Paternostro Ferdinando, Hong Wei-Jin, Zhu Guo-Sheng, Green Jeremy B, Milisavljevic Milan, Cotofana Mikaela V, Alfertshofer Michael, Hendrickx S Benoit, Cotofana Sebastian
Department of Experimental and Clinical Medicine, Anatomy and Histology Section, University of Florence, Florence, Italy.
Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China.
J Cosmet Dermatol. 2024 Dec;23(12):3936-3941. doi: 10.1111/jocd.16631. Epub 2024 Oct 12.
Aesthetic neuromodulator injections of the upper face are frequently performed to temporarily block muscular actions of the periorbital muscles to ultimately reduce skin rhytids. However, the adverse event rate in the literature for toxin-induced blepharoptosis ranges from 0.51% to 5.4%.
To identify access pathways by which injected neuromodulator product can travel from extra- to intra-orbital and therefore affect the levator palpebrae superioris muscle.
Nine non-embalmed human body donors were investigated in this study with a mean age at death of 72.8 (16.1) years. The 18 supraorbital regions were injected in 28 times (14 for supratrochlear and 14 for supraorbital) with 0.5 cc, whereas eight cases (four for supratrochlear and four supraorbital) were injected with 0.1 cc of colored product. Anatomic dissections were conducted to identify structures stained by the injected color.
The results of this injection- and dissection-based study revealed that both the supratrochlear and the supraorbital neurovascular bundles are access pathways for injected neuromodulator products to reach the intra-orbital space and affect the levator palpebrea superioris muscle. Out of 36 conducted injection passes, seven (19.44%) resulted in affection of the sole elevator of the eyelid of which 100% occurred only at an injection volume of 0.5 cc and not at 0.1 cc.
Clinically, the results indicate that a low injection volume, a superficial injection for the supraorbital location, and angling the needle tip away from the supratrochlear foramen (toward the contralateral temple) when targeting the corrugator supercilii muscles, can increase the safety profile of an aesthetic toxin glabellar treatment.
对上半脸进行美容性神经调节剂注射常用于暂时阻断眶周肌肉的活动，以最终减少皮肤皱纹。然而，文献中毒素诱导的上睑下垂不良事件发生率在0.51%至5.4%之间。
确定注射的神经调节剂产品从眶外进入眶内并因此影响提上睑肌的途径。
本研究对9名未防腐处理的人体供体进行了调查，平均死亡年龄为72.8（16.1）岁。在18个眶上区域进行了28次注射（滑车上神经14次，眶上神经14次），每次注射0.5 cc，而8例（滑车上神经4例，眶上神经4例）注射0.1 cc的有色产品。进行解剖以识别被注射颜色染色的结构。
这项基于注射和解剖的研究结果表明，滑车上神经血管束和眶上神经血管束都是注射的神经调节剂产品到达眶内间隙并影响提上睑肌的途径。在36次注射过程中，有7次（19.44%）导致了眼睑唯一提肌受到影响，其中100%仅发生在注射量为0.5 cc时，而非0.1 cc时。
临床上，结果表明低注射量、眶上部位浅注射以及在针对皱眉肌时将针尖角度远离滑车上孔（朝向对侧颞部），可提高眉间美容毒素治疗的安全性。
