arTICle | boTulInum ToxIn A |
botulinum toxin A in CentrAl brow frown lines
CosmetiC uses of Anthony V. Benedetto explains
functional anatomy, problem assessment, dosing, outcomes, adverse events and
treatment implications to be considered when treating glabellar frown lines
T
DR. ANTHONY V. BENEDETTO, DO, FACP is a Clinical Associate Professor of Dermatology at the Department of Dermatology, University of Pennsylvania School of Medicine. Dr. Benedetto is the founder and medical director of the Dermatologic SurgiCenter in Philadelphia, PA and in Drexel Hill, PA, where he practices Mohs Surgery and Cosmetic and Procedural Dermatologic Surgery
email
avb@benedettoderm.com
KEYWORDS onabotulinumtoxinA, glabella, corrugator, asymmetry, muscle fibers, injection, BoNT
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he area mosT frequenTly TreaTed with BonT is the central brow or glabella and its frown lines(3,4-13). The glabella is the smooth, flat, triangular elevation of the frontal bone superior to the nasal radix positioned between the two
superciliary ridges or arches. on the skin surface, the glabella is the space between the eyebrows. The muscles of the ‘glabellar complex’ were the first and currently the only muscles of the face or body into which BonTa (onabotulinumtoxina) can be injected for cosmetic purposes that have been approved in the usa by the fda. Treatment of all other muscles in any other part of the face or body with injections of onabotulinumtoxina for cosmetic reasons is done solely and expressly in an off label, non-approved manner. There are four depressor muscles of the brow that
cause the horizontal and vertical creases of the glabella. These muscles allow one to squint to protect the eyes from projectiles and the elements (i.e. glaring light, gusts of air and wind, dust and sand) by lowering the eyebrows and adducting them medially. However, hyperkinetic depressor muscles can cause persistent, unintentional adduction and lowering of the medial aspect of the eyebrows, causing wrinkling between the eyes. For example, this central brow frowning during moments of intense concentration can be misinterpreted by others as a veritable frown, which usually expresses negative feelings of concern, tiredness, disappointment, frustration, anger, pain, and suffering, etc. Weakening the four
March 2011 |
prime-journal.com
depressors of the glabella with injections of onabotulinumtoxinA can raise the eyebrows and virtually eliminate the frown lines of the glabella. This allows a person to appear more relaxed, conveying a positive sentiment when one ordinarily might be frowning and expressing a negative demeanor. An elevated brow generally expresses a positive attitude, whereas a depressed brow expresses a negative one. In addition, low-set eyebrows may promote the formation of upper eyelid and lateral canthal hooding. Arched or peaked eyebrows usually are more attractive in women whereas men in general prefer more horizontal eyebrows.
Ideal eyebrows The overall contour and shape of the eyebrows depend on many factors, including age, sex, culture, ethnicity and current fashion trends*G. The size, shape and position of the eyebrows can vary widely, depending on the shape of the face (i.e. oval, round, square, or long/narrow)*H In the literature and in clinical practice, there really is no rigid definition or description of the “ideal eyebrow” that can be applied to all faces universally. Eyebrows that appear aesthetically pleasing on one face may look abnormal and unattractive on another face. Therefore, a detailed pre-treatment assessment of how an individual’s eyebrow position and shape conforms to the ‘ideal brow’ contour for that particular individual is key to producing acceptable results with injections of onabotulinumtoxinA.
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