{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:18:01Z","timestamp":1783703881090,"version":"3.55.0"},"reference-count":20,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,10,12]],"date-time":"2024-10-12T00:00:00Z","timestamp":1728691200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Aesthetic neuromodulator injections of the upper face are frequently performed to temporarily block muscular actions of the periorbital muscles to ultimately reduce skin rhytids. However, the adverse event rate in the literature for toxin\u2010induced blepharoptosis ranges from 0.51% to 5.4%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify access pathways by which injected neuromodulator product can travel from extra\u2010 to intra\u2010orbital and therefore affect the levator palpebrae superioris muscle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nine non\u2010embalmed human body donors were investigated in this study with a mean age at death of 72.8 (16.1) years. The 18 supraorbital regions were injected in 28 times (14 for supratrochlear and 14 for supraorbital) with 0.5\u2009cc, whereas eight cases (four for supratrochlear and four supraorbital) were injected with 0.1\u2009cc of colored product. Anatomic dissections were conducted to identify structures stained by the injected color.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results of this injection\u2010 and dissection\u2010based study revealed that both the supratrochlear and the supraorbital neurovascular bundles are access pathways for injected neuromodulator products to reach the intra\u2010orbital space and affect the levator palpebrea superioris muscle. Out of 36 conducted injection passes, seven (19.44%) resulted in affection of the sole elevator of the eyelid of which 100% occurred only at an injection volume of 0.5\u2009cc and not at 0.1\u2009cc.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Clinically, the results indicate that a low injection volume, a superficial injection for the supraorbital location, and angling the needle tip away from the supratrochlear foramen (toward the contralateral temple) when targeting the corrugator supercilii muscles, can increase the safety profile of an aesthetic toxin glabellar treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.16631","type":"journal-article","created":{"date-parts":[[2024,10,12]],"date-time":"2024-10-12T08:14:09Z","timestamp":1728720849000},"page":"3936-3941","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Simulating Upper Eyelid Ptosis During Neuromodulator Injections\u2014An Exploratory Injection and Dissection Study"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3566-3499","authenticated-orcid":false,"given":"Ferdinando","family":"Paternostro","sequence":"first","affiliation":[{"name":"Department of Experimental and Clinical Medicine, Anatomy and Histology Section University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei\u2010Jin","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Guangdong Second Provincial General Hospital  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo\u2010Sheng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Guangdong Second Provincial General Hospital  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy B.","family":"Green","sequence":"additional","affiliation":[{"name":"Skin Associates of South Florida and Skin Research Institute  Coral Gables Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milan","family":"Milisavljevic","sequence":"additional","affiliation":[{"name":"Laboratory for Vascular Morphology Institute of Anatomy, Faculty of Medicine, University of Belgrade  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikaela V.","family":"Cotofana","sequence":"additional","affiliation":[{"name":"Cotofana Anatomy  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4892-2376","authenticated-orcid":false,"given":"Michael","family":"Alfertshofer","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Ludwig\u2010Maximilians\u2010University Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Benoit","family":"Hendrickx","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery University Hospital Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7210-6566","authenticated-orcid":false,"given":"Sebastian","family":"Cotofana","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Guangdong Second Provincial General Hospital  Guangzhou China"},{"name":"Department of Dermatology Erasmus Medical Centre  Rotterdam The Netherlands"},{"name":"Centre for Cutaneous Research Blizard Institute, Queen Mary University of London  London UK"},{"name":"Department of Plastic Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,12]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"American Society of Plastic Surgeons \u201cASPS Procedural Statistics Release \u201d(2020)."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5154.60343"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.7181\/acfs.2021.00003"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001178"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fsc.2022.01.006"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000008826"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins14040268"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.14133"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001154"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2002.121356"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4725.2006.32327.x"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.14361"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/15910199221067664"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/468727"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181ef822a"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjad070"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000299260.04932.38"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000282725.61640.e1"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.5.5.412"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjaa421"}],"container-title":["Journal of Cosmetic Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocd.16631","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T06:30:50Z","timestamp":1741761050000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jocd.16631"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,12]]},"references-count":20,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1111\/jocd.16631"],"URL":"https:\/\/doi.org\/10.1111\/jocd.16631","archive":["Portico"],"relation":{},"ISSN":["1473-2130","1473-2165"],"issn-type":[{"value":"1473-2130","type":"print"},{"value":"1473-2165","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,12]]},"assertion":[{"value":"2024-09-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}