Nerve Block Guided by Anatomic Landmarks Only Reduces Pain in Botulinum Toxin Type A Treatment for Glabellar and Forehead Wrinkles.

BACKGROUND: Botulinum toxin type A is widely used to treat glabellar and forehead wrinkles, but the pain caused by multiple injections often deters patients from receiving long-term treatment. Despite several methods used to alleviate this pain, consistency and effectiveness remain a challenge. Therefore, this study aimed to evaluate the effectiveness and safety of nerve block guided by anatomic landmarks only in reducing pain associated with botulinum toxin type A injections. PATIENTS AND METHODS: Between 2018 and 2022, the study enrolled 90 patients divided into 3 groups: the nerve block group (n = 30), the lidocaine cream group (n = 30), and the control group (n = 30). In the nerve block group, a landmarks-based technique was used to perform the nerve block. The study collected general information and comorbidities, and recorded pain at each point and time spent on preparation and treatment for each patient's forehead and glabellar area on each side. Patient-reported outcomes and complications were followed up at 2, 4, and 12 weeks after the injections. RESULTS: The nerve block group had significantly lower total pain scores in all regions compared to the lidocaine cream and control groups (P < 0.01). There were no significant differences in patient-reported outcomes between the groups at any follow-up point. Additionally, the complication rates related to injection were low and comparable among the 3 groups. CONCLUSIONS: Nerve block guided by anatomic landmarks only is a safe, effective, and consistent approach to reduce pain during botulinum toxin type A treatment for glabellar and forehead lines. This technique may offer advantages over other methods used to alleviate the pain associated with these injections.

Modified Progressive Tension Sutures for Closing the Wounds of Large Subcutaneous Tumor in Upper Back.

Large subcutaneous tumor removal in the upper back could leave "dead space" and increase postoperative complications. The progressive tension suture (PTS) has long been used in abdominoplasty to close dead space and reduce the complications rate. We aimed to explore the effectiveness of the modified PTS to reduce the complication of the large subcutaneous tumor removal in the upper back. Fity-nine patients with large subcutaneous upper back tumors (maximal length over 5 cm) were included in our prospective study and were randomly divided into the PTS group (n = 32) and the non-PTS group (n = 27). Based on the exposure of the deep fascia and the thickness of the flap, we modified the PTS technique and compared the outcomes (including necrosis, hematoma, and seroma) between the two groups. The tumor size, flap thickness, and the total surgical duration were comparable between the two groups. The incidence of flap necrosis (6.30% versus 25.90%, P = 0.0659) and seroma (0.00% versus 33.30%, P = 0.004) in the PTS group was lower than that in the non-PTS group. The length of hospital stay in the PTS group was shorter than that in the non-PTS group (6.4 ± 1.3 versus 9.4 ± 2.1 days, P < 0.0001). The modified PTS technique can effectively close the dead space after surgical removal of large upper back tumor and reduce the complications compared to the conventional approach.