited. However, as with all other injectable procedures, this one is also susceptible to adverse events and complications. When the safety zones are respected, the chance of any of these complications is practically null. Thus, this review aims to describe the main complications of treatment with BoNT on the upper face and to present a practical guide based on current evidence on how to avoid them. Methods The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Results The main complications secondary to BoNT injections on the upper face are: ptosis of eyelid or eyebrow, eyebrow asymmetry, diplopia, Lakeophthalmos, Palpebral ectropion, and prominence of the palpebral bags. To avoid such complications, it is necessary to have knowledge of the anatomy of this region and adequate and individualized planning based on the existing patterns of the frontalis muscle, glabella, and crow's feet. This review presents the specificities of each of these regions and practical suggestions to obtain satisfactory results, avoiding complications. Conclusion Particularly on the upper face treatment with BoNT offers predictable results, has few adverse effects, and is associated with high patient satisfaction. However, it is suggested that the commented parameters and safety areas be incorporated into daily practice so that the possibilities of complications are minimized as much as possible. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
The eyebrow position is a determining factor related to facial expression, especially concerning the anatomical relationship of the eyebrow with the eyelid. The changing position of the eyebrows with aging influences the individual’s expression and can give negative emotions such as loss of vitality, sadness, and tiredness, and influence facial beauty. Numerous procedures are available to the surgeon to prevent the eyebrows from falling after upper blepharoplasty or lift them in isolation. Despite the various surgical techniques undertaken to manage the eyebrow, conventional approaches are usually more aggressive procedures involving extensive skin resection at the hairline or scalp, endoscopic elevation, and temporal and coronal approaches. Given the growing search for less aggressive procedures that patients better tolerate, this study aims to describe a less invasive variation of the Castañares technique, focused on the elevation of the eyebrow’s tail, which may or may not be associated with blepharoplasty, the Surgical Fox Eye. The technique removes an ellipse of skin above the distal third of the eyebrow close to the hair bulbs and then sutures with a direct elevation of the eyebrow tail. The technique described is ideal for several cases, as it presents predictable and satisfactory clinical outcomes as to the patients’ expectations. It also presents easy healing with extensive durability with minimal chance of complications. Level of evidence: Level V—Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Non-surgical procedures with hyaluronic acid (HA) dermal fillers to rejuvenate or even lessen facial disharmonies bring safe and reproducible aesthetic results when applied by qualified professionals. HA is a polysaccharide polymer found naturally in the human dermis and serves as a matrix for collagen development. Its main characteristic is it's high volumizing and hydration ability. 1 Synthetically, HA can be obtained through the production of Streptococcus bacteria or from the rooster crest and is stabilized by the crosslinked process to make it more durable since natural AH has a short half-life of 12 to 24 hours. Then more cross-linked the HA, the greater its stiffness (resistance to deformation by the force of gravity, also known as G prime or G') and the greater its resistance to degradation. The physical-chemical properties vary for each product; they are specifically indicated for a particular face
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