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. 2021 Jun;20(6):1625-1633.
doi: 10.1111/jocd.14133. Epub 2021 Apr 16.

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

Sebastian Cotofana  1 , Angela P Pedraza  2 , Joely Kaufman  3 , Luiz E T Avelar  4 , Diana L Gavril  5 , Claudia A Hernandez  6 , Emy C Onishi  7 , Andreas Nikolis  8   9 , Thais Sakuma  10 , Konstantin Frank  11
Affiliations

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

Sebastian Cotofana et al. J Cosmet Dermatol. 2021 Jun.

Abstract

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.

Keywords: abobotulinum toxin; corrugator supercilii muscle; glabellar frown lines; incobotulinum toxin; onabotulinum toxin; procerus muscle.

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References

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