{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T15:18:54Z","timestamp":1778858334618,"version":"3.51.4"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T00:00:00Z","timestamp":1607385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Differences in the effectiveness of neuromodulator treatments for horizontal forehead lines dependent on depth of product administration have been described. However, knowledge in respect to the fascial anatomy of the forehead still remains elusive.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To relate the fascial anatomy of the forehead to the effectiveness of neuromodulator treatments by conducting a clinical, prospective, interventional split\u2010face study in which injections for the treatment of horizontal forehead lines are performed differently between facial sides.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study included a total of n\u00a0=\u00a014 patients with a mean age of 35.71 (7.8)\u00a0years and mean body mass index of 21.9 (3.0)\u00a0kg\/m<jats:sup>2<\/jats:sup>. One side of the forehead was injected superficially by positioning the product in the superficial fatty layer, whereas the contralateral side was injected deep targeting the supraperiosteal plane (random selection). The treatment outcome was rated by the physician and by two independent observers according to a forehead line severity scale (0\u20104) at 14 and at 30\u00a0days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All three observers agreed in their ratings (ICC: 0.942) that the deep injection technique resulted in a superior outcome: D14 (superficial vs deep) 0.17 (0.4) vs 0.14 (0.4; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.583) at rest and 1.26 (0.6) vs 0.43 (0.5; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) for frontalis contraction; D30 0.17 (0.4) vs 0.14 (0.3) at rest (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.583) and 1.21 (0.6) vs 0.43 (0.5; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) for frontalis contraction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results of this study underscore how detailed anatomic knowledge can enhance results of aesthetic interventions, in this case horizontal forehead line treatment with neuromodulators.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.13875","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T08:13:16Z","timestamp":1606723996000},"page":"1385-1392","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["To click or not to click \u2013 The importance of understanding the layers of the forehead when injecting neuromodulators \u2013 A clinical, prospective, interventional, split\u2010face study"],"prefix":"10.1111","volume":"20","author":[{"given":"Kristina","family":"Davidovic","sequence":"first","affiliation":[{"name":"Department of Radiology &amp; Medical School University of Belgrade Belgrade Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dmitry V.","family":"Melnikov","sequence":"additional","affiliation":[{"name":"Plastic Surgery Department I.M. Sechenov First Moscow State Medical University Moscow Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6994-8877","authenticated-orcid":false,"given":"Konstantin","family":"Frank","sequence":"additional","affiliation":[{"name":"Department for Hand, Plastic and Aesthetic Surgery Ludwig \u2013 Maximilian University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Gavril","sequence":"additional","affiliation":[{"name":"Private Practice Cluj\u2010Napoca Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy B.","family":"Green","sequence":"additional","affiliation":[{"name":"Skin Associates of South Florida, Skin Research Institute Coral Gables FL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David L.","family":"Freytag","sequence":"additional","affiliation":[{"name":"Department for Hand, Plastic and Aesthetic Surgery Ludwig \u2013 Maximilian University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Heisinger","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery Medical University of Vienna Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatjana","family":"Pavicic","sequence":"additional","affiliation":[{"name":"Private Practice Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5183-5433","authenticated-orcid":false,"given":"Michael H.","family":"Gold","sequence":"additional","affiliation":[{"name":"Gold Skin Care Center Tennessee Clinical Research Center Nashville TN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7210-6566","authenticated-orcid":false,"given":"Sebastian","family":"Cotofana","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy Mayo Clinic College of Medicine and Science Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,8]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Surgery TAS for AP The American Society For Aesthetic Plastic Surgery.Cosmetic (Aesthetic) Surgery National Data Bank Statistics.https:\/\/www.surgery.org\/sites\/default\/files\/ASAPS\u2010Stats2018_0.pdf. 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