Faria Gladstone Eustaquio de Lima, Nassif Alexander D, Medina Rebecca Ignacio Subirá, Espicalsky Sheila, Zattar Luciana, Boggio Ricardo Frota
Instituto Boggio - Medicina, ensino e pesquisa, Rua Cincinato Braga, 37, 8°Andar, Bela Vista, SP, 04004-030, Brazil.
Aesthetic Plast Surg. 2025 Jan;49(2):569-575. doi: 10.1007/s00266-024-04350-1. Epub 2024 Sep 3.
Myomodulation is a technique aimed at enhancing the dynamics of muscle contraction and relaxation through methods like hyaluronic acid (HA) injection. Achieving optimal outcomes depends on the precise placement of the injected product within the targeted anatomical plane. This is particularly important in the forehead, an area with elevated vascular risk. The selected treatment techniques must ensure both efficacy and safety. This study aims to assess the anatomical precision of HA injections in the forehead using different techniques and devices.
Four fresh frozen specimens were injected with HA by five experienced board-certified plastic surgeons using three different techniques/devices: (1) a 50 mm, 22G microcannula; (2) a 13 mm, 27G needle with the bevel down at a 45-degree angle; and (3) the same needle positioned at a 90-degree angle. Ultrasound analysis was used to evaluate the precision of each approach.
Both the cannula technique and the needle technique with the bevel down at a 45-degree angle consistently delivered the filler to the supraperiosteal layer in 100% of cases without spreading. However, the 90-degree needle technique, despite correct placement on the periosteum, resulted in filler dispersion across multiple layers.
The accuracy of filler placement in the forehead is influenced by the choice of device and its angulation. It is recommended to use a cannula with the entry point at the frontalis crest or a needle angled at 45 degrees to the skin. The use of a needle at a 90-degree angle should be avoided to ensure precise placement and avoid filler migration.
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肌调节术是一种旨在通过透明质酸（HA）注射等方法增强肌肉收缩和舒张动态的技术。要实现最佳效果，取决于将注射产品精确放置在目标解剖平面内。这在额头部位尤为重要，因为该区域血管风险较高。所选治疗技术必须确保疗效和安全性。本研究旨在评估使用不同技术和器械在额头进行HA注射的解剖学精确性。
由五位经验丰富的获得董事会认证的整形外科医生使用三种不同技术/器械向四个新鲜冷冻标本注射HA：（1）一根50毫米、22G的微套管；（2）一根13毫米、27G的针头，斜面朝下呈45度角；（3）同一根针头呈90度角放置。使用超声分析评估每种方法的精确性。
套管技术和斜面朝下呈45度角的针头技术在100%的病例中均能始终如一地将填充剂输送到骨膜上层，且无扩散。然而，90度针头技术尽管正确放置在骨膜上，但导致填充剂分散到多层。
额头填充剂放置的准确性受器械选择及其角度的影响。建议使用进入点位于额嵴的套管或与皮肤呈45度角的针头。应避免使用90度角的针头，以确保精确放置并避免填充剂迁移。
本期刊要求作者为每篇文章指定证据级别。有关这些循证医学评级的完整描述，请参阅目录或在线作者指南 www.springer.com/00266 。
