{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T03:00:46Z","timestamp":1781319646129,"version":"3.54.1"},"reference-count":16,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Glabellar neuromodulator injections are frequently guided by skin surface contraction patterns, assuming that visible rhytids reflect underlying muscular anatomy. However, emerging anatomical and imaging evidence has questioned the clinical relevance of pattern\u2010based treatment adaptations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To prospectively evaluate whether different glabellar contraction patterns influence clinical and patient\u2010reported outcomes when a standardized, anatomy\u2010based, FDA\u2010approved 5\u2010point injection algorithm is applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective, multicenter clinical study enrolled 125 patients treated across five independent centers. Patients were classified into five previously described glabellar contraction patterns (V\u2010shape, U\u2010shape, converging arrows, omega, and inverted omega) based on standardized photographs during maximal frowning. All patients received neuromodulator injections following the same standardized 5\u2010point technique using either onabotulinumtoxinA or abobotulinumtoxinA with dose equivalence. Clinical outcomes were assessed using the Glabellar Line Severity Scale (GLSS) at baseline, 15\u2009days, and 90\u2009days, while patient\u2010reported outcomes were evaluated with the Global Aesthetic Improvement Scale (GAIS) at 90\u2009days. Statistical analyses included non\u2010parametric group comparisons and multivariate ordinal logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 119 patients completed the study. A significant improvement in GLSS was observed at 15\u2009days (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), followed by partial regression at 90\u2009days (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 vs. baseline). No statistically significant differences in GLSS or GAIS were identified between contraction pattern groups at any time point (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Multivariate analysis demonstrated that age and body mass index significantly influenced treatment outcomes, whereas glabellar contraction patterns and Fitzpatrick skin type did not. Mild, transient local adverse events were observed and resolved spontaneously.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Glabellar contraction patterns do not significantly affect clinical or patient\u2010reported outcomes when neuromodulator injections are performed using a standardized, anatomy\u2010based 5\u2010point technique. These findings support prioritizing muscular anatomy and patient\u2010specific biological factors over surface rhytid patterns in glabellar neuromodulation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocd.70911","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:29:15Z","timestamp":1778736555000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Advancing the Evidence on Glabellar Contraction Patterns\u2014A Prospective Multicenter Study on Its Clinical Relevance for Glabellar Neuromodulator Injections"],"prefix":"10.1111","volume":"25","author":[{"given":"Marcelo","family":"Germani","sequence":"first","affiliation":[{"name":"Department of Biological Sciences, Bauru School of Dentistry University of S\u00e3o Paulo  Bauru Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor R. M.","family":"Munoz\u2010Lora","sequence":"additional","affiliation":[{"name":"Department of Facial Aesthetics Guarulhos University  S\u00e3o Paulo Guarulhos Brazil"},{"name":"HOF Pro Academy  Rio Verde Goi\u00e1s Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana M.","family":"Geroldo","sequence":"additional","affiliation":[{"name":"Department of Facial Aesthetics Guarulhos University  S\u00e3o Paulo Guarulhos Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Hayashida","sequence":"additional","affiliation":[{"name":"Private Practice  Paran\u00e1 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"In\u00e1cio","sequence":"additional","affiliation":[{"name":"Private Practice  Joinville Santa Catarina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Vitale","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences, Bauru School of Dentistry University of S\u00e3o Paulo  Bauru Brazil"},{"name":"Private Practice  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Bulh\u00f5es","sequence":"additional","affiliation":[{"name":"Private Practice  Salvador Bahia Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Thiesen","sequence":"additional","affiliation":[{"name":"Private Practice  Florian\u00f3polis Santa Catarina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Davidovic","sequence":"additional","affiliation":[{"name":"Center for Radiology and Magnetic Resonance Imaging University Clinical Center of Serbia  Belgrade Serbia"},{"name":"Faculty of Medicine University of Belgrade  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Escobar","sequence":"additional","affiliation":[{"name":"Private Practice  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rod","family":"Rodrich","sequence":"additional","affiliation":[{"name":"Dallas Plastic Surgery Institute  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5183-5433","authenticated-orcid":false,"given":"Michael H.","family":"Gold","sequence":"additional","affiliation":[{"name":"Department of Dermatology Gold Skin Care Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Bravo","sequence":"additional","affiliation":[{"name":"Private Practice  San Jose Costa Rica"}],"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 Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Centre for Cutaneous Research, Blizard Institute Queen Mary University of London  London UK"},{"name":"Department of Plastic and Reconstructive Surgery Guangdong Second Provincial General Hospital  Guangzhou Guangdong Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"International Society of Aesthetic Plastic Surgery \u201cISAPS Interntional Survey on Aesthetic\/Cosmetic Procedures in 2024. p. 1\u201386 \u201d(2024)."},{"key":"e_1_2_11_3_1","volume-title":"Botox Cosmetic (onabotulinumtoxinA): Prescribing Information","author":"U.S. Food and Drug Administration","year":"2019"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524\u20104725.2012.02505.x"},{"issue":"1","key":"e_1_2_11_5_1","first-page":"23","article-title":"Glabellar Wrinkles: A Pilot Study of Contraction Patterns","volume":"2","author":"Trindade de Almeida R. d. 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