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      Effective Locations for Injecting Botulinum Toxin into the Mentalis Muscle; Cadaveric and Ultrasonographic Study

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          The mentalis muscle is now considered key structures when performing procedures for rejuvenating the lower face. The aim of this study was to determine the anatomical morphology and location of the mentalis muscle and thereby provide anatomical information for facilitating clinical procedures designed to rejuvenate the lower face. Forty-four adult hemifaces from five Thai cadavers and 21 Korean cadavers were dissected to identify the locations of the mentalis muscle. Sixty-six hemifaces from 33 healthy young Korean subjects were included in an ultrasonographic study. The depth of the mentalis muscle below the skin surface, the thickness of the mentalis muscle, and the distance from the bone to the mentalis muscle were measured at the two points that were 5 mm lateral to the most-prominent point of the chin. The mentalis muscle was classified into two types based to its shape: in type A (86.4%, 38 of the 44 cases) it was dome shaped in three dimensions, while in type B (13.6%, 6 of the 44 cases) it was flat. The mentalis muscle was present mostly at the area 5–10 mm from the midsagittal line and 20–30 mm from a horizontal line connecting the mouth corners. The mentalis muscle was present between depths of 6.7 to 10.7 mm below the skin. This new information about the location of the mentalis muscle may help when identifying the most effective and safe botulinum toxin injection points and depths during esthetic procedures for weakened facial rhytides on the lower face.

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          Diffusion, spread, and migration of botulinum toxin.

          Botulinum toxin (BoNT) is an acetylcholine release inhibitor and a neuromuscular blocking agent used for the treatment of a variety of neurologic and medical conditions. The efficacy and safety of BoNT depends on accurate selection and identification of intended targets but also may be determined by other factors, including physical spread of the molecule from the injection site, passive diffusion, and migration to distal sites via axonal or hematogenous transport. The passive kinetic dispersion of the toxin away from the injection site in a gradient-dependent manner may also play a role in toxin spread. In addition to unique properties of the various BoNT products, volume and dilution may also influence local and systemic distribution of BoNT. Most of the local and remote complications of BoNT injections are thought to be due to unwanted spread or diffusion of the toxin's biologic activity into adjacent and distal muscles. Despite widespread therapeutic and cosmetic use of BoNT over more than three decades, there is a remarkable paucity of published data on the mechanisms of distribution and its effects on clinical outcomes. The primary aim of this article is to critically review the available experimental and clinical literature and place it in the practical context. © 2013 International Parkinson and Movement Disorder Society.
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            The current use of botulinum toxin.

            Botulinum toxin is the most potent neurotoxin known, and has been in clinical use since the late 1970s. The toxin inhibits the release of acetylcholine from nerve terminals by inhibiting transport of the synaptic vesicles, thus causing functional denervation lasting up to 6 months. Our understanding of the mechanism of action of the toxin and the spectrum of diseases treatable with this agent continues to increase. Efficacy has been demonstrated in hemifacial spasm, dystonia, spasticity, hyperhidrosis and other conditions. Alternative serotypes are used in some centres, generally after the development of immunoresistance to the standard toxin (serotype A), and are likely to be in routine use in the near future. This paper reviews the history, pharmacology and current uses of botulinum toxin. Copyright 2000 Harcourt Publishers Ltd.
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              Contraindications and complications with the use of botulinum toxin.

               Arnold Klein (2016)
              Cosmetic use of BTX has skyrocketed in recent years, especially since the approval of BTX-A for treatment of glabellar lines. Complications and adverse reactions can easily arise, particularly for the novice injector. This paper provides insights from an experienced physician on how to avoid these complications, and how to treat them when and if they occur. The main cosmetic uses for BTX are analyzed for possible complications and adverse events. Injection techniques are discussed. Comparisons between BTX-A and BTX-B are given to point out the need for different injection techniques based on the product being used. Treatment recommendations for the Glabella, Brow, Crow's Feet, Upper Lip Wrinkling/Lines, Depressor Anguli Oris, Nasolabial Folds, Mentalis, Neck and Hyperhidrosis are discussed, as well as systemic complications. It is important for the injecting physician to be familiar with these potential complications, even though the use of BTX has been safe and generally well tolerated, because it will lead to even greater success with the use of BTX.

                Author and article information

                Toxins (Basel)
                Toxins (Basel)
                27 January 2021
                February 2021
                : 13
                : 2
                [1 ]Department of Dental Hygiene, Catholic Kwandong University, 24 Beomil-ro 579beon-gil, Gangneung 25601, Korea; choi9989@ 123456cku.ac.kr
                [2 ]Department of Oral Biology, Division in Anatomy and Developmental Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; hkbae410@ 123456yuhs.ac (H.B.); hjk776@ 123456yuhs.ac (H.-J.K.)
                [3 ]Department of Dental Hygiene, Division of Health Sciences, Namseoul University, 91 Daehak-ro, Seobuk-gu, Cheonan 31020, Korea; jung18342@ 123456naver.com
                [4 ]Department of Materials Science & Engineering, College of Engineering, Yonsei University Seoul, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
                Author notes
                [* ]Correspondence: hks318@ 123456yuhs.ac

                Da-Yae Choi and Hyungkyu Bae contributed equally to this work.

                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).



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