Respecting Upper Facial Anatomy for Treating the Glabella with Neuromodulators to Avoid Medial Brow Ptosis - A Refined 3-Point Injection Technique.

BACKGROUND Current injection algorithms for treating the glabella rely on a five- or seven-point injection technique with possible medial eyebrow ptosis and lateral eyebrow elevation as undesirable outcomes. OBJECTIVE The objective of this study was to investigate the efficacy and safety profile of a refined 3-point injection technique targeting horizontal and vertical glabellar lines. METHODS A total of n=105 patients (27 males and 78 females) with a mean age of 40.90 ± 9.2 years were investigated. The injection technique relied on targeting the muscular origin of the procerus and the corrugator supercilii muscles exclusively. The time of effect onset and the injection related outcome 120 days after the treatment was evaluated using the 5-point glabellar line severity scale. RESULTS The onset of the neuromodulator effect was on average 3.5±1.5 days. There was no statistically significant difference in the amplitude of movement before or 14 days after the treatment with 2.99 ± 4.4 mm vs. 3.39 ± 3.6 mm (p=0.149) for the medial head of the eyebrow and with 3.18 ± 4.7 mm vs. 3.33 ± 4.3 mm (p=0.510) for the lateral head of the eyebrow, respectively. CONCLUSION Incorporating anatomic concepts into clinical practice for glabellar frown line neuromodulator treatments with the investigated 3-point injection technique resulted in the absence of adverse events like eyebrow ptosis, upper eyelid ptosis, medial eyebrow ptosis and lateral frontalis hyperactivity. This technique demonstrated efficacy throughout the 4-month study period.