{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T15:55:11Z","timestamp":1778774111963,"version":"3.51.4"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":6,"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":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>While traditionally focused on treating glabellar and forehead rhytids through direct neuromodulator injections, recent findings on the biomechanics of facial muscles suggest that glabellar treatments alone may influence forehead wrinkles by altering the dynamic balance between depressor and elevator muscles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether glabellar\u2010only neuromodulator treatments can reduce forehead wrinkle severity without direct injections into the frontalis muscle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective, interventional study included 18 participants with moderate to very severe glabellar lines. Neuromodulator (AbobotulinumtoxinA; 37.5 sU (=\u200915\u2009IU)) injections were administered exclusively in the glabella at three intervals over 7\u2009months. Glabellar Severity Scale (GLSS), Forehead Wrinkle Scale (FWS), Frontal Skin Displacement (FSD), and Eyebrow Position Scoring (EPS) were assessed at baseline and 30\u2009days after each cycle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>GLSS scores significantly improved across treatment cycles (baseline: 3.0; post\u2010third cycle: 1.0; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). FWS improved from 3.0 at baseline to 1.0 after the third cycle (<jats:italic>p<\/jats:italic>\u2009=\u20090.005), while FSD showed a significant reduction from 37.2\u2009mm to 17.9\u2009mm (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). No changes in eyebrow position were detected following EPS assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Glabellar\u2010only neuromodulator treatments with 37.5 sU (=\u200915\u2009IU) effectively reduced forehead rhytid severity, likely by altering the balance between depressor and elevator muscles. This approach minimizes risks associated with direct frontalis injections and offers a novel strategy for forehead rejuvenation. Moreover, the observed progressive improvement across treatment cycles suggests that this strategy may continuously enhance aesthetic outcomes over time, supporting the rationale for maintenance treatments at regular intervals.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.70188","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T11:31:01Z","timestamp":1754566261000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Continuous Improvement of Frontal Rhytids Following Glabella Only Treatments With Neuromodulators\u2014A Clinical Prospective Pilot Study"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1134-8542","authenticated-orcid":false,"given":"Victor R. M.","family":"Munoz\u2010Lora","sequence":"first","affiliation":[{"name":"Department of Periodontology and Implantology University of Guarulhos  S\u00e3o Paulo Brazil"},{"name":"Let's HOF Academy  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Rogerio","sequence":"additional","affiliation":[{"name":"Let's HOF Academy  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Thiesen","sequence":"additional","affiliation":[{"name":"Private Practice  Sao Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana C. N.","family":"Carnevali","sequence":"additional","affiliation":[{"name":"Private Practice  Sao Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6366-8428","authenticated-orcid":false,"given":"Carlos","family":"Bravo","sequence":"additional","affiliation":[{"name":"Private Practice  San Jose Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0193-349X","authenticated-orcid":false,"given":"Sachin M.","family":"Shridharani","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Washington University  St. Luis Missouri USA"},{"name":"Private Practice  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Eccleston","sequence":"additional","affiliation":[{"name":"Private Practice  Birmingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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 Charit\u00e9 \u2010 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcelo","family":"Germani","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences, Bauru School of Dentistry University of S\u00e3o Paulo  Sao Paulo Brazil"}],"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 Plastic Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Department of Dermatology Erasmus University Medical Center  Rotterdam the 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