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Anatomical Considerations to Improve Aesthetic Treatments Using Neuromodulators
Published in Yates Yen-Yu Chao, Optimizing Aesthetic Toxin Results, 2022
Nicholas Moellhoff, Sebastian Cotofana
The orbicularis oculi muscle is located strictly subdermal with contact to the bone and ligaments at the cranial aspect of the tear trough, the tear trough ligament, and the medial canthal ligament. The procerus and corrugator supercilii muscles each have distinct bony origins (Figure 11.2). The origin of the procerus muscle is located at the nasal bone at the root of the nose in the midline and the paramedian plane, and it inserts into the skin of the glabella at the level of the upper margin of the hairy eyebrow. The origin of the corrugator supercilii muscle is the supraciliary arch of the frontal bone in the paramedian plane. It inserts the skin in the middle third of the eyebrow. The frontalis muscle has no bony connection but is enveloped by two fasciae extending from the galea aponeurotica. While it extends over the forehead, its muscle fibers invest into the orbicularis oculi (in the lateral, middle, and medial third of the eyebrow), corrugator supercilii (in the middle third of the eyebrow), and procerus muscle (in the midline) at a horizontal level, corresponding to the upper margin of the hairy eyebrow (Figure 11.1).
Botulinum toxin practical skills
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
When treating this area, yet again take note to palpate your injection site a minimum of 1cm from the lateral bony orbital rim. It is useful to use your finger as both a marker and barrier against toxin spread when injecting as you would when treating the glabella complex. Three injections are used for each side when treating the orbicularis oculi muscle with the middle injection ever so slightly lateral to the others (Figure 9.8). It is best practice to treat the orbicularis oculi muscle with the patient lying flat so as to decrease the chance of botulinum toxin spreading medially into the levator palpebrae muscles. This risk is further mitigated by leaving your finger in place for 30 seconds after toxin injection to decrease the risk of it spreading medially.
Cheek and Zygomatic Arch
Published in Ali Pirayesh, Dario Bertossi, Izolda Heydenrych, Aesthetic Facial Anatomy Essentials for Injections, 2020
Emanuele Bartoletti, Ekaterina Gutop, Chytra V. Anand, Giorgio Giampaoli, Sebastian Cotofana, Ali Pirayesh
This inverted triangle overlies the area around the zygomatico-maxillary suture and is in direct contact with the bone. The superior boundary is formed by the zygomaticocutaneous ligament and/or the zygomaticus minor muscle and the medial boundary by a thin layer of connective tissue enveloping the angular vein. The lateral and inferior boundary is formed by the zygomaticus major muscle and the transverse facial septum. The orbital part of the orbicularis oculi muscle and the midcheek SMAS form the anterior boundary. This compartment has no connections to the buccal fat pad.
Neostigmine and ketorolac as adjuvants to local anesthetic through peribulbar block in patients undergoing vitrectomy surgeries: A randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2022
Mayada K. Mohamad, Norhan A. Sherif, Rehab S. Khattab, Noha A. Osama, Iman S. Aboul Fetouh
To assess ocular akinesia, the patients were asked to look in four directions: lateral, medial, superior, and inferior. The ocular movement in each direction was scored as 2 if it was normal, 1 if it was limited, and 0 if there was no movement (total score: 0–8). The patient was also asked to forcefully close his eyes to assess the orbicularis oculi muscle on a scale of 0–2 (0, complete akinesia; 1, partial; 2, normal movement). The signs of successful block were dropping of the upper lid with inability to open the eyes (ptosis), absent eye movement in all four directions (akinesia), and inability to fully close the eye once opened. The onset of akinesia was calculated in seconds from the time of injection till complete loss of movement, while the duration of akinesia was calculated in minutes from the time of movement loss till full return of movement.
The eye area as the most difficult area of activity for esthetic treatment
Published in Journal of Dermatological Treatment, 2022
Anna Kołodziejczak, Helena Rotsztejn
Fatty bags under the eyes, often mistaken for swelling, are most often associated with a genetic tendency to accumulate fat under the eyes. An orbital hernia may be located within the upper and lower eyelid. In young people, the orbital septum is very tense and supports superior ocular and infernal ocular fat. The osseocutaneous facial ligaments comprise the primary structural divisions of the facial fat compartments. The strong orbicularis oculi muscle of the eye is an additional support. With age, this septum gradually weakens and the muscle decreases its volume and support force. At that time, hernias may occur. The lower eyelid fatty hernia is referred to as "bags under the eyes" (1,2,4,7). As a result of aging, mounds of loose skin, muscles and fat hernia (Malar Festoons) are also formed in the eye area (2–4).
Contralateral orbicularis oculi muscle transposition in facial paralysis: functional, aesthetic and electromyographic outcomes. A case report and literature update
Published in Orbit, 2022
Pedro Fernández-Pérez, Ricardo Romero-Martín, Bárbara González-Ferrer, Margarita Sánchez-Orgaz, Álvaro Arbizu-Duralde, Rafael Montejano-Milner
Facial paralysis can have multiple causes, the most frequent of which are idiopathic (Bell’s palsy), congenital, tumoral, infectious, inflammatory, iatrogenic and traumatic in nature. Multiple surgical techniques and approaches for repairing facial palsy have been described. From an ophthalmological viewpoint, when the orbicularis oculi muscle (hereinafter called the orbicularis muscle) function is compromised, treatment ranges from corneal protection through aesthetic reconstruction techniques to motor function restoration. Initially, treatment should seek to avoid corneal complications (such as infection and leukoma) that may interfere with vision, and lubricating eye drops and wet chambers may be indicated.2 Surgical procedures can be either static, (e.g. gold or platinum pretarsal weight implants, injection of fillers, permanent tarsorrhaphy and spacer grafts plus canthoplasty for lower eyelid ectropion correction) or dynamic (e.g. like temporalis muscle transposition, different methods of orbicularis muscle reinnervation and contralateral orbicularis muscle transposition).2 Patients with iatrogenic or traumatic paralysis lasting more than 12 months are considered as unlikely to make a full recovery.7 Despite the increasing complexity and sophistication of all the surgical manoeuvres mentioned, no cases have yet been reported in which a better post-operative outcome than a grade III in HBS was obtained.8