Thinning of the lower third of the face using botulinum toxin in the masseter muscle

Bravo, Bruna Souza Félix; Balassiano, Laila Klotz de Almeida; Rocha, Camila Roos Mariano da; Bastos, Julien Totti de; Silva, Priscila Mara Chaves e; Freitas, Bruno Messias Pires de

doi:10.5935/scd1984-8773.201681566

Cited by 2 publications

(1 citation statement)

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“…[4][5][6] Increasing anatomic knowledge of facial anatomy, resulted in the administration of neuromodulators to treat jawline contouring and midfacial volume loss (depressor anguli oris and platysma) or were utilized to indirectly treat temporal volume loss by targeting the masseter muscle. [7][8][9] The masseter muscle can also be targeted with neuromodulators for lower facial volume reduction and facial slimming; this is predominantly popular in Asian populations. 10,11 However, reduction in lower facial volume can additionally be achieved by targeting the parotid and the submandibular glands with neuromodulators; this is a standard treatment for reducing excess saliva production (sialorrhea).…”

Section: Introductionmentioning

confidence: 99%

Safety considerations for treating the parotid and submandibular glands with neuromodulators for facial slimming

Gelezhe,

Frank,

Casabona

et al. 2023

J of Cosmetic Dermatology

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BackgroundNeuromodulators 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.ObjectiveTo 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 methodsA 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.ResultsThe 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.ConclusionThe 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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