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Background: Botulinum toxin type A (BoNT‐A) can not only reduce the dynamic wrinkles but also improve the skin quality. This study aims to quantitaively and comprehensively assess the improvement of dynamic wrinkles and skin quality following BoNT‐A treatment on the upper face. Methods: Patients were recruited to receive BoNT‐A treatment of the glabellar, frontal, and lateral periorbital wrinkles. Antera 3D camera was used to evaluate the skin quality and dynamic wrinkle severity. Follow‐up visits were at 1 week, 1 month, 3 months, and 6 months after treatment. Different filters were utilized to quantitatively detect the severity of fine wrinkles (FWS), the volume of pores (PV), the roughness of skin texture (STR), and the severity of dynamic wrinkles (DWS). Results: Twenty‐four participants (average 30.5 ± 7.2 years) were recruited. The significant improvement of PV, FWS, and STR in different areas usually maintained from 1 to 6 months after injections but of DWS only existed within 3 months. For each area, the improvement rates of FWS, PV, and STR peaked at 3 months or 6 months after treatment while the maximal improvement of DWS was observed at 1 month posttreatment. Conclusion: After BoNT‐A treatment for dynamic wrinkles on the upper face, the skin quality of target regions can also be ameliorated. The improvement of skin quality and dynamic wrinkles presented unparallel patterns. The former is with a slower onset but longer duration while the latter exhibits a more rapid onset but shorter duration. [ABSTRACT FROM AUTHOR]

Background: Botulinum toxin type A (BoNT‐A) injection is a popular cosmetic procedure in East Asian countries, and there are multiple types of toxins on the market. Whether different toxin types induce different changes in the masseter has not been studied. Objective: We aimed to investigate and compare the changes induced by injection of different types of BoNT‐A in the masseter. Methods: Upon retrospective review of clinical records and routine ultrasound examination results of patients who underwent BoNT‐A injection, four groups were set for comparison: unapproved toxin, OnabotulinumtoxinA, LanbotulinumtoxinA, and non‐injected. Clinical records and ultrasound images were collected. Ultrasound images were taken in both horizontal and coronal planes. Elasticity of the masseter muscle was also investigated by measuring the surface wave speed. Results: A total of 24 patients were included (six patients per group). All patients were young females. For the non‐injected group, the deep inferior tendon was clear and the muscle bundles were arranged, with little fibrous content. Patients who received unapproved toxin injection showed highly disarranged muscle and fiber bundles, with much fiber content present. The changes in OnabotulinumtoxinA and LanbotulinumtoxinA groups were in between those in the non‐injected and unapproved toxin groups. Muscle rigidity was the highest in the unapproved toxin group, and generally higher in injected groups compared with the non‐injected group. Conclusion: Different types of BoNT‐A may induce different changes in the masseter. [ABSTRACT FROM AUTHOR]

Background: Large calves are considered unattractive. Botulinum toxin type A (BoNT‐A), acting as a neurotoxin that reduces muscle contraction, is widely used in calf contouring. However, there lacks detailed anatomical data to guide clinical injection. Objectives: This study aims to use ultrasonography to provide depth information of the calf muscles and determine the morphological types of the gastrocnemius muscle. Methods: Ultrasound scanning was performed at six sites on 40 Chinese adults. A real‐time ultrasound scannerwas used to detect the depth of the gastrocnemius muscle and the soleus muscle. Results: The thickness of the gastrocnemius muscle and the soleus muscle was measured. The depth from the skin to the surface, the middle, and the bottom of the gastrocnemius muscle was measured. The morphology of gastrocnemius muscle was classified into four different types under ultrasound according to the muscle bulge pattern. Conclusion: This study took ultrasonic measurements of Asian calves to guide accurate and effective BoNT‐A injection in real clinical practice. [ABSTRACT FROM AUTHOR]

Background: Botulinum neurotoxin A injection is a popular noninvasive alternative for the treatment of masseter hypertrophy. This study was conducted to identify a safe injection volume to avoid sunken lateral cheek after botulinum neurotoxin A injection in the masseter muscle. Methods: One milliliter or 0.5 ml of indocyanine green was randomly injected into either side of the masseter muscles of 18 fresh cadaver heads. The bilateral spreads of indocyanine green within the masseter were observed by a fluorescence imager. The masseters were then dissected, and the spreading distance was measured. Results: Dye spreading showed an oval shape parallel to the long axis of the masseter muscle. The lower edges of the masseters were all stained with indocyanine green. The upward spreading exceeded the mouth corner‐tragus line in 94.44% (17/18) of the masseters on the 1‐ml side, and 11.11% (2/18) of the masseters on the 0.5‐ml side. The spreading area and upward spreading distance on the 1‐ml side (9.95 ± 0.48 cm2, 3.18 ± 0.31 cm) were significantly larger than the 0.5‐ml side (7.13 ± 0.80 cm2, 2.08 ± 0.32 cm). Conclusions: The spread of indocyanine green within the masseter occurs in direct proportion to its volume. A bolus of 1 ml easily exceeded the mouth corner‐tragus line and cause sunken cheek. [ABSTRACT FROM AUTHOR]

Background: Full lips are beauty standards. Botulinum toxin A (BTA) paralyzes the orbicularis oris muscle to achieve the eversion of the lip, and thus makes the lip look plump. Aims: This study presents three cases of BTA injection to the lip and evaluates the possible changes in the labial morphology and the lip surface area. Methods: Three patients received a total of 4U BTA injection at the vermilion border of the upper lip. Vectra® H1 3D imaging system was used to capture 3D photographs of the lips before injection and two weeks after injection. Eight linear distances and the upper lip surface area were measured. Anthropometric measurements before and after injection were compared. Results: Patients displayed a larger upper vermillion height (P =.038) and a smaller cutaneous upper lip height (P =.024). There was a trend for a larger upper lip surface area, but not statistically significant (P =.109). Symptoms of slight perioral muscular palsy and mouth incompetence lasted about one month in three patients. Conclusion: BTA helps to enlarge the upper lip and shorten the philtrum. The BTA injection can be an option for lip enhancement with caution. [ABSTRACT FROM AUTHOR]

Background: Botulinum toxin type A (BTA) injection is a widely‐used procedure to correct cosmetic problems caused by muscular hyperactivity. "Cobblestone chin" refers to the appearance of remarkable chin creases caused by mentalis contraction. Aims: The aim of this case report is to raise the awareness of paradoxical bulging after BTA injection in mentalis. Patient/Methods: A 26‐year‐old female asked for cosmetic correction of the "cobblestone chin". BTA injection was performed routinely to the mentalis muscle. However, on the second day after injection, an unusual paradoxical bulging at chin was presented. Results: We speculated that the imbalanced relaxation of mentalis caused by improper injection and uneven diffusion of BTA is responsible for the bulging. After a supplementary injection of BTA in the remaining hyperactive muscle fibers based on the ultrasound examination, the bulging was relieved and chin contour improved significantly. Conclusion: Injection of BTA in mentalis should cover the whole thickness of the muscle to prevent imbalanced paralysis and paradoxical chin bulging, especially in severe mentalis hyperactivity cases. [ABSTRACT FROM AUTHOR]