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Chapter-22 Neuromodulators and Soft Tissue Fillers

BOOK TITLE: Sataloff's Comprehensive Textbook of Otolaryngology: Head & Neck Surgery (Facial Plastic and Reconstructive Surgery) - Volume 3

Author
1. Lee Linda N
2. Kontis Theda C
ISBN
9789351524595
DOI
10.5005/jp/books/12699_23
Edition
1/e
Publishing Year
2016
Pages
24
Author Affiliations
1. Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
2. Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Chapter keywords
neuromodulators, soft tissue fillers, neurotoxins, facial muscles, Botulinum toxins, presynaptic cholinergic receptors, neuromuscular junction, Neurotoxin injections, blepharoplasty, glabellar complex, corrugator supercilii muscles, central procerus muscle, eyelid retractor muscles, baseline ptotic brows, Temporary ecchymosis, erythema

Abstract

This chapter discusses neuromodulators and soft tissue fillers, where neurotoxins weaken the facial muscles that contract to produce wrinkles, whereas the fillers fill areas of deficient facial volume. Botulinum toxins bind presynaptic cholinergic receptors to prevent acetylcholine release at the neuromuscular junction. The results of injection of neurotoxin last for about 10–12 weeks. Neurotoxin injections should not be performed 3–6 months prior to a scheduled blepharoplasty or brow lift. The glabellar complex, which includes the paired corrugator supercilii muscles and the central procerus muscle, is the only FDA approved treatment area for all neurotoxins. Injections should stay 1 cm superior to the level of the bony orbital rim and into the belly of the corrugator muscles to prevent diffusion into the eyelid retractor muscles. Patients with short vertical height of the forehead or baseline ptotic brows that utilize the frontalis muscle to assist with brow elevation should be identified prior to treatment. Temporary ecchymosis and injection site erythema are the most common mild adverse events from neurotoxin injection and usually resolve spontaneously.

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