{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T16:13:47Z","timestamp":1785600827039,"version":"3.56.0"},"reference-count":16,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T00:00:00Z","timestamp":1657584000000},"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":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>From early dynamic lines in smiling and squinting young people, crow's feet lines in the lateral canthal region evolve through prolonged tissue remodeling into mature, stable rhytids after the mid\u2010to\u2010late thirties, and requests for rejuvenating treatment. Because of the heterogeneous fanning behavior of crow's feet lines, individualizing neuromodulation with botulinum toxin injections might be a sound strategy to maximize aesthetic outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To investigate the prevalence of variable crow's feet line patterns at maximum contracture and while smiling and comment on the relative distribution of such patterns and the influence of aging. These considerations will be the basis and rationale for future studies that will individualize the total 24\u2010unit dose according to the distribution of crow's feet lines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Identifying CFL orientation at maximum frown and while smiling; assessment tool: the four\u2010class 2015\u2010version of Kane's classification further modified by converting the former \u201ccentral fan pattern\u201d into a new, more precisely defined \u201cextended full\u2010fan pattern\u201d class.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 323 cohort subjects had a mean age of 51.5\u00a0\u00b1\u20099.28\u2009years. Although with some differences, outcomes in a central\u2010southern real\u2010world European Caucasian population appear similar to the distribution first studied in 2003 in a highly selected population in New England involved in double\u2010blind clinical trials. The full\u2010fan pattern predominated both at maximum contraction and when smiling, followed in prevalence by the upper\u2010fan pattern at maximum contraction and the extended full\u2010fan pattern while smiling. Age significantly influenced the crow's feet line pattern\u2014lower\u2010fan patterns were more frequent than other patterns in the real\u2010world younger middle\u2010age group (40\u201349\u2009years old); full\u2010fan and extended full\u2010fan patterns progressively more prevalent with aging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The study confirms but somewhat modifies the previous evidence about the non\u2010homogeneous distribution of crow's feet line fanning patterns in different age groups and reinforces the case to individualize the topography of botulinum toxin injections.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.15172","type":"journal-article","created":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T16:27:04Z","timestamp":1655742424000},"page":"4294-4300","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Heterogeneous crow's feet line patterns and customized botulinum toxin rejuvenating treatment"],"prefix":"10.1111","volume":"21","author":[{"given":"Maurizio","family":"Cavallini","sequence":"first","affiliation":[{"name":"Head, Operative Unit of Dermatologic and Plastic Surgery CDI Hospital  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Papagni","sequence":"additional","affiliation":[{"name":"Agor\u00e0 \u2014 Italian Scientific Society of Aesthetic Medicine  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Augelli","sequence":"additional","affiliation":[{"name":"Operative Unit of Dermatologic and Plastic Surgery CDI Hospital  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele\u00a0Ferruccio","family":"Muti","sequence":"additional","affiliation":[{"name":"IDE Istituto Dermatologico Europeo National Secretariat AICPE (Associazione Italiana Chirurghi Plastici Estetici)  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0500-461X","authenticated-orcid":false,"given":"Adriano","family":"Santorelli","sequence":"additional","affiliation":[{"name":"Head, Plastic and Aesthetic Surgery Health Park Clinic  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Raichi","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology Consultant in Aesthetic Medicine  Sanremo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,7,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000293"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000082192.45787.B6"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000336"},{"key":"e_1_2_11_5_1","volume-title":"Anatomy for Plastic Surgery of the Face, Head, and Neck","author":"Watanabe K","year":"2016"},{"key":"e_1_2_11_6_1","unstructured":"OnabotulinumtoxinA Prescribing Information. https:\/\/www.accessdata.fda.gov\u203adrugsatfda_docs (accessed: March 24 2022)."},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000220"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2002.124070"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000757"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjw025"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000128"},{"key":"e_1_2_11_12_1","unstructured":"BOTOX100 Units \u2010 Summary of Product Characteristics (SmPC).https:\/\/www.medicines.org.uk\/emc\/medicine\/112#gref. 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