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Physicians using neuromodulators need to develop an in-depth and holistic understanding of the facial musculature as a single, large, functional structure that does not work in isolation. In this Special Topic, I review the anatomy of the continuous fibromuscular layer of the face, discuss how certain age-related indications develop as a consequence of imbalances to this unified structure, and propose considerations for neuromodulator-based interventions of the upper, mid, and lower face. I provide evidence-supported recommendations on the most optimal applications of neuromodulators to help rebalance the musculoaponeurotic layer for more natural outcomes. Through outcomes of my patients, I show how the facial mimetic muscles can be modulated with careful placement of botulinum toxin, without causing unnatural facial expressions, to achieve an expressive, well-balanced face that reflects health, vitality and happiness.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8386905 | PMC |
http://dx.doi.org/10.1097/GOX.0000000000003755 | DOI Listing |
J Cosmet Dermatol
July 2025
Medical Research Inc., Wonju, Korea.
Background: Platysmal bands contribute to neck ageing and lower-face descent. Although botulinum toxin A (BoNT-A) is approved for this indication, conventional whole-muscle dosing requires many superficial injections with attendant risks.
Objective: To develop an anatomically guided protocol that targets motor-dense zones of the platysma, optimizing efficacy while reducing dose and complications.
Cells
March 2025
Department of Experimental Physiology and Pathophysiology, Medical University of Białystok, 15-222 Białystok, Poland.
Empagliflozin (EMPA), a sodium-glucose co-transporter 2 (SGLT2) inhibitor, prevents endothelial dysfunction, but its effects on vascular tone in hypertension remain unclear. This study investigated whether EMPA modulates vasomotor tone via sirtuin 1 (SIRT1) and AMP-activated protein kinase (AMPK) pathways in spontaneously hypertensive rats (SHR) and controls (Wistar Kyoto rats, WKY). Functional (wire myography, organ bath) and biochemical (Western blot) studies were conducted on the third-order of the superior mesenteric arteries (sMAs) and/or aortas.
View Article and Find Full Text PDFJ Am Acad Dermatol
February 2025
Allergan Aesthetics, An AbbVie Company, Irvine, California.
Background: Platysma prominence (PP) refers to the undesirable effects that may occur with platysma muscle contraction.
Objective: Evaluate safety and efficacy of onabotulinumtoxinA for improving Moderate (Grade 3) to Severe (Grade 4) PP in adults.
Methods: Participants were randomized 1:1 to receive a total dose of onabotulinumtoxinA 26, 31, or 36 U or placebo on Day 1 and monitored for 120 days.
Dissecting deep to the superficial musculoaponeurotic system (SMAS), a popular option for facelifts, has the potential for injury to the parotid gland leading to postoperative sialoceles and fistulas. Similarly, deep plane procedures in the neck that include partial submandibular gland resection may lead to salivary gland leaks. We previously described the management of sialocele following rhytidectomy.
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