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Ultrasonographic Analysis of Trapezius Muscle for Efficient Botulinum Toxin Type A Injection

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  • Non-Surgical Aesthetic
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Abstract

Background

Patients nowadays seek medical reduction of the upper trapezius muscle to achieve aesthetic pleasing necklines. Botulinum toxin type A (BoNT-A), a neurotoxin that reduces the force of muscle contraction, is widely used for shoulder contouring. However, detailed metrical data are lacking to guide clinical injection.

Methods

Forty healthy young women were enrolled. All subjects were seated for point marking and measuring of trapezius muscle (TM) anatomical data. At marked locations, the thickness of the subcutaneous tissue, the thickness of the TM, the TM’s anterior border, and the depth from the skin surface to the middle of TM were measured using a real-time ultrasound scanner. In addition, photos were taken to assess the shoulder area proportion and shoulder angle.

Results

The shoulder area size among participants was 90 ± 15.2 cm2, the average area proportion was 0.55 ± 0.1, and the shoulder angle was 23.12° ± 2.9°. Ultrasonography data reveal that the thickness of the subcutaneous tissue, the thickness of the TM, and the depth from the skin surface to the middle of TM all thickened from the anterior line to the posterior line (P < 0.001). The length of the TM extending forward was 1.47 ± 0.4 cm (range 0.51–1.31 cm). To better evaluate the appearance of the trapezius muscle, we constructed a grading system correlated to shoulder angle.

Conclusion

In this study, ultrasonography and photos were applied to assess the TM’s anatomical features. Trapezius hypertrophy was described on a scale from 0 to 2 based on the shoulder angle. The findings of the present study provide a practical clinical guidance for precise and efficient BoNT-A administration.

Level of Evidence IV

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References

  1. Sarwer DB, Polonsky HM (2016) Body image and body contouring procedures. Aesthet Surg J 36(9):1039–1047. https://doi.org/10.1093/asj/sjw127

    Article  PubMed  Google Scholar 

  2. Camargo PR, Neumann DA (2019) Kinesiologic considerations for targeting activation of scapulothoracic muscles - part 2: Trapezius. Braz J Phys Ther 23(6):467–475. https://doi.org/10.1016/j.bjpt.2019.01.011

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bae JH, Lee JS, Choi DY, Suhk J, Kim ST (2018) Accessory nerve distribution for aesthetic botulinum toxin injections into the upper trapezius muscle: Anatomical study and clinical trial: reproducible BoNT injection sites for upper trapezius. Surg Radiol Anat 40(11):1253–1259. https://doi.org/10.1007/s00276-018-2059-4

    Article  PubMed  Google Scholar 

  4. Childers MK (2004) Targeting the neuromuscular junction in skeletal muscles. Am J Phys Med Rehabil 83(10 Suppl):S38-44. https://doi.org/10.1097/01.phm.0000141129.23219.42

    Article  PubMed  Google Scholar 

  5. Chen W, Zhang X, Xu Y, Xu Z, Qin H, Zhang L (2021) Ultrasound-guided five-point injection of botulinum toxin for patients with trapezius hypertrophy. J Orthop Surg Res 16(1):634. https://doi.org/10.1186/s13018-021-02758-y

    Article  PubMed  PubMed Central  Google Scholar 

  6. Turo D, Otto P, Shah JP, Heimur J, Gebreab T, Zaazhoa M, Armstrong K, Gerber LH, Sikdar S (2013) Ultrasonic characterization of the upper trapezius muscle in patients with chronic neck pain. Ultrason Imaging 35(2):173–187. https://doi.org/10.1177/0161734612472408

    Article  PubMed  PubMed Central  Google Scholar 

  7. Abbott Z, Richardson JK (2007) Subacromial impingement syndrome as a consequence of botulinum therapy to the upper trapezii: a case report. Arch Phys Med Rehabil 88(7):947–949. https://doi.org/10.1016/j.apmr.2007.04.006

    Article  PubMed  Google Scholar 

  8. Benitez PA (2022) Onabotulinumtoxin A for correcting trapezius muscle hypertrophy in Asian women. J Cosmet Dermatol 21(6):2677–2679. https://doi.org/10.1111/jocd.14423

    Article  PubMed  Google Scholar 

  9. Kwanchuay P, Petchnumsin T, Yiemsiri P, Pasuk N, Srikanok W, Hathaiareerug C (2015) Efficacy and safety of single botulinum toxin type A (Botox®) injection for relief of upper trapezius myofascial trigger point: a randomized, double-blind, placebo-controlled study. J Med Assoc Thai 98(12):1231–1236

    PubMed  Google Scholar 

  10. Oliver M, MacDonald J, Rajwani M (2006) The use of botulinum neurotoxin type A (Botox) for headaches: a case review. J Can Chiropr Assoc 50(4):263–270

    PubMed  PubMed Central  Google Scholar 

  11. Vasileiadis GI, Sakellariou VI, Papagelopoulos PJ, Zoubos AB (2012) Posttraumatic focal dystonia of the shoulder. Orthopedics 35(6):e977-980. https://doi.org/10.3928/01477447-20120525-47

    Article  PubMed  Google Scholar 

  12. Jeong SY, Park KY, Seok J, Ko EJ, Kim TY, Kim BJ (2017) Botulinum toxin injection for contouring shoulder. J Eur Acad Dermatol Venereol 31(1):e46–e47. https://doi.org/10.1111/jdv.13705

    Article  CAS  PubMed  Google Scholar 

  13. Lee JH, Lee KY, Kim JY, Son WH, Jeong JH, Gil Jeong Y, Kwon S, Han SH (2017) Botulinum toxin injection-site selection for a smooth shoulder line: an anatomical study. Biomed Res Int 2017:3092720. https://doi.org/10.1155/2017/3092720

    Article  PubMed  PubMed Central  Google Scholar 

  14. Li Z, Yang Y, Yu N, Zhou W, Li Z, Chong Y, Zhang Y, Wang HC, Chen C, Long X, Wang X (2021) The, “visible” muscles on ultrasound imaging make botulinum toxin injection more precise: a systematic review. Aesthet Plast Surg. 46(1):406–418. https://doi.org/10.1007/s00266-021-02493-z

    Article  Google Scholar 

  15. Zhou RR, Wu HL, Zhang XD, Ye LL, Shao HJ, Song XH, Song ML, Zheng SS (2018) Efficacy and safety of botulinum toxin type a injection in patients with bilateral trapezius hypertrophy. Aesthet Plast Surg. 42(6):1664–1671. https://doi.org/10.1007/s00266-018-1201-3

    Article  Google Scholar 

  16. Yeh YT, Peng JH, Peng HP (2018) Literature review of the adverse events associated with botulinum toxin injection for the masseter muscle hypertrophy. J Cosmet Dermatol 17(5):675–687. https://doi.org/10.1111/jocd.12721

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Haiyu Pang for her support on statistical methods.

Funding

National Key R&D Program of China (2020YFE0201600) CAMS Innovation Fund for Medical Sciences (No. 2020-I2M-C&T-A-004) CAMS Innovation Fund for Medical Sciences (CIFMS 2021-I2M-1-003) the Medical Science and Health Technology Innovation Project (2022-I2M-1-068).

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Author notes

  1. Liquan Wang, Tianhao Li and Yarong Chi contributed equally to this article.

Authors and Affiliations

  1. Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China

    Liquan Wang, Tianhao Li, Yarong Chi, Mengyuan Zhang, Wenchao Zhang, Yuming Chong, Jiuzuo Huang, Nanze Yu & Xiao Long

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  1. Liquan Wang
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Contributions

All authors have read and approved the final manuscript. LW, TL, and NY performed the research. JH, NY, XL designed the research study. YC, MZ, WZ and YC contributed essential reagents or tools and analyzed the data. LW and TL wrote the paper.

Corresponding authors

Correspondence to Nanze Yu or Xiao Long.

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The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of our Institutional Ethical Committee.

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Informed consent was obtained from all participants.

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Wang, L., Li, T., Chi, Y. et al. Ultrasonographic Analysis of Trapezius Muscle for Efficient Botulinum Toxin Type A Injection. Aesth Plast Surg 47, 2029–2036 (2023). https://doi.org/10.1007/s00266-022-03191-0

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