Safety considerations for treating the parotid and submandibular glands with neuromodulators for facial slimming

• Published in: Journal of cosmetic dermatology 2023-11, Vol.22 (11), p.2957-2963
• Main Authors: Gelezhe, Pavel, Frank, Konstantin, Casabona, Gabriela, Kaye, Kai O, Kassirer, Samuel, Moelhoff, Nicholas, Freytag, David L, Gotkin, Robert H, Alfertshofer, Michael, Cotofana, Sebastian
• Format: Article
• Language: English
• Subjects: Age; Body mass index; Carotid arteries; Exocrine glands; FDA approval; Females; Gender differences; Generalized linear models; Investigations; Medical imaging; Skin; Ultrasonic imaging; Veins & arteries
• ISSN: 1473-2130; 1473-2165
• DOI: 10.1111/jocd.15973

Background Neuromodulators have predominantly been used for the treatment of upper facial lines, but their use has expanded to include lower face and neck treatments. However, the injection sites for these treatments are based on skin surface landmarks, which may pose risks to nearby structures and result in undesired outcomes. Objective To investigate the spatial relationship between the FDA‐approved skin surface landmarks for neuromodulator injections in the parotid and submandibular glands and the topographical anatomy of critical facial structures such as the facial artery, facial vein, external carotid artery, and retromandibular vein. Materials and methods A cross‐sectional retrospective analysis was conducted on contrast‐enhanced cranial CT scans. The scans were analyzed for the morphology and location of the parotid and submandibular glands. Measurements were taken for gland volume, craniocaudal extent, anterior–posterior extent, and distances between the skin surface and gland capsule or nearby structures such as arteries. Results The study sample consisted of 53 subjects, including 7 males and 46 females, with a mean age of 36.91 years and a mean BMI of 23.28 kg/m2. The mean volume of the parotid gland was 31.9 ± 3.0 cc in males and 28.5 ± 3.6 cc in females with p