Abramo Antonio Carlos
Post-Graduate Course of Plastic Surgery of the Institute of Assistance in Plastic Surgery of São Paulo, Endorsed by the Brazilian Society of Plastic Surgery and Brazilian Medical Association, General Hospital São Luiz - Jabaquara, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil.
Aesthetic Plast Surg. 2018 Oct;42(5):1379-1387. doi: 10.1007/s00266-018-1157-3. Epub 2018 Jul 9.
In this series of patients the cutaneous insertion and strength of voluntary contraction of the muscles in the upper third of the face were used as guidelines for botulinum toxin application named "BTA Codes."
Anatomical dissection of fresh cadavers identified the shape and cutaneous insertions of the muscles in the upper third of the face. Patient voluntary contraction of the muscles in the upper third of the face created different patterns of skin lines classified by the 4-grade Facial Wrinkle Scale. For botulinum toxin application injections points followed the muscle cutaneous insertion and dose the 4-grade Facial Wrinkle Scale.
Injection points ranged from 3 to 23 points per patient, average of 9.4 points. Dose per point varied from 2.5 to 7.5 U, ranging from 12.5 to 72.5 U per patient, average of 33.82 U. Skin lines resulting from the voluntary contraction of the muscle prior to toxin application were stated as baseline 1. The absence of skin lines and muscle activity on day fifteen after toxin application defined baseline 2. Skin lines resulting from the recovered voluntary contraction of the muscle after toxin application like those of baseline 1 established baseline 3. The botulinum toxin effect was the time elapsed between baselines 2 and 3, ranging from 171 to 204 days, average of 183.72 days, greater than the 3 or 4 months reported in the literature.
"BTA Codes" is a set of rules to apply botulinum toxin supported by muscle anatomy and degree of voluntary contraction to enhance the duration of its effect.
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在这组患者中，面部上三分之一肌肉的皮肤附着点和自主收缩强度被用作肉毒杆菌毒素应用的指导原则，称为“BTA 编码”。
对新鲜尸体进行解剖，确定面部上三分之一肌肉的形状和皮肤附着点。患者面部上三分之一肌肉的自主收缩产生了不同的皮肤纹路模式，根据 4 级面部皱纹量表进行分类。肉毒杆菌毒素应用的注射点遵循肌肉皮肤附着点，剂量根据 4 级面部皱纹量表确定。
每位患者的注射点为 3 至 23 个，平均 9.4 个。每个点的剂量为 2.5 至 7.5 单位，每位患者的剂量为 12.5 至 72.5 单位，平均 33.82 单位。毒素应用前肌肉自主收缩产生的皮肤纹路被视为基线 1。毒素应用后第 15 天皮肤纹路和肌肉活动消失定义为基线 2。毒素应用后肌肉恢复自主收缩产生的皮肤纹路与基线 1 相似，确定为基线 3。肉毒杆菌毒素的效果是基线 2 和基线 3 之间的时间间隔，为 171 至 204 天，平均 183.72 天，长于文献报道的 3 或 4 个月。
“BTA 编码”是一套基于肌肉解剖结构和自主收缩程度应用肉毒杆菌毒素的规则，以延长其效果持续时间。
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