The latest research highlight from Professor Sebastian Cotofana and The Harley Academy Research Group
World-renowned anatomist Professor Sebastian Cotofana shares a key study influencing the world of medical aesthetics.
Title: The Relationship Between Glabellar Contraction Patterns and Glabellar Muscle Anatomy: A Magnetic Resonance Imaging-Based Study
Authors: Rams D, et al.
Published: Aesthetic Surgery Journal, October 2024
Keywords: Melancholia, Glabellar Rhytids, Neuromodulator Treatments
In 1872, Charles Darwin described a specific forehead wrinkle pattern when observing individuals suffering from depression and melancholia, which was labelled in 1878 by Heinrich Schuele as omega melancholicum or the omega sign. They thought that this specific upper facial expression was a clinical sign and indicator for the mental state of these patients.
In 1985, however, the connection to other facial expressions and the involvement of specific muscles was established via electromyography, thereby linking facial expressions to the activity of specific facial muscles.
In 2010 and 2012, a Brazilian group centred around dermatologist Dr Ada Trinidade de Almeida claimed that the government regulatory board-approved injection algorithm for treating the glabellar region with neuromodulators needed optimisation and individual adjustments.
The authors suggested that a glabellar injection algorithm should be modified based on five specific contraction patterns which are visible when patients frown; this concept was termed glabellar contraction patterns. Subsequent publications evaluated whether this strategy was generalisable to other ethnicities or had any tangible clinical merit.
Based on the former findings, Rams and his colleagues from the Department of Anatomy of the Jagiellonian University Medical College in Kraków, Poland conducted an MRI-based study in young, toxin naïve individuals which they stratified into the previously described five glabellar contraction patterns.
They investigated the length, width, thickness and surface area of the frontalis, procerus, orbicularis oculi and corrugator supercilii muscles through multiplanar measuring methods. Their analyses revealed that there were no statistically significant differences in the evaluated muscle parameters; independent of which contraction pattern the subjects displayed, no difference was visible via MRI in their underlying musculature.
Clinically, the results point out that the glabellar can be treated via the standard and approved injection neuromodulator algorithm, independent of which glabellar contraction pattern the patient has. Small adjustments in dosage, however, should be made to account for interindividual differences, but the injection points and depth of product placement should remain unaltered.
These findings are novel and change a 14-year-old concept which previously may have resulted in those patients receiving neuromodulator treatments that were positioned suboptimally. This may have potentially caused an increased risk for adverse events and reduced efficacy. Future studies will be needed to further increase our knowledge of how to better treat glabellar rhytids
Title: Case Reports on Hand Prejuvenation: Clinical Outcomes in Middle-Aged Women with Hyaluronic Acid Filler Plus Lidocaine
Authors: Siquier-Dameto G, Malgapo D.
Published: International Journal of Women’s Dermatology, November 2024
Keywords: Hand Rejuvenation, Hyaluronic Acid, Injectables
Abstract: Hand rejuvenation with hyaluronic acid filler injections is gaining more attention for its ability to correct volume loss and improve skin quality. The hand dorsum is prone to loss of dermal elasticity and subcutaneous atrophy as individuals age, and administering hyaluronic acid fillers has become an option to restore the smoothness and youthful contour of the hand.
The aim of this study is to demonstrate that injections with Definisse Touch Filler Plus Lidocaine are effective and safe for hand rejuvenation. Ten subjects underwent filler placement of 0.5 to 1.0 ml in the dorsal superficial lamina, which is devoid of sensory nerves and major skin vessels, using a blunt cannula via the fanning technique.
Measurements were done before, immediately after and one month after the treatment using validated aesthetic scales. There was a significant correction of volume loss immediately after the first treatment, and an improvement in skin texture and topography one month after the procedure.
Therefore, injecting a low G-prime hyaluronic acid along the dorsal superficial lamina via cannula was found to provide an effective and tolerable option for improving the appearance of aged hands.
Title: Comparative Analysis of Cellulite Treatment Modalities: A Systematic Review
Authors: Lim S, et al.
Published: Aesthetic Plastic Surgery, November 2024
Keywords: Aesthetic Devices, Body Treatments, Cellulite
Abstract: Cellulite is a highly prevalent and aesthetically distressing skin condition. Whilst there are a variety of treatment modalities, none are definitively established. This systematic review aims to assess invasive and non-invasive treatment modalities for cellulite management. Overall, 753 studies were initially identified, of which 24 satisfied the eligibility criteria, with a total of 2,084 patients.
Evaluated interventions included mechanical stimulation, topical therapy, shock wave therapy (SWT), laser and light-based devices, radiofrequency therapy, subcutaneous injectables and ultrasound. SWT emerged as a standout intervention, demonstrating a consistent cellulite reduction score of 2.07 ± 0.39 across four studies.
Radiofrequency therapy exhibited a statistically significant reduction of thigh circumference and subcutaneous tissue thickness. Subcutaneous injectables, specifically collagenase clostridium histolyticum-aaes, demonstrated a statistically significant improvement in the clinician-reported photonumeric cellulite severity scale (17.0%) and patient-reported photonumeric cellulite severity scale (25.7%). SWT, radiofrequency therapy and subcutaneous injectables have shown promising findings in cellulite treatment.
