A 3D Morphometrical Evaluation of Brow Position After Standardized Botulinum Toxin A Treatment of the Forehead and Glabella

Schlager, Stefan; Kostunov, Jana; Henn, Dominic; Stark, Birgit; Iblher, Niklas

doi:10.1093/asj/sjy205

Cited by 5 publications

(11 citation statements)

References 17 publications

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“…One strength of the present study is the innovative approach to determine the 2-and 3-dimensional location of the injection points purely on anatomy and on the muscular origin of the targeted muscles. Despite the plethora of currently available injection points and algorithms, 2,8,14 the presented injection technique is unique as it relies exclusively on targeting the origins of the muscles responsible for glabellar frown lines. Another strength of this study is the long follow-up period with 120 days (=4 months), which allows for evaluation of onset, duration, and the reduction in effectiveness of the administered neuromodulators.…”

Section: Discussionmentioning

confidence: 99%

Respecting upper facial anatomy for treating the glabella with neuromodulators to avoid medial brow ptosis—A refined 3‐point injection technique

Cotofana

Pedraza²,

Kaufman

et al. 2021

J of Cosmetic Dermatology

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Background: Current injection algorithms for treating the glabella rely on a five-or seven-point injection technique with possible medial eyebrow ptosis and lateral eyebrow elevation as undesirable outcomes.Objective: The objective of this study was to investigate the efficacy and safety profile of a refined 3-point injection technique targeting horizontal and vertical glabellar lines.Methods: A total of n=105 patients (27 males and 78 females) with a mean age of 40.90 ± 9.2 years were investigated. The injection technique relied on targeting the muscular origin of the procerus and the corrugator supercilii muscles exclusively. The time of effect onset and the injection-related outcome 120 days after the treatment was evaluated using the 5-point glabellar line severity scale. Results:The onset of the neuromodulator effect was on average 3.5 ± 1.5 days. There was no statistically significant difference in the amplitude of movement before or 14 days after the treatment with 2.99 ± 4.4 mm vs. 3.39 ± 3.6 mm (p = 0.149) for the medial head of the eyebrow and with 3.18 ± 4.7 mm vs. 3.33 ± 4.3 mm (p = 0.510) for the lateral head of the eyebrow, respectively. Conclusion:Incorporating anatomic concepts into clinical practice for glabellar frown line neuromodulator treatments with the investigated 3-point injection technique resulted in the absence of adverse events like eyebrow ptosis, upper eyelid ptosis, medial eyebrow ptosis, and lateral frontalis hyperactivity. This technique demonstrated efficacy throughout the 4-month study period. K E Y W O R D S abobotulinum toxin, corrugator supercilii muscle, glabellar frown lines, incobotulinum toxin, onabotulinum toxin, procerus muscle How to cite this article: Cotofana S, Pedraza AP, Kaufman J, et al. Respecting upper facial anatomy for treating the glabella with neuromodulators to avoid medial brow ptosis-A refined 3-point injection technique.

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Section: Discussionmentioning

confidence: 99%

Respecting upper facial anatomy for treating the glabella with neuromodulators to avoid medial brow ptosis—A refined 3‐point injection technique

Cotofana

Pedraza²,

Kaufman

et al. 2021

J of Cosmetic Dermatology

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“…45 More frequently, "pseudo Mephisto eyebrows" are seen following glabella complex injection, due to the ptosis of the eyebrow head (Figure 2A,B). 46 Glabellar complex includes eyebrow depressors:…”

Section: Ae S the Tic Complic Ationsmentioning

confidence: 99%

“… 45 More frequently, “pseudo Mephisto eyebrows” are seen following glabella complex injection, due to the ptosis of the eyebrow head (Figure 2A,B). 46 Glabellar complex includes eyebrow depressors: corrugator, procerus, and medial fibers of orbicularis oculi muscles. Frontalis muscle, which is a brow elevator, overlays the corrugator and parts of orbicularis oculi muscles.…”

Section: Aesthetic Complicationsmentioning

confidence: 99%

Botulinum toxin complications in registered and off‐label aesthetic indications

Landau

Nestor

Almeida

et al. 2020

J of Cosmetic Dermatology

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Botulinum toxin A (BTXA) is one of the most popular nonsurgical cosmetic procedures worldwide. Overall, this procedure is associated with favorable complications profile. Nevertheless, any medical intervention carries inherent risks. This synopsis systematically reviews adverse effects of aesthetic BTXA for both approved and off‐label indications. Based on published data, the approach for prevention and management is discussed.

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“…Os pacientes classificados neste padrão apresentam linhas glabelares perpendiculares e transversais formadas por corrugadores e o procerus em formato de "U". Durante a contração estimulada, exibem predominância de aproximação e depressão discretas da glabela, com o movimento 20 . Ocorre simultaneamente elevação da cauda dos supercílios.…”

Section: Padrõesunclassified

“…A atividade muscular provoca linhas hipercinéticas perpendiculares à direção de contração dos músculos, formando rugas inestéticas horizontais, verticais e oblíquas 8 . O uso da pele glabelar foi descrito pela primeira vez por Carl Von Graefe em 1819 e atualmente ela é a área em que se utiliza a toxina botulínica para fins estéticos 9 . Erroneamente se tem padronizado a aplicação de toxina botulínica nesta região, bem como em região frontal 10 ., mas muitos médicos injetores, não têm utilizado em sua avaliação clínica, as diversas características anatômicas étnicas e espectros cinéticos determinam padrões de contração da musculatura, que são únicos para cada pessoa 11 .…”

Section: Introductionunclassified

Padrões de contração glabelar e a utilização da toxina Botulínica – UPDATE

Rodrigues¹

2020

Arch. Health

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Introdução: A atividade muscular na glabela provoca rugas perpendiculares à direção de contração dos músculos, mas os padrões de contração glabelar ainda não foram adequadamente classificados, nas diversas etnias. Objetivo: Revisar os padrões de contração glabelar encontrados em etnias diferentes e a sugestão mais plausível de uso de toxina botulínica. Métodos: Foi realizado uma revisão bibliográfica de artigos em bases indexadas MEDLINE e LILACS, utilizando os descritores: Toxina botulínica A, linhas glabelares, rítides glabelares, rugas glabelares, padrões de rugas. Resultados: Seis padrões foram identificados. A classificação permitiu identificar os músculos mais importantes em cada padrão de contração. Discussão/conclusão: Existem diferenças interpessoais na mímica facial e a classificação das rugas glabelares permite tratamento mais acurado e individualizado com a toxina botulínica.Descritores: Toxina botulínica A, linhas glabelares, rítides glabelares, rugas glabelares, padrões de rugas ABSTRACT Introduction: The muscular activity in the glabella causes wrinkles perpendicular to the direction of muscle contraction, but the patterns of glabellar contraction have not yet been classified, in different ethnicities. Objective: To review the patterns of glabellar contraction found in different ethnicities and a more plausible suggestion of using botulinum toxin. Methods: A bibliographic review of articles was performed on MEDLINE and LILACS indexed bases, using the descriptors: Botulinum toxin A, glabellar lines, glabellar rhythms, glabellar wrinkles, wrinkle patterns. Results: Six patterns were identified. The common classification identifies the most important muscles in each contraction pattern. Discussion / conclusion: differences there are interpersonal differences in facial mimicry and a classification of glabellar wrinkles allows for more accurate and individualized treatment with botulinum toxin.

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A 3D Morphometrical Evaluation of Brow Position After Standardized Botulinum Toxin A Treatment of the Forehead and Glabella

Cited by 5 publications

References 17 publications

Respecting upper facial anatomy for treating the glabella with neuromodulators to avoid medial brow ptosis—A refined 3‐point injection technique

Respecting upper facial anatomy for treating the glabella with neuromodulators to avoid medial brow ptosis—A refined 3‐point injection technique

Botulinum toxin complications in registered and off‐label aesthetic indications

Padrões de contração glabelar e a utilização da toxina Botulínica – UPDATE

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