Alfertshofer Michael, Calomeni Mariana, Welch Scott, Metelitsa Andrei, Knoedler Samuel, Frank Konstantin, Green Jeremy B, Moellhoff Nicholas, Knoedler Leonard, Cotofana Sebastian
Aesthet Surg J. 2024 Aug 20;44(9):NP661-NP669. doi: 10.1093/asj/sjae067.
Neuromodulator treatments of the perioral region are increasingly popular and aim to modulate the position of the modiolus. The predominantly targeted muscle is the depressor anguli oris (DAO) which allows for the modiolus to reposition cranially once temporarily relaxed.
The aim of this study was to identify the precise anatomic position of the DAO in relation to the marionette line, thereby increasing precision and reducing adverse events during neuromodulator treatments.
A total of n = 80 DAO muscles were investigated in n = 40 healthy, toxin-naïve volunteers (11 males, 29 females) with a mean [standard deviation] age of 48.15 [15] years and a mean BMI of 24.07 [3.7] kg/m2. The location of the DAO in relation to the labiomandibular sulcus, and its depth, extent, and thickness were investigated with high-frequency ultrasound imaging.
The skin surface projection of the labiomandibular sulcus separates the DAO into medial and lateral portions. The distance between skin surface and muscle surface was on average 4.4 mm, with males having a greater distance (P < .001) and higher BMI being an important influencing factor for a greater distance (P < .001). The thickness of the DAO was on average 3.5 mm, with a range of 2.8 to 4.8 mm and with females having thinner muscles compared with males (P < .001). The most favorable injection depth was calculated to be 6.1 mm for intramuscular product placement.
Understanding the perioral anatomy and the influence of age, sex, and BMI will potentially allow injectors to increase the efficacy and duration of neuromodulator treatments while expertly managing adverse events.
口周区域的神经调节剂治疗越来越受欢迎，旨在调节口角的位置。主要靶向的肌肉是降口角肌（DAO），一旦该肌肉暂时放松，口角就会向上重新定位。
本研究的目的是确定DAO相对于木偶纹的确切解剖位置，从而提高神经调节剂治疗的精确性并减少不良事件。
对40名未使用过毒素的健康志愿者（11名男性，29名女性）的80条DAO肌肉进行了研究，志愿者的平均年龄为48.15 [15]岁，平均体重指数为24.07 [3.7] kg/m²。使用高频超声成像研究DAO相对于唇下颌沟的位置及其深度、范围和厚度。
唇下颌沟的皮肤表面投影将DAO分为内侧和外侧部分。皮肤表面与肌肉表面之间的平均距离为4.4毫米，男性的距离更大（P <.001），较高的体重指数是距离更大的一个重要影响因素（P <.001）。DAO的平均厚度为3.5毫米，范围为2.8至4.8毫米，女性的肌肉比男性薄（P <.001）。肌肉内注射产品的最适宜注射深度经计算为6.1毫米。
了解口周解剖结构以及年龄、性别和体重指数的影响，可能会使注射者提高神经调节剂治疗的疗效和持续时间，同时熟练管理不良事件。
