Kamat Amala, Quadros Trisha
Department of Dermatology, Topiwala National Medical College, Mumbai, Maharashtra; Cosmetic Dermatology, Kamat Nursing Home, Ponda, Goa, India.
Cosmetic Dermatology, Kamat Nursing Home, Ponda, Goa; Medicine, K.S. Hegde Medical Academy, Mangalore, Karnataka, India.
Indian J Dermatol Venereol Leprol. 2019 Mar-Apr;85(2):182-189. doi: 10.4103/ijdvl.IJDVL_211_17.
Botulinum A exotoxin is an established treatment for glabellar frown lines, crow's feet, and horizontal furrows of the forehead. The glabella is probably the most common site for botulinum toxin treatment in Asians. Five glabellar contraction patterns have been classified in earlier studies based on eyebrow approximation, depression, and elevation. Unfortunately, this was found to be confusing by many practitioners. Indians, as all Asians, have smaller muscles compared to the European population, and there is no consensus on the optimal dosage per injection site or concentration of toxin to be used.
(a) Identification and classification of glabellar wrinkle patterns in Indians. (b) Optimization of the minimal effective dose of toxin per site.
Retrospective photographic analysis of 200 patients who received botulinum toxin for the first time to treat glabellar wrinkles was conducted. The wrinkle patterns were identified and classified by the authors based on the prevalence of perpendicular and transverse glabellar lines, nasal, and forehead wrinkles.
Six patterns were identified: (1) 11 (2) U (3) Pi (4) X (5) W (6) I. The relevant muscles were identified and doses optimized for those sites.
The doses mentioned in this study are not universal for all patients and toxin units would have to be altered and individualized according to the bulk of the facial muscles and individual needs.
The investigators classification, injection patterns, and dosage may provide valuable guidance to facial esthetic treatment.
A型肉毒杆菌外毒素是治疗眉间皱纹、鱼尾纹和前额横向皱纹的既定疗法。眉间可能是亚洲人进行肉毒杆菌毒素治疗最常见的部位。在早期研究中，根据眉毛的靠近、下压和上抬情况，已将五种眉间收缩模式进行了分类。不幸的是，许多从业者发现这种分类令人困惑。与欧洲人群相比，印度人以及所有亚洲人的肌肉都较小，对于每个注射部位的最佳剂量或所用毒素的浓度尚无共识。
（a）识别并分类印度人的眉间皱纹模式。（b）优化每个部位毒素的最小有效剂量。
对200例首次接受肉毒杆菌毒素治疗眉间皱纹的患者进行回顾性照片分析。作者根据眉间垂直和横向皱纹、鼻部及前额皱纹的发生率对皱纹模式进行识别和分类。
识别出六种模式：（1）11 （2）U （3）Pi （4）X （5）W （6）I。确定了相关肌肉，并针对这些部位优化了剂量。
本研究中提及的剂量并非适用于所有患者，毒素单位必须根据面部肌肉的大小和个体需求进行调整和个体化。
研究者的分类、注射模式和剂量可能为面部美容治疗提供有价值的指导。
