Simulating Upper Eyelid Ptosis During Neuromodulator Injections-An Exploratory Injection and Dissection Study.

Autor: Paternostro F; Department of Experimental and Clinical Medicine, Anatomy and Histology Section, University of Florence, Florence, Italy., Hong WJ; Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China., Zhu GS; Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China., Green JB; Skin Associates of South Florida and Skin Research Institute, Coral Gables, Florida, USA., Milisavljevic M; Laboratory for Vascular Morphology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia., Cotofana MV; Cotofana Anatomy, Rochester, Minnesota, USA., Alfertshofer M; Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Munich, Germany., Hendrickx SB; Department of Plastic and Reconstructive Surgery, University Hospital Leuven, Leuven, Belgium., Cotofana S; Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China.; Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands.; Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK.; Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Jazyk: angličtina
Zdroj: Journal of cosmetic dermatology [J Cosmet Dermatol] 2024 Oct 12. Date of Electronic Publication: 2024 Oct 12.
DOI: 10.1111/jocd.16631
Abstrakt: Background: Aesthetic neuromodulator injections of the upper face are frequently performed to temporarily block muscular actions of the periorbital muscles to ultimately reduce skin rhytids. However, the adverse event rate in the literature for toxin-induced blepharoptosis ranges from 0.51% to 5.4%.
Objective: To identify access pathways by which injected neuromodulator product can travel from extra- to intra-orbital and therefore affect the levator palpebrae superioris muscle.
Methods: Nine non-embalmed human body donors were investigated in this study with a mean age at death of 72.8 (16.1) years. The 18 supraorbital regions were injected in 28 times (14 for supratrochlear and 14 for supraorbital) with 0.5 cc, whereas eight cases (four for supratrochlear and four supraorbital) were injected with 0.1 cc of colored product. Anatomic dissections were conducted to identify structures stained by the injected color.
Results: The results of this injection- and dissection-based study revealed that both the supratrochlear and the supraorbital neurovascular bundles are access pathways for injected neuromodulator products to reach the intra-orbital space and affect the levator palpebrea superioris muscle. Out of 36 conducted injection passes, seven (19.44%) resulted in affection of the sole elevator of the eyelid of which 100% occurred only at an injection volume of 0.5 cc and not at 0.1 cc.
Conclusion: Clinically, the results indicate that a low injection volume, a superficial injection for the supraorbital location, and angling the needle tip away from the supratrochlear foramen (toward the contralateral temple) when targeting the corrugator supercilii muscles, can increase the safety profile of an aesthetic toxin glabellar treatment.
(© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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