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The “Visible” Muscles on Ultrasound Imaging Make Botulinum Toxin Injection More Precise: A Systematic Review

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  • Non-Surgical Aesthetic
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Abstract

Background

Botulinum toxin (BoNT) injection is the most commonly performed procedure in cosmetic surgery. However, blind injection is unable to take individual anatomical variations into consideration, which is the main contributing factor to complications. Ultrasound (US) imaging was introduced to reduce complications and improve effects. This article will review uses of US in aesthetic BoNT injection.

Method

A systematic electronic search was performed using the PubMed, MEDLINE, Web of science. Search terms were set to focus on aesthetic BoNT injection. Two independent reviewers subsequently reviewed the resultant articles based on strict inclusion and exclusion criteria. Selected manuscripts were analysed and grouped by procedure categories. Clinical cases were all performed by one plastic surgeon in our department.

Results

The search finally retained 24 articles. Five procedural categories were identified, including masseter (n = 16), frontalis (n = 2), glabella complex (n = 2), trapezius (n=1), and gastrocnemius (n = 3). US imaging is practical and instructive for pre-operative assessments as in needle-type selection, injection point localization and depth setting, as well as post-operative follow-ups regarding injection feedback (for instance, the extent of muscle volume decreases). What's more, ultrasound-guided injection makes needle trajectory visualized so as for the needle to reach the target muscle in avoidance of potential damage to neurovascular bundle, gland or adjacent muscle.

Conclusion

Muscles, such as masseter, frontalis, glabella complex, trapezius and gastrocnemius, and their adjacent structures can be well visualized using US, and as such, US can be a useful tool for a variety of pre-operative, intra-operative and post-operative procedures.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Author notes

  1. Zhijin Li and Yanlong Yang contributed equally to this work.

Authors and Affiliations

  1. Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District, Beijing, 100730, China

    Zhijin Li, Nanze Yu, Zirong Li, Hayson Chenyu Wang, Xiao Long & Xiaojun Wang

  2. The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Yanlong Yang

  3. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Wenzhe Zhou, Yuming Chong & Yuwei Zhang

  4. Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China

    Cheng Chen

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  1. Zhijin Li
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Correspondence to Nanze Yu or Xiaojun Wang.

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Supplementary Information

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Video.1. The video demonstrates the process of botox masseter injection under ultrasound guide (E-CUBE 7). Ultrasound can help visualize the masseter and navigate the needle to the targeted layer. The process of withdrawing needle can be showed clearly as well so as to make out-of-plane technique easy to carry out

Supplementary file1 (WMV 9400 kb)

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Li, Z., Yang, Y., Yu, N. et al. The “Visible” Muscles on Ultrasound Imaging Make Botulinum Toxin Injection More Precise: A Systematic Review. Aesth Plast Surg 46, 406–418 (2022). https://doi.org/10.1007/s00266-021-02493-z

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