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A schematic image showing the temporalis muscle covered by two fasciae: the superficial temporal fascia (STF) and deep temporal fascia (DTF).
Source publication
The hypertrophied temporalis and masseter muscles give a muscular shaped and bulky contour to the face. Botulinum neurotoxin injection methods are commonly used for facial contouring; however, adverse effects have been reported owing to a lack of delicate anatomical information. The anatomical considerations when injecting botulinum neurotoxin into...
Contexts in source publication
Context 1
... through muscle fascia at a rate of 77 percent. 34 Once botulinum neurotoxin has been injected into these fascial layers, it may diffuse down toward the fascial layer, resulting in unwanted paralysis and no effect on muscle atrophy. Consequently, understanding the fascial layers of the muscles is important when treating with botulinum neurotoxin (Fig. 2). 35 In addition, the thickness of the temporalis muscle should be considered in deciding the dose of botulinum ...
Context 2
... to lower part of the masseter. The middle lower part of the masseter is recommended as the safest and most effective botulinum neurotoxin injection site for masseter muscle hypertrophy. The upper part of the muscle is inappropriate for injection because the parotid duct passes through and because of the existence of the superficial aponeurosis (Figs. 6 and 12). 44,45 In addition, the posterior part overlaps with the parotid gland, which should be ...
Context 3
... though botulinum neurotoxin procedures are minimally invasive compared to surgical procedures, there is still a risk of damaging the nerve trunks. Therefore, a precise knowledge of the Fig. 12. The tendinous digitation of the superficial part of the masseter muscle. The numbers and lengths of the tendinous digitation were higher in male (left) than in female subjects (right). Male subjects had three tendinous digitations, whereas female subjects had two tendinous digitations. Plastic and Reconstructive Surgery • September ...
Citations
... 6,7 This trend is particularly evident in Asia, where surveys indicate a preference for fillers over fat grafting for enhancing facial volume broadly, rather than targeting isolated areas. [8][9][10][11] Achieving a harmonious and symmetrical appearance necessitates consideration of the face in motion, not merely at rest. This approach requires detailed understanding of the anatomical configuration and dynamic changes of the facial soft tissues overlying the skeletal framework, as well as the age-related transformations these tissues undergo. ...
Background
The skin & SMAS layer remodeling technique (SSRT) represents a significant advancement in facial aesthetic treatments. Traditional methods primarily address wrinkles and volume loss, whereas SSRT focuses on achieving both volume and natural lifting effects through strategic filler injections. This technique emphasizes the anatomical and dynamic properties of facial tissues, particularly the SMAS, to enhance facial symmetry and contours while maintaining natural movement.
Materials and Methods
SSRT employs a combination of firm and soft hyaluronic acid fillers to sculpt a youthful, dynamic appearance, simulating the natural lift of a smiling expression. This study explores the effects of gravity on facial tissues and uses advanced imaging techniques to corroborate the shifting of tissues. The technique is compared with other recognized methods, such as true lift and myomodulation, to evaluate its effectiveness in balancing volume enhancement and dynamic facial expressions.
Results
The results indicate that SSRT uniquely balances volume enhancement and dynamic facial expressions, achieving a visibly lifted but natural appearance. The use of advanced imaging techniques substantiates SSRT's effectiveness by showing the shifting of tissues. SSRT reduces the risks associated with excessive filler use and aligns with contemporary aesthetic preferences.
Conclusion
SSRT offers a novel approach by mimicking the facial lift observed when lying down, providing insights into potential transformative “lifts” when upright. By strategically combining firm and soft hyaluronic acid fillers, SSRT achieves a balance of volume and lift, enhancing facial symmetry and maintaining natural movement. This technique represents a significant advancement in facial aesthetic treatments, offering a natural and dynamic alternative to traditional methods.
... Dear Editor, Subzygomatic arch depression frequently manifests in elderly individuals as a result of masseter muscle and fat atrophy. 1,2 Nonetheless, this depression may also appear prominent in younger individuals with well-defined zygomatic arches. Literature on managing subzygomatic arch depression is sparse, leaving a gap in understanding optimal treatment approaches. ...
... Botulinum neurotoxin is used for esthetic purposes from a comprehensive perspective, as well as for treatment purposes for bruxism, migraine, and myofascial pain syndrome. 2 It is applied to the facial muscles to prevent wrinkles that will occur in middle and older ages due to esthetic concerns. For this purpose, this procedure is frequently applied to orbicularis oculi, zygomaticus major, and corrugator supercilii in the face area. ...
... According to these data, for the injection to be applied to the muscle, it must be made at least 30.58 mm superior to the upper edge of the arcus zygomaticus. In the study conducted by Yi et al, 2 it is recommended to inject a minimum of 45 mm superior to the arcus zygomaticus. Racial and sample size differences should be considered when evaluating this difference. ...
Regio temporalis is a site where botulinum neurotoxin is applied for various medical reasons, such as migraine, bruxism, and myofascial pain syndrome. The region is also one of the target regions in flap surgery. This study aimed to define the region topographically. In addition, it was aimed to reveal the intramuscular nerve distribution of the temporalis.11 fixed cephalus (cadaver head) and 2 fresh cephalus were used. The lateral canthus of the eye was marked as point A, and the middle of the ear tragus as point B. The transverse and vertical distances of the branching point of the superficial temporal artery to the A and B points were measured. Transverse distances of the superficial temporal artery and superficial temporal vein to A and B points were measured. The muscle was examined in 5 equal parts (L0–L1–L2–L3–L4), and each part’s vertical muscle and tendon lengths were examined. Intramuscular nerve density was demonstrated by applying the modified Sihler staining to fresh temporalis’. Superficial temporal artery had an average transverse distance of 8.56±1.9 mm in women and 12.56±1.94 mm in men from the middle of the ear tragus. The artery was 64.21±5.59 mm posterior in females and 63.48±6.53 mm in males from the lateral canthus of the eye. Our study determined that the branching point of the superficial temporal artery was below the upper level of the arcus zygomaticus in 10% of cases and above it in 90% of cases. In our study, the L2 point had the highest vertical muscle length at 45.67 mm, while the L3 point had the highest vertical tendon length at 41.25 mm. The point where the muscle length had the highest ratio with 1.49 compared to the tendon length, was the L2 point. The temporalis’ for which the modified Sihler staining was applied was examined in 5 quadrants. It was determined that the nerve densities were in the second and third quadrants from anterior to posterior. The distance of superficial landmarks to neurovascular structures is extremely important in interventions to the regio temporalis. Considering the average distances given in our study is important in avoiding damage in surgical procedures and not injecting into vascular structures. The point where the muscle length had the highest ratio of 1.49 compared to the tendon length was the L2 point. The area in line with this point is the most suitable area for injection. The L2 point is also the most suitable area for injection as it has the highest muscle length. Since the nerve densities were observed in the modified Sihler staining applied temporalis’ 2 and 3 quadrants from anterior to posterior, botulinum neurotoxin injections to these areas will give more effective results.
... As the interest in minimally invasive antiaging procedures grows, the need for safer and effective fillers, botulinum neurotoxin, and threading has risen and developed. 1,2 The most commonly used antiaging treatment is hyaluronic acid fillers, which involves injecting filler into aging tissues to restore volume and smooth wrinkles. Hyaluronic acid, a common component in skin and connective tissue, is a favorable material for creating injectable fillers due to its biocompatibility and low risk of causing an immune response. ...
Introduction
The advances of self‐crossing hyaluronic acid (SC‐HA) fillers combination use with polydioxanone thread in minipigs were examined for compatibility, effectiveness, and immune response.
Materials and Methods
A 12‐week experiment was conducted using 6 minipigs (3 male and 3 female each) to evaluate the effects of SC‐HA filler. The molecular weight of SC‐HA filler was fixed at 200 kDa and alternative storage modulus of G80, G250, and G500 were examined. The procedure involved injecting SC‐HA filler and polydioxanone threads into the skin tissue of anesthetized minipigs, and tissue sampling after 1 month (three minipigs), and 3 months (three minipigs) for histological staining and analysis. The immune reaction was observed during the experiment.
Results
The practitioner reported it was easy to inject the SC‐HA filler in combination with polydioxanone threads. All four storage modulus of SC‐HA fillers were injectable within the polydioxanone thread containing cannula. Also, during the procedure, there were no immune responses at the treated sites. The results of the histological tissue examination confirmed that there was no chemical interaction between SC‐HA filler and the existing polydioxanone thread, and it was observed that SC‐HA filler was more uniformly distributed within the tissue with lower storage modulus, resulting in a higher production of collagen in the surrounding filler. When combined with scaffold polydioxanone thread, the scaffold polydioxanone thread helped spread the filler evenly, resulting in a more evenly distributed collagen around the filler.
Conclusion
Today, the combination therapy of filler and polydioxanone thread in one procedure is challenging due to the high viscosity of conventional fillers. However, this study confirmed that combination therapy of filler and polydioxanone thread is possible with SC‐HA fillers. Additionally, it was found that polydioxanone thread does not seem to interfere with the crosslinking reaction of SC‐HA filler, and if used with a higher pH of polydioxanone, it may enhance the cross‐linking reaction and achieve a higher viscosity value. Finally, the study resulted in the idea of concrete as SC‐HA filler and reinforcing rod for polydioxanone thread.
... Eine intravasale Injektion oder die Diffusion in die angrenzende mimische Muskulatur sollten möglichst vermieden werden [25]. In diesem Zusammenhang definierten Yi et al. [26] auf der Basis der Daten von Bae et al. [25], Lee et al. [27] und anhand der modifizierten Technik nach Sihler [28] Landmarken zur sicheren intramuskulären Injektion, um unerwünschte Wirkungen zu vermeiden (Abb. 1). ...
... Kaudal der Linie zwischen Tragus und Mundwinkel (Cheilion) kommt in den meisten Fällen der Muskelbauch des M. masseter zur Darstellung, der im Rahmen der Vorbereitung auf den Eingriff nach Palpation und sonographischer Kontrolle zur korrekten Positionierung der Nadel auch markiert werden kann. Zur Vermeidung einer Lähmung der mimischen Muskulatur sollten die Bereiche III und VI lediglich in der Pars profunda des Muskels infiltriert werden [26]. Die kompensatorische Vorwölbung nichttherapierter Bereiche kann durch eine kontinuierliche retrograde Injektion in alle Schichten vermieden werden. ...
... Entsprechend der modifizierten Sihler-Technik stellt das Gebiet V die bevorzugte Region für eine Injektion dar. Die Bereiche VI (aufgrund der anatomischen Nähe zur A. facialis), I und II (durch die Lage des Nervus massetericus und des Ductus parotideus) sowie IV (wegen der Überlappung der Glandula parotis) stellen keine geeigneten Punktionsstellen dar [26]. ...
Jeder dritte Bundesbürger leidet an Bruxismus. Zur Behandlung können Schienen eine kurzfristige Symptombesserung und einen Attritionsschutz erwirken. Jedoch sind die Möglichkeiten für eine effektive Reduktion der Bruxismusepisoden und eine Behandlung des Wachbruxismus begrenzt. Seit den 1990er-Jahren wird Botulinumtoxin
zur Therapie des Bruxismus eingesetzt; in den letzten Jahren mehren sich die klinischen Studien und erbringen inzwischen gute Evidenz für die Effektivität der Behandlung.
... Sihler staining, a technique that selectively stains myelin sheaths, offers a clear visualization of nerve pathways while keeping the nerves intact. This method is extensively recognized in mapping the distribution of motor neurons [49]. Imaging showed that the facial nerve's temporal branch (TBFN) courses superomedially towards the upper eyelid. ...
This study introduces the Lines and Dots (LADs) technique, a new approach for administering botulinum toxin type A (BoNT-A) in treating forehead wrinkles. (1) Background: BoNT-A application patterns in the forehead often rely solely on the anatomy of the frontalis muscle. The LADs technique proposes a combination of anatomical features with nerve pathways. (2) Methods: The technique employed a grid system aligned with the supraorbital and supratrochlear nerve pathways and used an electronic acupuncture pen for validation. This study analyzed treatment outcomes for efficacy and safety and proposed a predictive model for BoNT-A dosage. (3) Results: LADs was associated with a high satisfaction rate and low side effect incidence. The predictive model followed BoNT-A Units=0.322×Muscle Pattern Code+1.282×Line Type Code+2.905×Severity Pre-Treatment+3.947. (4) Conclusions: The LADs technique offers an alternative approach to treating forehead wrinkles, optimizing efficacy while minimizing the BoNT-A dose required.
... The injection point was as guided as the previously suggested article by Yi et al. [1] The BoNT injection has been administered in the lower half of the masseter muscle, in two separate points, as per guidelines. Injection into the upper part of the muscle may cause damage to the parotid duct and superficial aponeurosis, as well as being less effective due to less distributed intramuscular neural arborization. ...
Masseter are commonly botulinum neurotoxin targeted muscle for facial contouring in aesthetic field. However, paradoxical masseteric bulging is common adverse effect that has not been discussed with ultrasonographic observations. Retrospective study has been conducted from October, 2021 to January, 2023, out of 324 patients have done blinded botulinum neurotoxin injection in the masseter at the middle and lower portion of the masseter with each side of 25 units (letibotulinum neurotoxin type A), 3 patients demonstrated paradoxical masseteric bulging has been reported and the image observed by ultrasonography by physician. Based on the observations made, we can infer that the function of the moving muscle involves twisting of the muscle fibers during contraction, along with the twisting of the deep inferior tendon, which causes the muscle to be divided into anterior and posterior compartments rather than into superficial and deep compartments of masseter. In ultrasonographic observe the skin surface of a patient with paradoxical masseteric bulging, it is observable that either the anterior or posterior part contracts significantly. The functional units of anterior and posterior compartment are observable as muscular contraction of inward movement of the muscle from either the anterior or posterior functional unit.
... 1 Non-invasive cosmetic procedures, such as thread lifting, dermal fillers and botulinum neurotoxin injections, have been proven to effectively address these issues. [2][3][4][5][6] Thread lifting, in particular, utilizes threads composed of materials such as polydioxanone (PDO), poly-L-lactic acid (PLLA) and etc. to lift and tighten sagging skin on the face. 7 The threads are inserted via a cannula and then pulled taut to lift and smooth wrinkles and sagging skin. ...
Introduction
Thread lifting is a non‐surgical cosmetic procedure that utilizes threads to lift and tighten sagging skin on the face. In Lateral face lifting with anchoring technique, the threads are inserted into the skin and anchored in place to provide support to the skin at artery free zone. This technique utilizes a long cog thread, allowing for stronger fixation points. The optimal location for thread anchoring is in the fascia of the treatment area.
Method and materials
The study was performed with twelve cadavers with twenty‐four specimens of head from cadavers and was processed using phosphotungstic acid‐based contrast enhancement micro‐computed tomography and conventional computed tomography. The superficial temporal artery with branches of parietal and temporal were then observed with image Slicer program to analyze the safe anchoring place for the deep temporal fascia. The main branch was selected with diameter over 0.3 mm and less than 0.3 mm was regarded as arteriole. Additionally, a case of deep temporal tagging with the Secret Miracle (Hyundae Meditech Co., Ltd., South Korea) has been used for lifting procedures.
Result
The main branch of the parietal branch located posteriorly was located mean of ‐13 mm (range of +5.5 mm to ‐23 mm). And the temporal artery ran most anteriorly had mean of 44 mm anteriorly (range of 32 to 59 mm). The safe area for the tagging is at the deep temporal fascia between the superior temporal line and inferior temporal line. The safe range of deep temporal fascia is a vertical line crossing tragus from 1 to 3 cm anteriorly.
Conclusion
By analyzing the result of the superficial temporal artery of parietal and temporal branches the ideal tagging place for the thread anchoring area has been suggested.
... These bands are often perceived as a concern, as they appear as two bulky vertical cords running from the lower border of the mandible to the suprasternal region, giving the neck a less youthful and defined appearance. Platysmal bands can be visible at a younger age in patients with thin skin and may be less noticeable in patients with more fatty tissue [8,26,27]. ...
Background
The platysmal band is created by the platysma muscle, a thin superficial muscle that covers the entire neck and the lower part of the face. The platysmal band appears at the anterior and posterior borders of the muscle. To date, no definite pathophysiology has been established. Here, we observed a lack of knowledge of the anatomy of the platysma muscle using ultrasonography in this study.
Methods
We conducted a descriptive, prospective study observing the platysmal band in resting and contraction states to reveal muscle changes. Twenty-four participants (aged 23–57 years) with anterior and posterior neck bands underwent ultrasonography in resting and contracted states. Ten cadavers were studied aged 67–85 years to measure the thickness of the platysma muscle at 12 points: horizontally (medial, middle, lateral) and vertically (inferior mandibular margin, hyoid bone, cricoid cartilage, superior margin of clavicle).
Results
The anterior and posterior borders of the platysma muscle were thicker than the middle of the platysma muscle when in a contracted state, and the muscle also had a convex shape when contracted. The thickness of the platysma muscle was not significantly different over 12 points in the resting state. During contraction, the platysma muscles contracted in the medial and lateral margins of the muscle, which was more significant in the posterior bands.
Conclusion
The anterior and posterior platysmal bands are related to muscle thickness during contraction. These observations support the change in platysmal band treatment only at the anterior and posterior border of the muscle.
... There have been studies to reduce injection points by suggesting anatomical injection points in previous studies [12, 15, 20-23, 25, 27-40]. Since many studies have suggested guidelines for BoNT injection for rejuvenation [22,24,26,34], pain control during the injection is one of the most concern the practitioner has. Therefore, pain relief can be attempted using cryoanalgesia, intravenous regional anesthesia, and nerve blocks. ...
Introduction:
Hyperhidrosis, causing excessive sweat, can be treated with Botulinum neurotoxin injection. Botulinum toxin, an effective and safe treatment for hyperhidrosis, unfortunately involves significant pain due to multiple injections. This study aims to propose a more efficient and less painful approach to nerve blocks for relief, by identifying optimal injection points to block the median nerve, thereby enhancing palmar hyperhidrosis treatment.
Methods:
This study, involving 52 Korean cadaver arms (mean age 73.5 years), measured the location of the median nerve relative to the transverse line at the pisiform level to establish better nerve block injection sites.
Results:
In between the extensor carpi radialis and palmaris longus, the median nerve was located at an average distance of 47.39 ± 6.43 mm and 29.39 ± 6.43 mm from the transverse line at the pisiform level.
Discussion:
To minimize discomfort preceding the botulinum neurotoxin injection, we recommend the optimal injection site for local anesthesia to be located 4 cm distal to the transverse line of the pisiform, within the tendons of the palmaris longus and flexor carpi radialis muscles.
