{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:41:19Z","timestamp":1792003279918,"version":"4.4.0"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Botulinum toxin type A (BoNT-A) chemodenervation is commonly used for facial synkinesis and aesthetic indications, but landmark-based techniques are limited by anatomical variability and risk of off-target delivery. High-resolution ultrasound (US) can be used to enhance precision and safety. This systematic review explores the role of US-guided BoNT-A facial chemodenervation in evaluating anatomical accuracy, clinical efficacy, complications, and patient satisfaction. A comprehensive search of 6 databases through April 2025 identified studies assessing US-guided BoNT-A chemodenervation for facial indications. Sixteen studies were included, comprising randomized controlled trials, prospective cohorts, cadaveric trials, and anatomical mapping investigations. Data on injection accuracy, clinical outcomes, adverse events, and patient-reported measures were extracted. Risk of bias was assessed using validated tools. US guidance improved injection accuracy, with cadaveric trials demonstrating up to 88% accuracy, whereas landmark-based techniques reported 50%. Clinical studies reported improvements in rhytid reduction, oral commissure elevation, neck relaxation, and facial symmetry. Adverse events were infrequent and mild. Patient satisfaction was consistently higher with US guidance. Anatomical studies identified muscle depth variation and vascular risk zones, supporting real-time sonographic targeting. As a result, the authors found that US-guided BoNT-A chemodenervation improves the safety, precision, and outcomes and should be considered in both therapeutic and aesthetic applications.<\/jats:p>\n                  <jats:p>Level of Evidence: 3 (Therapeutic)<\/jats:p>\n                  <jats:p\/>","DOI":"10.1093\/asj\/sjaf175","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T11:51:38Z","timestamp":1756813898000},"page":"195-201","source":"Crossref","is-referenced-by-count":5,"title":["Ultrasound Guidance for Botulinum Toxin Injection of Muscles Innervated by the Facial Nerve: A Systematic Review of Anatomical Precision, Safety, and Outcomes"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5433-5808","authenticated-orcid":false,"given":"Raisa","family":"Chowdhury","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Schiff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan H","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh","family":"Mohan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"2026012908465263300_sjaf175-B1","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1111\/j.1473-2165.2011.00593.x","article-title":"Advances in the use of botulinum neurotoxins in facial esthetics","volume":"11","author":"Flynn","year":"2012","journal-title":"J Cosmet Dermatol"},{"key":"2026012908465263300_sjaf175-B2","doi-asserted-by":"publisher","first-page":"82","DOI":"10.3390\/toxins15020082","article-title":"Cosmetic treatment using botulinum toxin in the oral and maxillofacial area: a narrative review of esthetic techniques","volume":"15","author":"Hong","year":"2023","journal-title":"Toxins (Basel)"},{"key":"2026012908465263300_sjaf175-B3","doi-asserted-by":"publisher","first-page":"S344","DOI":"10.1097\/dss.0000000000001412","article-title":"The use of botulinum neurotoxin type A in aesthetics: key clinical postulates","volume":"43","author":"Nestor","year":"2017","journal-title":"Dermatol Surg"},{"key":"2026012908465263300_sjaf175-B4","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1111\/dsu.12463","article-title":"Safety of botulinum toxin A in aesthetic treatments: a systematic review of clinical studies","volume":"40","author":"Cavallini","year":"2014","journal-title":"Dermatol Surg"},{"key":"2026012908465263300_sjaf175-B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7181\/acfs.2021.00003","article-title":"Scientific review of the aesthetic uses of botulinum toxin type A","volume":"22","author":"Park","year":"2021","journal-title":"Arch Craniofac Surg"},{"key":"2026012908465263300_sjaf175-B6","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1055\/s-0040-1715189","article-title":"The treatment of facial asymmetry with botulinum toxin: current concepts, guidelines, and future trends","volume":"53","author":"Heydenrych","year":"2020","journal-title":"Indian J Plast Surg"},{"key":"2026012908465263300_sjaf175-B7","doi-asserted-by":"publisher","first-page":"15","DOI":"10.2147\/ccid.s6492","article-title":"Botulinum toxin type A for the management of glabellar rhytids","volume":"3","author":"Tremaine","year":"2010","journal-title":"Clin Cosmet Investig Dermatol"},{"key":"2026012908465263300_sjaf175-B8","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1002\/lary.22404","article-title":"Botulinum toxin in the treatment of facial synkinesis and hyperkinesis","volume":"122","author":"Filipo","year":"2012","journal-title":"Laryngoscope"},{"key":"2026012908465263300_sjaf175-B9","doi-asserted-by":"publisher","first-page":"109","DOI":"10.3390\/toxins16020109","article-title":"Optimizing botulinum toxin A administration for forehead wrinkles: introducing the lines and dots (LADS) technique and a predictive dosage model","volume":"16","author":"Alhallak","year":"2024","journal-title":"Toxins (Basel)"},{"key":"2026012908465263300_sjaf175-B10","doi-asserted-by":"publisher","first-page":"58445","DOI":"10.12775\/qs.2025.39.58445","article-title":"Complications and anatomical considerations in botulinum neurotoxin type A injections for upper face rejuvenation: a systematic review","volume":"39","author":"K\u0105pa","year":"2025","journal-title":"Qual Sport"},{"key":"2026012908465263300_sjaf175-B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.fsc.2006.12.003","article-title":"Anatomic considerations for treatment with Botulinum toxin","volume":"15","author":"Petrus","year":"2007","journal-title":"Facial Plast Surg Clin North Am"},{"key":"2026012908465263300_sjaf175-B12","doi-asserted-by":"publisher","first-page":"293","DOI":"10.5115\/acb.22.266","article-title":"Novel anatomical guidelines for botulinum neurotoxin injection in the mentalis muscle: a review","volume":"56","author":"Yi","year":"2023","journal-title":"Anat Cell Biol"},{"key":"2026012908465263300_sjaf175-B13","doi-asserted-by":"publisher","first-page":"413","DOI":"10.3390\/toxins16100413","article-title":"Ultrasound-guided botulinum toxin-A injections into the masseter muscle for both medical and aesthetic purposes","volume":"16","author":"Popescu","year":"2024","journal-title":"Toxins (Basel)"},{"key":"2026012908465263300_sjaf175-B14","doi-asserted-by":"publisher","first-page":"853","DOI":"10.5114\/ada.2019.82795","article-title":"The whole truth about botulinum toxin\u2014a review","volume":"37","author":"Witmanowski","year":"2020","journal-title":"Postepy Dermatol Alergol"},{"key":"2026012908465263300_sjaf175-B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/978-3-031-36962-9_279-1","volume-title":"Handbook of Oral and Maxillofacial Surgery and Implantology","author":"Nazari","year":"2025"},{"key":"2026012908465263300_sjaf175-B16","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1097\/ruq.0000000000000520","article-title":"Dermatology ultrasound imaging technique, tips and tricks, high-resolution anatomy","volume":"36","author":"Catalano","year":"2020","journal-title":"Ultrasound Q"},{"key":"2026012908465263300_sjaf175-B17","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1016\/j.pmr.2010.05.001","article-title":"High-frequency ultrasound guidance for neurotoxin injections","volume":"21","author":"Alter","year":"2010","journal-title":"Phys Med Rehabil Clin N Am"},{"key":"2026012908465263300_sjaf175-B18","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1007\/s00266-021-02493-z","article-title":"The \u201cvisible\u201d muscles on ultrasound imaging make botulinum toxin injection more precise: a systematic review","volume":"46","author":"Li","year":"2022","journal-title":"Aesthetic Plast Surg"},{"key":"2026012908465263300_sjaf175-B19","doi-asserted-by":"publisher","first-page":"370","DOI":"10.5535\/arm.19211","article-title":"Accuracy of ultrasound-guided and non-guided botulinum toxin injection into neck muscles involved in cervical dystonia: a cadaveric study","volume":"44","author":"Ko","year":"2020","journal-title":"Ann Rehabil Med"},{"key":"2026012908465263300_sjaf175-B20","doi-asserted-by":"publisher","first-page":"1628","DOI":"10.1007\/s00266-023-03708-1","article-title":"Mapping the vascular and muscular topography of the glabellar region: implication for improving safety and efficacy of the glabellar injections","volume":"48","author":"Ismailoglu","year":"2024","journal-title":"Aesthetic Plast Surg"},{"key":"2026012908465263300_sjaf175-B21","first-page":"E65","article-title":"Vascular complications after facial filler injection: a literature review and meta-analysis","volume":"12","author":"Sito","year":"2019","journal-title":"J Clin Aesthet Dermatol"},{"issue":"3","key":"2026012908465263300_sjaf175-B22","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1053\/j.sult.2023.11.005","article-title":"Ultrasound in aesthetics: filler and non-filler applications","volume":"45","author":"Cavallieri","year":"2023","journal-title":"Semin Ultrasound CT MR"},{"key":"2026012908465263300_sjaf175-B23","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/978-3-031-36266-8_2","volume-title":"Facial Danger Zones: Ultrasound Anatomy","author":"Christiansen","year":"2023"},{"key":"2026012908465263300_sjaf175-B24","doi-asserted-by":"publisher","first-page":"57","DOI":"10.20517\/2347-9264.2022.19","article-title":"Ischemic complications of dermal fillers","volume":"9","author":"Mehta","year":"2022","journal-title":"Plast Aesthet Res"},{"key":"2026012908465263300_sjaf175-B25","doi-asserted-by":"publisher","first-page":"674","DOI":"10.3390\/toxins14100674","article-title":"Does ultrasound guidance improve the effectiveness of neurotoxin injections in patients with cervical dystonia? (A prospective, partially-blinded, clinical study)","volume":"14","author":"Ty\u015blerowicz","year":"2022","journal-title":"Toxins (Basel)"},{"key":"2026012908465263300_sjaf175-B26","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s13089-015-0028-2","article-title":"Perceived barriers in the use of ultrasound in developing countries","volume":"7","author":"Shah","year":"2015","journal-title":"Crit Ultrasound J"},{"key":"2026012908465263300_sjaf175-B27","doi-asserted-by":"publisher","first-page":"263","DOI":"10.4018\/979-8-3693-1214-8.ch013","volume-title":"Emerging Technologies for Health Literacy and Medical Practice","author":"Lobo","year":"2024"},{"key":"2026012908465263300_sjaf175-B28","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026012908465263300_sjaf175-B29","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1136\/bmjebm-2022-112102","article-title":"Using Risk of Bias 2 to assess results from randomised controlled trials: guidance from Cochrane","volume":"28","author":"Flemyng","year":"2023","journal-title":"BMJ Evid Based Med"},{"key":"2026012908465263300_sjaf175-B30","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.jclinepi.2018.01.012","article-title":"GRADE guidelines: 18. How ROBINS-I and other tools to assess risk of bias in nonrandomized studies should be used to rate the certainty of a body of evidence","volume":"111","author":"Sch\u00fcnemann","year":"2019","journal-title":"J Clin Epidemiol"},{"key":"2026012908465263300_sjaf175-B31","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle\u2013Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol"},{"key":"2026012908465263300_sjaf175-B32","doi-asserted-by":"publisher","first-page":"560","DOI":"10.3390\/toxins11100560","article-title":"Ultrasonographic and three-dimensional analyses at the glabella and radix of the nose for botulinum neurotoxin injection procedures into the procerus muscle","volume":"11","author":"Cho","year":"2019","journal-title":"Toxins (Basel)"},{"key":"2026012908465263300_sjaf175-B33","doi-asserted-by":"publisher","first-page":"96","DOI":"10.3390\/toxins13020096","article-title":"Effective locations for injecting Botulinum toxin into the mentalis muscle; cadaveric and ultrasonographic study","volume":"13","author":"Choi","year":"2021","journal-title":"Toxins (Basel)"},{"key":"2026012908465263300_sjaf175-B34","doi-asserted-by":"publisher","first-page":"2641","DOI":"10.1016\/j.ultrasmedbio.2019.06.414","article-title":"Ultrasonographic analyses of the forehead region for injectable treatments","volume":"45","author":"Choi","year":"2019","journal-title":"Ultrasound Med Biol"},{"key":"2026012908465263300_sjaf175-B35","first-page":"1837","article-title":"Efficiency of ultrasound and water capsule-guided local injection of botulinum toxin type A treatment on patients with facial spasm","volume":"19","author":"Ding","year":"2015","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2026012908465263300_sjaf175-B36","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1002\/ca.23754","article-title":"Clinical anatomy considerations on the muscular and vascular components of the midface by ultrasonographic imaging","volume":"34","author":"Hormazabal-Peralta","year":"2021","journal-title":"Clin Anat"},{"key":"2026012908465263300_sjaf175-B37","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3390\/toxins14010017","article-title":"Anatomical injection guidelines for glabellar frown lines based on ultrasonographic evaluation","volume":"14","author":"Kim","year":"2022","journal-title":"Toxins (Basel)"},{"key":"2026012908465263300_sjaf175-B38","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1002\/ca.23507","article-title":"Three-dimensional territory and depth of the corrugator supercilii","volume":"33","author":"Lee","year":"2019","journal-title":"Clin Anat"},{"key":"2026012908465263300_sjaf175-B39","doi-asserted-by":"publisher","first-page":"293e","DOI":"10.1097\/prs.0000000000005202","article-title":"Locational relationship between the lateral border of the frontalis muscle and the superior temporal line","volume":"143","author":"Lee","year":"2019","journal-title":"Plast Reconstr Surg"},{"key":"2026012908465263300_sjaf175-B40","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1093\/asj\/sjz341","article-title":"Sonographic analysis of the upper labial orbicularis oris and its clinical implications","volume":"40","author":"Park","year":"2020","journal-title":"Aesthet Surg J"},{"key":"2026012908465263300_sjaf175-B41","doi-asserted-by":"publisher","first-page":"e13159","DOI":"10.1111\/dth.13159","article-title":"Rejuvenation of periocular region in Koreans: a multimodal approach combining botulinum toxin, fillers, and micro-focused ultrasound with visualization for optimal results","volume":"33","author":"Park","year":"2020","journal-title":"Dermatol Ther"},{"key":"2026012908465263300_sjaf175-B42","doi-asserted-by":"publisher","first-page":"3437","DOI":"10.1016\/j.bjps.2021.05.045","article-title":"Targeted chemodenervation of the posterior belly of the digastric muscle for the management of jaw discomfort in facial synkinesis","volume":"74","author":"Pescarini","year":"2021","journal-title":"J Plast Reconstr Aesth Surg"},{"key":"2026012908465263300_sjaf175-B43","doi-asserted-by":"publisher","first-page":"3787","DOI":"10.1111\/jocd.15167","article-title":"Ultrasonographic analyses of Crow's feet and novel guideline for botulinum toxin injection","volume":"21","author":"Piao","year":"2022","journal-title":"J Cosmet Dermatol"},{"key":"2026012908465263300_sjaf175-B44","doi-asserted-by":"publisher","first-page":"1808","DOI":"10.1007\/s00266-024-04471-7","article-title":"Ultrasound-guided \u201ccross injection\u201d technique for mouth corner lift with Botulinum toxin type A","volume":"49","author":"Tang","year":"2025","journal-title":"Aesthetic Plast Surg"},{"key":"2026012908465263300_sjaf175-B45","doi-asserted-by":"publisher","first-page":"617e","DOI":"10.1097\/prs.0000000000010802","article-title":"Ultrasound-guided injections for treatment of facial paralysis sequelae: a randomized study on body donors","volume":"153","author":"Kildal","year":"2024","journal-title":"Plast Reconstr Surg"},{"key":"2026012908465263300_sjaf175-B46","doi-asserted-by":"publisher","first-page":"2867","DOI":"10.1111\/jocd.16365","article-title":"A prospective and randomized study comparing ultrasound-guided real time injection to conventional blind injection of botulinum neurotoxin for glabellar wrinkles","volume":"23","author":"Wu","year":"2024","journal-title":"J Cosmet Dermatol"},{"key":"2026012908465263300_sjaf175-B47","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1093\/asj\/sjae037","article-title":"Deciphering depressor anguli oris for lower face rejuvenation: a prospective ultrasound-based investigation","volume":"44","author":"Zhang","year":"2024","journal-title":"Aesthet Surg J"},{"key":"2026012908465263300_sjaf175-B48","doi-asserted-by":"publisher","first-page":"5337","DOI":"10.3390\/jcm13175337","article-title":"Prospective analysis of the effectiveness of targeted botulinum toxin type A injection using an ultrasound-guided single-point injection technique for lower face contouring","volume":"13","author":"Ryoo","year":"2024","journal-title":"J Clin Med"},{"key":"2026012908465263300_sjaf175-B49","doi-asserted-by":"publisher","first-page":"NP130","DOI":"10.1093\/asj\/sjy128","article-title":"Ultrasound-guided botulinum neurotoxin type A injection for correcting asymmetrical smiles","volume":"38","author":"Lee","year":"2018","journal-title":"Aesthet Surg J"}],"container-title":["Aesthetic Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjaf175\/64265758\/sjaf175.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/46\/2\/195\/64265758\/sjaf175.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/46\/2\/195\/64265758\/sjaf175.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T13:46:57Z","timestamp":1769694417000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/asj\/article\/46\/2\/195\/8253962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,15]]},"references-count":49,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,9,15]]},"published-print":{"date-parts":[[2026,1,29]]}},"URL":"https:\/\/doi.org\/10.1093\/asj\/sjaf175","relation":{},"ISSN":["1090-820X","1527-330X"],"issn-type":[{"value":"1090-820X","type":"print"},{"value":"1527-330X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2025,9,15]]}}}