Understanding clinical meaningfulness when targeting the depressor anguli oris muscle (DAO) with neuromodulators: a clinical prospective interventional study.

BACKGROUND: Neuromodulator injections in the US increased by 24% from 2021 to 2022. This rise is attributed to new products and growing acceptance of minimally invasive aesthetic treatments. Recent studies emphasize the importance of facial anatomy for precision and, consequently, a higher efficacy of neuromodulator treatments. This study aims to evaluate the clinical efficacy of a novel previously proposed injection technique targeting the depressor anguli oris (DAO) muscle to improve oral commissure position. This clinical, prospective study included 34 volunteers from the Shinobu Clinic, São Paulo, Brazil. Patients received 3 units of onabotulinumtoxinA per side, injected mid-distance between the oral commissure and jawline, following the labiomandibular sulcus (LMS). Standardized photographs and assessments using the Oral Commissure Severity Scale (OCSS) and Global Aesthetic Improvement Scale (GAIS) were conducted before and 30 days post-treatment. Statistical analyses included t-tests, Wilcoxon Signed Rank test, and generalized linear models. The average increase in commissural height was 5.22% (p < 0.001). OCSS ratings improved significantly from baseline (clinician: 1.21 to 0.72, p < 0.001; patient: 0.93 to 0.69, p < 0.001). However, GAIS scores indicated no significant change (patient: 0.32, observer: 0.38; p = 0.491). The proposed injection technique improves perioral aesthetics objectively and subjectively. However, the lack of significant change in GAIS scores suggests that perceived improvements may not be clinically meaningful to patients. Future studies should focus on patient-centered evaluation methods to better assess aesthetic outcomes.

Increasing precision during neuromodulator injections for frontal rhytids-Using ultrasound imaging to identify the line of convergence.

BACKGROUND: Recent research introduced the concept of the "line of convergence" as a guide for injectors to enhance precision and avoid complications when treating the frontalis muscle with toxins. However, currently, no pre-injection ultrasound scanning is employed to increase precision and reduce adverse events when searching for the line of convergence. OBJECTIVE: To explore the feasibility and practicality of implementing pre-injection ultrasound scanning into aesthetic neuromodulator treatments of the forehead. METHODS: The sample of this study consisted of n = 55 volunteers (42 females and 13 males), with a mean age of 42.24 (10.3) years and a mean BMI of 25.07 (4.0) kg/m2. High-frequency ultrasound imaging was utilized to measure the thickness, length, and contractility of the frontal soft tissue and to determine the precise location of the line of convergence during maximal frontalis muscle contraction. RESULTS: The results revealed that the line of convergence was located at 58.43% (8.7) of the total forehead height above the superior border of the eyebrow cilia without a statistically significant difference between sex, age, or BMI. With frontalis muscle contraction, the forehead shortens in males by 25.90% (6.5), whereas in females it shortens only by 21.74% (5.1), with p < 0.001 for sex differences. CONCLUSION: This study demonstrated the feasibility and practicality of pre-injection ultrasound scanning for facial aesthetic neuromodulator treatments. Knowing the location of the line of convergence, injectors can determine precisely and on an individual basis where to administer the neuromodulator deep or superficial or when the injection location is at risk to cause eyebrow ptosis.

La importancia del conocimiento de la anatomía facial en armonización facial / The knowledge of facial anatomy in facial harmonization

La odontología argentina ha considerado reciente- mente la incorporación de armonización orofacial en odontología, acompañando los cambios que vienen sucediendo en el mundo con respecto a este tema. Países con especialización en armonización orofacial en odontología, como Brasil, 2019 o Venezuela, 2020, son muestra de ello. La evolución de la tecnología, junto con los cambios de paradigmas de la sociedad, ha cambiado aún el con- cepto de tratamiento desde la OMS. Actualmente bus- ca, como beneficio para los pacientes, el bienestar físico mental y social, no solo tratar o prevenir patologías. Acompañando estos conceptos las ciencias se adap- tan también a las necesidades de la población. El conocimiento de la anatomía facial también ha avanzado gracias a la tecnología y volumen de trabajos científicos desarrollados para conocer en profundidad cada una de las estructuras faciales y su relación entre ellas. Para ello ha sido fundamental la preparación actualizada de profesionales que traba- jan abordando tejidos blando de cara y cuello (AU)

Argentine dentistry has recently considered the incorporation of Orofacial Harmonization in Dentistry accompanying the changes that have been happening in the world regarding this issue, countries specializing in Orofacial Harmonization in Dentistry such as Brazil 2019 or Venezuela 2020 are proof of this. The evolution of technology together with the paradigm shifts of society has changed still the concept of treatment from the OMS Looking for a benefit for patients physical mental and social well-being and not only treat or prevent pathologies. Accompanying these concepts, the sciences also adapt to the needs of the population. Knowledge of facial anatomy has also advanced thanks to technology and volume of scientific works developed to know in depth each one of the structures facial features and their relationship between them, being essential the updated preparation of the professionals who work addressing soft tissues of the face and neck (AU)

Clinical validation of the upper face first principle-A clinical, prospective, interventional split-face study.

BACKGROUND: Previous clinical and anatomic investigations have identified the clinical relevance of facial biomechanics. Based on this new understanding, principles for facial aesthetic procedures were established: Lateral Face First, Deep Layers First, and Upper Face First. OBJECTIVE: To test the upper face first principle by showing that an injection sequence, starting in the upper face is superior to an injection sequence starting in the lower face. METHODS: This study was designed as an interventional split-face study administering the same amount and type of soft tissue filler for the upper, middle, and lower face but in a different sequence: upper, middle, lower face versus lower, middle, and upper face. A total of 15 patients (5 males and 10 females) with a mean age of 39.4 years (9.6) and a mean BMI of 23.4 kg/m2 (1.7) were studied. Follow-up at D0, D30, and D90 was conducted utilizing semiquantitative scores and objective 3D imaging. RESULTS: Despite not reaching statistical significance, midfacial volume and jawline contouring were rated better at every follow-up visit (D0, D30, D90) when treated with the upper versus the lower face first injection algorithm. The global aesthetic improvement scale showed statistically significantly better values for the upper face first algorithm when compared to the lower face first algorithm at all evaluated time points with all p < 0.001. CONCLUSION: Applying the upper face first injection algorithm seems to result in better aesthetic outcomes when directly compared to the lower face first algorithm. Semiquantitative and objective outcome measurements confirm its clinical effectiveness.

Applied anatomy of the layers and soft tissues of the forehead during minimally-invasive aesthetic procedures.

BACKGROUND: An increasing demand of minimally-invasive aesthetic procedures of the forehead concomitantly leads to higher numbers of adverse events. Adequate application of anatomical knowledge is required to increase safety and efficacy of different minimally-invasive aesthetic procedures in this anatomical region. OBJECTIVE: To describe the layered anatomy of the forehead soft tissues with respect to their thicknesses and how they relate to different minimally-invasive aesthetic treatments. METHODS: A total of n = 85 healthy study participants (69 females and 16 males) with a mean age of 40.84 ± 10.9 years and a mean body mass index of 22.65 ± 2.6 kg/m2 were investigated with ultrasound-based imaging to measure the thickness of different forehead soft tissues. RESULTS: The mean overall soft tissue thickness of the forehead was measured to be 4.18 ± 0.7 mm for the entire study population. Increasing BMI values correlated statistically significantly with increasing thickness of all measured forehead soft tissues with exception of the frontalis muscle. On a statistically significant level, males showed thicker forehead soft tissues than females, with exception of the retrofrontalis fat and the frontalis muscle. CONCLUSION: On basis of the findings obtained in this study, basic treatment principles can be derived and improved for the injection of neuromodulators, hyaluronic acid as well as the application of polydiaxonane (PDO) threads and micro-focused ultrasound. Precise knowledge and thorough understanding of the layers and soft tissues of the forehead is required to guarantee safe and effective procedures in this aesthetically important facial region.

After the Temporal Lifting Technique-What comes next?

BACKGROUND: The temporal lifting technique can provide lateral facial lifting when administering hyaluronic acid (HA)-based soft tissue fillers into the subdermal plane of the temple. However, the central facial oval is not influenced by this technique. OBJECTIVES: To identify the safety and esthetic effectiveness of additional midfacial injection points (in addition to the temporal lifting technique) that can volumize the medial midface, lift the lateral face, and increase jawline contouring when included into a full-face injection algorithm. METHODS: The patient records of nine consecutive patients (all females) with a mean age of 35.0 (8.4) years and a mean body mass index of 21.7 (2.4) kg/m2 were retrospectively analyzed after a full-face injection algorithm was performed using HA-based fillers. The additional injection points target the supraperiosteal plane of the medial zygomatic arch, the lateral infraorbital region, and the pyriform fossa using both needles and cannula. RESULTS: No adverse events were observed during the 6-month retrospective observational period. The volume of the medial midface increased, the volume of the lateral midface decreased, and the contour of the jawline improved; all effects reached a highly statistically significant level with p < 0.001. CONCLUSION: Despite each individual injection is currently performed on a daily clinical basis the evaluated injection algorithm following the temporal lifting technique shows some evidence that it is safe and esthetically effective. Future studies will need to confirm the results presented herein in a larger sample and with objective outcome measures to guide safe and effective esthetic outcomes.

Ortho-surgical management of a Conradi-Hünermann syndrome patient: rare case report.

The Conradi-Hünermann Disease is a rare syndrome, which affects the cranial development and the anatomy of dental occlusion. After interdisciplinary treatment completion, the patient reached satisfactory facial anatomy, as well as regular occlusal relationship, attested 2 years of accompaniment.

Correlación entre fuerza oclusal, profundidad del músculo masetero y estructura dentoesqueletofacial / Correlation between bite force, masseter muscle thickness and dentoskeletofacial structure

Este estudio evaluó la relación de la morfología facial y la estructura dentoesquelética con la razón profundidad muscular y fuerza oclusal en 40 pacientes, 20 normales y 20 con exceso vertical y mordida abierta. Se utilizaron ecografías bilaterales de masetero en contracción y relajación, radiografías cefálicas y P-A y un gnatodinamómetro para medir la fuerza oclusal bilateralmente a nivel de los primeros molares.- El promedio de la profundidad muscular en contracción fue de 11.72 mm para pacientes normales y 11.35 mm para pacientes con exceso vertical, sin diferencia significativa. El promedio de fuerza oclusal fue de 53.99 Kg para normales y de 36.21 Kg para excesivos (diferencia altamente significativa). El coeficiente de correlación entre fuerza oclusal y profundidad muscular en contracción no fue significativo (r<0.25).- El estudio sugiere una alta correlación entre fuerza oclusal y morfología facial, a diferencia de la falta de correlación notoria entre profundidad de masetero y morfología facial. En este grupo de individuos, en el que los pacientes con exceso vertical mostraron alta variabilidad morfológica, la fuerza oclusal y la morfología facial fueron independientes de la profundidad muscular, contrario a los estudios hasta ahora realizados.

An evaluation of the relationship between facial morphology and dentoeskeletal structure with muscular thickness and bite force was done. A group of 40 patients, 20 normal and 20 with vertical excess and open bite (10 of which had mandibular length excess) were selected. A bilateral masseter ultrasound imaging technique was used during contraction and resting posture. Profile and P-A radiographs were taken and a transducer was used to measure bite force bilaterally at the level of the first molars. Muscular thickness average during contraction was 11,72 mm. for normal patients and 11,35 mm. for patients with vertical excess, which did not show a significant difference (p>0.05). The average bite force was 53,99 Kg. for normal patients and 36,21 Kg. for others, which indicated a significant difference. The correlation between bite force and muscular thickness in contraction was of no significance (r<0.25). This study suggests a high correlation between bite force and facial morphology and no correlation between masseter thickness and facial morphology. In contrast to other studies, individuals with variable vertical excess showed that bite force and the facial morphology were not related to muscular thickness.