Respecting upper facial anatomy for treating the glabella with neuromodulators to avoid medial brow ptosis-A refined 3-point injection technique

Background Current injection algorithms for treating the glabella rely on a five- or seven-point injection technique with possible medial eyebrow ptosis and lateral eyebrow elevation as undesirable outcomes. Objective The objective of this study was to investigate the efficacy and safety profile of a refined 3-point injection technique targeting horizontal and vertical glabellar lines. Methods A total of n=105 patients (27 males and 78 females) with a mean age of 40.90 +/- 9.2 years were investigated. The injection technique relied on targeting the muscular origin of the procerus and the corrugator supercilii muscles exclusively. The time of effect onset and the injection-related outcome 120 days after the treatment was evaluated using the 5-point glabellar line severity scale. Results The onset of the neuromodulator effect was on average 3.5 +/- 1.5 days. There was no statistically significant difference in the amplitude of movement before or 14 days after the treatment with 2.99 +/- 4.4 mm vs. 3.39 +/- 3.6 mm (p = 0.149) for the medial head of the eyebrow and with 3.18 +/- 4.7 mm vs. 3.33 +/- 4.3 mm (p = 0.510) for the lateral head of the eyebrow, respectively. Conclusion Incorporating anatomic concepts into clinical practice for glabellar frown line neuromodulator treatments with the investigated 3-point injection technique resulted in the absence of adverse events like eyebrow ptosis, upper eyelid ptosis, medial eyebrow ptosis, and lateral frontalis hyperactivity. This technique demonstrated efficacy throughout the 4-month study period.