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The Twentieth Century and Beyond
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
The main objective of the modern cosmetic patient in the dermatology clinic is to improve the appearance of the aging face. The most popular procedures for that purpose include botulinum toxin injections to relax forehead and periorbital facial muscles that wrinkle the face: injections of hyaluronic acid fillers to fill lower face lines and folds and aged lips; chemical peels to lessen pigmentary changes and fine lines related to sun damage; lasers to remove unwanted brown spots and broken blood vessels; and lasers and other devices to tighten or resurface the face. These procedures are done in an outpatient clinical setting with or without local anesthesia. Unlike some of the procedures performed by plastic surgeons, all procedures done by dermatologists are outside the operating room. Cosmetic procedures such as botulinum toxin injections, dermal filler injections, and laser treatments are now a mainstay of dermatology offices all over the world, and their addition to the dermatologist's repertoire has been followed with an ever-expanding list of services and a multibillion-dollar industry. Some dermatologists make cosmetic procedures their primary focus, while others (such as the present author) focus solely on medical and/or surgical dermatology, and many offer both medical and cosmetic services. These procedures, developed over the last 150 years, are outlined in Table 16.4.
Adapting Injection Techniques to Different Regions
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana, Nicholas Moellhoff
Two different types of facial lines exist: dynamic and static. Dynamic facial lines are formed by muscular contraction (i.e., frontalis muscle causing horizontal forehead lines or corrugator supercilii muscle and procerus muscle causing vertical and horizontal glabella lines). The musculature is connected to the overlying skin directly, as in the periorbital region, or indirectly, where the mode of action is transmitted through layers of fascia (forehead) and/or the superficial musculoaponeurotic system (SMAS) (midface) connecting the muscles with the skin. The muscles exert different movement axes, depending on the course of their fibers. The orientation of the rhytids formed on the skin surface is perpendicular to the muscle fascicle contraction, including patterns of horizontal and vertical contraction or radiating in a peripherally orientated manner. Static facial lines, however, are the result of different age-dependent processes. Over time and with increasing age, the muscles increase in length, increase in tone at rest, and have a reduced movement amplitude. In addition to facial muscle sarcopenia, the age-dependent loss of muscle volume, the tightening of the muscles, and the reduced amplitude of facial expressions can cause permanent wrinkles and accentuate skin creases due to muscular contractions and the shifting of position of overlying fat tissues (Cotofana et al., 2021a).
Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
The masseters are muscles of the cheek and lower jaw and are the primary muscles of mastication. They are important cosmetically as it is possible to make the face appear slimmer by administering botulinum toxin to the masseters. This treatment has, however, fallen out of favour due to the significant risk of localised (and permanent) osteoporosis of the mandible with subsequent fractures. They arise from the zygomatic and maxillary processes of the zygoma and insert on the coronoid process and lateral aspect of the mandibular ramus. Their arterial blood supply comes from the masseteric artery, which itself is a branch of the external carotid artery and passes over the mandibular notch, which is located between the coronoid process of the mandible and the temporomandibular joint. Unlike many other facial muscles, the masseters receive their nervous innervation from the trigeminal nerve or, more precisely, the V3 segment or mandibular nerve. See Figure 3.23.
Facing facial weakness: psychosocial outcomes of facial weakness and reduced facial function in facioscapulohumeral muscular dystrophy
Published in Disability and Rehabilitation, 2023
W. A. van de Geest-Buit, N. B. Rasing, K. Mul, J. C. W. Deenen, S. C. C. Vincenten, I. Siemann, A. Lanser, J. T. Groothuis, B. G. van Engelen, J. A. E. Custers, N. C. Voermans
To reach a majority of all Dutch FSHD patients, we contacted three largely overlapping cohorts of patients known at the FSHD expertise center in the Netherlands by secured e-mail. First, participants in the FOCUS-2 study, an ongoing natural history-study in patients with FSHD, were invited by the research physician (n = 162) [28]. Additionally, patients followed-up at the FSHD-outpatient clinic who were not participating in the FOCUS-2 study were invited by their physician (n = 122). Finally, all adult participants of the Dutch FSHD registry [29] were contacted by the administrator (n = 340). Patients were allowed to fill out the questionnaires only once in case of multiple invitations. Inclusion criteria were: clinically and/or genetically confirmed FSHD, and age ≥16 years. Only completed questionnaires were analyzed. The questionnaires had been split into four parts, to allow participants to take a break and help them to fill out all questionnaires. Patients with neurological comorbidities which affect the facial muscles (e.g., Bell’s palsy or stroke with residual facial weakness) were excluded. Patient enrollment is depicted in Figure 1. Participant acquisition and data collection took place between June and August 2020. Patients filled out the questionnaires and an informed consent form via a secured online program (RadQuest).
Neuromuscular retraining therapy combined with preceding botulinum toxin A injection for chronic facial paralysis
Published in Acta Oto-Laryngologica, 2023
Junhui Jeong, Jeon Mi Lee, Jin Kim
We used a computer-based numerical scoring system to evaluate the facial functions. To develop the system, we evaluated the anatomical elements of facial muscles by adding weighted values in a specific manner based on the vectors of facial muscle movements. We incorporated easily recognizable facial points using a modern camera-based interface technology. The designated points were selected with reference to an anatomical vector of facial muscles. The system measured the contraction ranges at major locations of the paralyzed and synkinetic muscles (Figure 2). The proportions of facial movements on the affected side, compared with the normal side at rest and while saying ‘e,’ were averaged and presented as percentages. Based on the percentages, primary and secondary facial movement scores were assigned for the paralyzed and synkinetic muscles, respectively. Then, the final facial movement scores were obtained by subtracting the secondary facial movement scores from primary facial movement scores. The evaluations were performed before and after 1 year of treatment by one senior author who was the most experienced. There was no inter-rater or intra-rater variability in this system.
Treatment considerations in myasthenia gravis for the pregnant patient
Published in Expert Review of Neurotherapeutics, 2023
Myasthenia gravis (MG) is an autoimmune disease where antibodies against the acetylcholine receptor (AChR) in the postsynaptic membrane at the neuromuscular junction cause the typical muscle weakness [1,2]. More rarely, pathogenic antibodies are instead directed against muscle-specific kinase (MuSK) or lipoprotein-related protein 4 (LRP4) antigens functionally linked to AChR in the membrane. The muscle weakness can be generalized or localized. It occurs most frequently in extraocular muscles with diplopia and ptosis as troublesome symptoms. Weakness in swallowing and speech muscles as well as in facial muscles is common. Neck, shoulder, and arm muscles have frequently some weakness, whereas leg muscles are rarely affected [3]. Respiratory muscle weakness represents the major threat of MG, and myasthenic crisis with the need of ventilatory support can occur, especially during respiratory infections. Fluctuations during the day and over time are typical for MG. Repetitive and prolonged muscle use increases or precipitates the weakness.