Increasing precision during neuromodulator injections for frontal rhytids—Using ultrasound imaging to identify the line of convergence

Background Recent research introduced the concept of the “line of convergence” as a guide for injectors to enhance precision and avoid complications when treating the frontalis muscle with toxins. However, currently, no pre‐injection ultrasound scanning is employed to increase precision and reduce a...

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Bibliographic Details
Published in:Journal of cosmetic dermatology 2024-07, Vol.23 (7), p.2373-2379
Main Authors: Meneses, Claudia C. B., Freitas, Silvio, Knoedler, Leonard, Knoedler, Samuel, Davidovic, Kristina, Bravo, Carlos, Pappas, AmberLeigh, Biesman, Brian S., Alfertshofer, Michael, Cotofana, Sebastian
Format: Article
Language:English
Subjects:
Adult
Botulinum Toxins, Type A - administration & dosage
Botulinum Toxins, Type A - adverse effects
Cosmetic Techniques - adverse effects
facial anatomy
Facial Muscles - diagnostic imaging
Facial Muscles - drug effects
Feasibility Studies
Female
Forehead
Humans
Injections, Intramuscular - methods
line of convergence
Male
Middle Aged
Muscle Contraction - drug effects
neuromodulator injections
Skin Aging - drug effects
Ultrasonography - methods
ultrasound
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Summary:Background Recent research introduced the concept of the “line of convergence” as a guide for injectors to enhance precision and avoid complications when treating the frontalis muscle with toxins. However, currently, no pre‐injection ultrasound scanning is employed to increase precision and reduce adverse events when searching for the line of convergence. Objective To explore the feasibility and practicality of implementing pre‐injection ultrasound scanning into aesthetic neuromodulator treatments of the forehead. Methods The sample of this study consisted of n = 55 volunteers (42 females and 13 males), with a mean age of 42.24 (10.3) years and a mean BMI of 25.07 (4.0) kg/m2. High‐frequency ultrasound imaging was utilized to measure the thickness, length, and contractility of the frontal soft tissue and to determine the precise location of the line of convergence during maximal frontalis muscle contraction. Results The results revealed that the line of convergence was located at 58.43% (8.7) of the total forehead height above the superior border of the eyebrow cilia without a statistically significant difference between sex, age, or BMI. With frontalis muscle contraction, the forehead shortens in males by 25.90% (6.5), whereas in females it shortens only by 21.74% (5.1), with p 
ISSN:1473-2130
1473-2165
1473-2165
DOI:10.1111/jocd.16368