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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
Because of the problem of forehead vasculature, injection – whether with cannula or needles – should preferably not proceed in the superficial fat compartment. Frontalis muscle is a very dynamic structure and usually does not cover completely the entire forehead. Superficial injection above the muscle and underlying the very thin layer of skin can be very unforgiving; any unevenness will be easily visible. Injection within in the frontalis muscle is possible but not preferred. Intramuscular filler injection is not the usual practice; muscles move and have a specific pattern of distribution. The deep fat compartment is a choice to accommodate fillers but for the forehead it is very limited in amount. Using cannula in the forehead area has to contend with many loose septal structures in order to reach different corners (Figure 4.4). Because of the wavy bony structure and the rigid character of a cannula, injecting directly with cannula dissection could not easily remain within a single layer (Figure 6.12). Hydrodissection with saline (using the harmless liquid to prepare the subgaleal space) could evenly loosen these septa and facilitate an even distribution of fillers (see Section 4.3).
Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
The frontalis muscle is the primary elevator of the eyebrows, and it is a long flat muscle which runs across the anterior aspect of the frontal bone of your skull. One of the things which makes the frontalis muscle unique is that it has no bony attachments and, instead, attaches to the muscles surrounding it. The medial continuity of the frontalis muscle is the procerus; inferiorly, it is continuous with the corrugators and orbicularis oculi muscles and laterally with the orbicularis oculi and temporalis muscles (Figure 3.13).
Botulinum Toxins
Published in Ali Pirayesh, Dario Bertossi, Izolda Heydenrych, Aesthetic Facial Anatomy Essentials for Injections, 2020
Massimo Signorini, Alastair Carruthers, Laura Bertolasi, Neil Sadick, Wolfgang G. Philipp-Dormston, Dario Bertossi
The FDA has recently approved the treatment of forehead lines, which now allows on-label injection of the full upper face. The two frontalis muscles are responsible for forehead lines. These are large, flat muscles with no bony origin. Inferiorly, their fibers insert in the deep dermis and subcutaneous tissue of the brows, while the superior origin is from the galea at the approximate level of the hairline. Fibers run upward, generating horizontal lines at right angles with their direction. Functionally, the lower part of frontalis muscles elevate the brows, while the upper part depresses the hairline. The fibers of the paired muscles may remain parallel or may converge as they rise cranially. More often, they divert superolaterally to leave an empty triangle in the central forehead. Fortunately, in contrast with the variable position of the medial margins, the lateral margins are usually at the level of the temporal crest, or temporal fusion line. The forehead may vary significantly in height, with forehead lines localized to either the lower or upper segment, or evenly distributed. The visibility of the frontalis muscles may vary widely between individuals.
Polytetrafluoroethylene frontalis suspension in blepharospasm with eyelid apraxia: an effective and well-tolerated adjunct to botulinum toxin therapy
Published in Orbit, 2021
Adam R. Sweeney, Christopher R. Dermarkarian, Katherine J. Williams, Richard C. Allen, Michael T. Yen
Frontalis suspension was performed as similarly described with five stab incisions and without an eyelid crease incision6,7 (Figure 1). A CV-0 polytetrafluoroethylene suture (GORE-TEX suture, W.L. Gore & Associates, Newark, Delaware) was passed through the incisions with a Wright fascia lata needle (Figure 2). The surgeons ensured subperiosteal passes at the level of the superior orbital rim, thereby creating a septal pulley as previously described.7 Deep passes were employed from the brow to a central forehead incision and deeply buried 3 mm suture tails within the frontalis muscle. The eyelid position was surgically set at an MRD1 of approximately 4 mm. Immediately following surgery, antibiotic ointment was used on the incisions. Postoperative oral antibiotics were also prescribed per the surgeon’s routine with the placement of an exogenous foreign body. Following surgery, botulinum toxin was not given soon than postoperative week four.
The spectrum of orbital dermoid cysts and their surgical management
Published in Orbit, 2020
Jasmina Bajric, Gerald J. Harris
Dermoid cysts are the most common orbital tumors of childhood.1,2 They are benign choristomas that arise from sequestration of ectoderm along the lines of embryonic fusion of mesodermal processes destined to be bone.3 They can stem from any of the suture lines within the osseous orbit, and the frontozygomatic suture is the most common point of origin.3–6 With desquamation of their epidermal lining and secretion of their dermal glandular elements, the cysts enlarge over time. Although the number of suture lines in the orbit is limited, the patterns of cyst expansion relative to adjacent and overlying anatomic structures are varied. These impact the potential morbidity of dissection and resection. For example, with superior expansion, the frontalis muscle insertion and/or frontal branches of the facial nerve may be interposed between the skin surface and the cyst’s osseous base.
Conjoint fascial sheath suspension with levator muscle advancement for severe blepharoptosis
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Yucheng Qiu, Rui Jin, Xue Dong, Yirui Shen, Feixue Ding, Zhizhong Deng, Xianyu Zhou, Youcong Ning, Jun Yang, Fei Liu
This technique has several advantages over previous approaches. The structures of the eyebrows were not dissected to expose the frontalis muscle during this surgery, inducing less tissue injury than in frontalis suspension. In addition, the eyelid opening is not powered by the frontalis, which reduces the appearance of forehead furrows [21,28]. In patients with severe blepharoptosis, there may not be enough levator to be removed because the ratio between the levator resection amount and the eyelid elevation is 5:1. With the combined suspension of CFS, the amount of levator muscle removed is greatly reduced, and the modified technique can provide stronger power to ameliorate ptosis, compared with simple CFS suspension or levator shortening surgery.