Forehead

OBJECTIVE To determine whether injection every 4 months with onabotulinumtoxinA provides longerlasting reduction or elimination of glabellar rhytides. METHODS Toxin-naive women (N = 45) aged 30 to 50 with moderate to severe glabellar lines at maximum contraction completed the study. Five sites were treated with 4 U of onabotulinumtoxinA. Participants were assessed at day 30; those with glabellar severity of none to mild remained in the study. Participants received identical treatments at months 4, 8, 12, 16, and 20, and were assessed without treatment at 24, 25, and 26 months. RESULTS Baseline physician-and participant-rated treatment responders at maximum contraction were 84% and 80%, respectively, at month 20; and 56% and 58%, respectively, at month 26. Mean changes from physician-and participant-assessed Facial Wrinkle Scale at maximum contraction from baseline to all postbaseline measurements were significant (pr.001). The percentage of participants reporting neutral (0) to couldn't be more satisfied (1 4) with their appearance ranged from 91% to 100% during months 1 to 24. At month 26, 87% of participants reported satisfaction, with appearance scores between 0 and 1 4. No adverse events were reported. CONCLUSIONS OnabotulinumtoxinA delivered for 20 months significantly reduces or progressively eliminates glabellar rhytides for up to 6 months after the last treatment.

We establish criteria for aesthetic forehead flap reconstructions and evaluate the effect of mathematical models and computer simulation of the operation in preoperative and perioperative planning. We study a case series of 13 patients in an academic tertiary referral medical center. Most patients had nasal defects after Mohs' surgery for tumor ablation. Patients were followed up for 2 years after reconstructive surgery. Three patients underwent midline forehead flap nasal reconstructions, and t0 patients underwent paramedian forehead flap nasal reconstructions. We used patient satisfaction and physician evaluation of aesthetic form and function restoration as the main outcome measures. There were no major complications. Minor complications included short-term pincushioning in all patients, scar contrac-Lure that resolved after 8 months in one patient, and forehead necrosis after primary closure of the upper forehead in one patient. Computer simulation correlated two-dimension flap design to the transposition process. We conclude that the forehead flap is the optimal reconstructive modality for resurfacing large nasal defects. The paramedian forehead flap is superior to the midline forehead flap for nasal reconstruction, especially for distal tip reconstructions. Mathematical models and computer simulation of the reconstructive procedure that relate the two-dimensional flap design to the transposition process reveal subtle geometric relationships of the flap transposition that facilitate the design of the optimal flap for reconstruction. (OTOLARYNGOL HEAD NECK SURG 1995; 113: 740-7.) rain I¥1any surgeons consider forehead skin the best match of color and texture in reconstructing nasal defects. Unfortunately, because of the thickness of forehead skin, composite grafts cannot survive reliably solely on imbibition. Thus surgeons traditionally transpose the tissue from the forehead onto the nose by a two-stage procedure: the first stage transfers the tissue on a vascular pedicle, and the second stage divides the pedicle after inosculation and

Aim: To establish a new clinical index to evaluate the presence of hypo-hypertelorism with greater accuracy. Material and Methods: After screening a wide range of population, 310 elementary school children (185 boys, 125 girls) aged 7–15 years were included in this study. For this cross-sectional study, a millimetre ruler was used. The anatomical interpupillary distance was measured by a modified Viktorin's method. In addition, inner and outer intercanthal distances were obtained. The data were analyzed by Student's t -test for two independent samples using SPSS for Windows. There were children with clinical hypertelorism (n=92, group 1), children with large fronto-occipital circumference (FOC) (n=101, group 2), and age- and sex-matched normal controls (n=117, group 3). Due to variations in FOC among healthy subjects, we introduced a new practical concept for evaluation of interpupillary distance, namely the interpupillary index, the simple product obtained by dividing the...

Oculodermal melanocytosis (nevus of Ota) is a benign, congenital, melanocytic pigmentary disorder, most commonly involving the area innervated by the first and second divisions of the trigeminal nerve. We describe a case of cutaneous melanoma that developed in a nevus of Ota.

Evidence materials in a presumed suicide case were studied by a firearm examiner and a forensic chemist. The victim's body with double gunshot wounding in his forehead, a machine gun in the sustained fire mode with a silencer, and four cartridge cases were found. Examinations of the evidence, the case file studies, and experiments dedicated to the case were carried out. Relationships between the placement of cartridge cases and the gun were established using a fast camera. The distributions of gunshot residues on the evidence materials and within the comparative gunshot patterns were studied by means of optical and electron microscopy, X-ray microanalysis, and infrared spectroscopy. The shooting distance was assessed to be 30 cm or more, whereas the greatest distance that could have been achieved by the victim himself was about 11-13 cm. The obtained results supported the version of homicide rather than suicide.

The eyelid-eyebrow region is the center for facial expression. Youth and beauty are associated with smooth, wrinkle-free skin and proportional facial features. The position of the eyebrows conveys emotion, and consequently, even a minor change in brow position can alter the expression of an individual's face. Repositioning the eyebrows and reducing the prominence of the glabellar frown lines can change the expression from one of anger and hostility to one that is more pleasant and natural. Various methods have been used for rejuvenation of the upper face. The height or length of the forehead is a useful guide for choosing the appropriate technique. We performed the coronal browlift using the subgaleal dissection plane, with subperiosteal dissection of 2.5 cm of the periosteal band over the supraorbital rim. We believe that this technique provided us with the benefits of the two dissection planes, with a more permanent result.

AIm: The scalp and forehead are the anatomical regions where non-melanoma malignant skin tumors are commonly seen due to direct sun exposure. After surgery for non-melanoma malignant skin tumors located in the scalp and forehead, many complex defects can develop, ranging from sole skin defects to deep defects in which bone and dura mater are opened. mAterIAl and methOds: This study examined 43 patients who presented to the Department of Plastic Surgery in Ankara Numune Training and Research Hospital and were diagnosed with non-melanoma malignant tumors of scalp and forehead between 2006 and 2013. The number of operations, the operation techniques applied, the number and type of complications (if any) of free tissue transplantation were also investigated. Various techniques are used for reconstruction of scalp and forehead region following resection of non-melanoma skin tumors. results: In order to accomplish satisfactory results these patients have to be carefully assessed with specific parameters while performing the reconstruction of the defect and reconstruction should be planned. Patients with local invasion may need adjuvant radiotherapy postoperatively and reconstruction with free flaps is reliable in the prevention of the possible comorbid problems due to radiotherapy. COnClusIOn: Multidisciplinary approach is needed and the treatment should be managed with neurosurgical team, radiation oncologists and medical oncologists.

The neurological complications of bee venom poisoning vary from optic neuritis to pontine hematoma. However, to our best knowledge, trigeminal neuropathic pain secondary to bee sting has not been reported previously in the literature. We report the case of a 52-year-old male patient with right-sided trigeminal neuropathic pain that began a month earlier, following a honeybee sting to the right forehead. The patient was successfully treated by CT-guided percutaneous trigeminal tractotomy. The present report demonstrated that a honeybee sting may result in trigeminal neuropathic pain and CT-guided percutaneous trigeminal tractotomy is effective in the treatment of such cases.

IMPORTANCE This article provides new data on a controversial issue, the influence of doses on the diffusion characteristics of 2 botulinum toxins type A. OBJECTIVE To assess the fields of effect of abobotulinumtoxinA and onabotulinumtoxinA at the same labeled unit dose (1:1 U) comparing sweat gland and muscle activity. DESIGN, SETTING, AND PARTICIPANTS A prospective, single-center, randomized, double-blind study was conducted at the Brazilian Center for Studies in Dermatology in Porto Alegre, Brazil. The participants included 19 women. INTERVENTIONS Each patient received2UofabobotulinumtoxinA on one side of the forehead and2UofonabotulinumtoxinA on the other side. MAIN OUTCOMES AND MEASURES Horizontal and vertical diameter and area of the fields of anhidrotic effect, the amplitude of evoked compound muscle action potentials, and the 4-point validated Wrinkle Severity Scale were assessed at 28 days.

Background Focal injections of botulinum toxin A are used successfully for the treatment of hyperkinetic facial wrinkles. Efficacy can be measured by several methods. However, so far none has been investigated for its reproducibility. Objectives To investigate the reproducibility of a clinical 0-3 score for glabellar frown lines. Methods In the first part of the study, a standardized photographic documentation of glabellar frown lines was produced. Based on the results of this phase, a consensus atlas of glabellar frown lines was developed and participants were trained using this atlas. In the main study, 50 standardized photographs were shown on two consecutive days to 28 dermatologists. The reproducibility of the score was investigated by conventional kappa statistics. Results In the main study, we found an unweighted kappa according to Fleiss of 0AE62 for interobserver reproducibility. Intraobserver reproducibility showed an unweighted kappa according to Cohen of between 0AE57 and 0AE91 for each observer, and a weighted kappa according to Cicchetti and Allison of between 0AE68 and 0AE94. Conclusions The clinical 0-3 score for glabellar frown lines shows a good inter-and intraobserver reproducibility.

BACKGROUND Injection of filler materials into the dermis is well tolerated with few mild and transient side effects. Injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s). The glabella is a particular danger zone for injection necrosis regardless of the type of filler used.

Background The taxonomic revision carried out in 1996 on the genus Malassezia, which now comprises seven different species, made necessary a re-evaluation of the data concerning the ecology and pathogenicity of these lipophilic yeasts. Very little has been published since then. Objectives The aim of this work was to contribute to the knowledge of the aetiology of pityriasis versicolor (PV) with a mycological study made according to the new species. Methods Ninety-six patients with PV completed the study. In all of them, samples were taken from the lesions for direct microscopy with KOH1 Parker ink and culture. Samples were also taken from normal skin of the trunk and the forehead of the same patients for culture. Cultures were made in modified Dixon medium in Petri dishes, incubated at 31 8C and the isolates were identified by morphological and physiological characteristics. Results In the PV lesions, direct microscopy always showed the typical mixture of globose blastoconidia and pseudomycelium. Only one patient, having received previous topical antimycotic treatment, was negative. The spherical yeasts observed in vivo were morphologically identical to the globose yeasts characteristic of M. globosa. In culture, M. globosa was found in 97% of cases, alone in 60% of them and associated with M. sympodialis in 29% and M. slooffiae in 7%. These two species were also found in similar percentages on the clinically uninvolved skin of the trunk, whereas M. globosa was not isolated at these sites. However, on the forehead, a small number of colonies of M. globosa was recovered in 12% of cases. Conclusions These results support the data previously reported and strongly suggest that M. globosa in its mycelial phase is the causative agent of PV.

The subperiosteal midface-lift has benefited from significant technological advances in medicine. The endoscope now allows extensive subperiosteal undermining of facial soft tissue through minimal access incisions. Improved understanding of facial anatomy and the facial aging process now allow repositioning and remodeling of the soft tissue envelope with excellent aesthetic results. The subperiosteal midface-lift by a temporal approach is a procedure designed to rejuvenate the middle third of the face. After subperiosteal detachment, the soft tissues of the cheek, jowls, lateral canthus, and inferior orbital rim can be lifted to reestablish their youthful relationship with the underlying skeleton. It is a technique that produces satisfactory cosmetic results in most cases, causing malar augmentation, nasolabial fold improvement, and mild jowl improvement. We describe our preferred technique in detail and discuss its indications, complications, advantages, and limitations.

Forehead is a part of the human body that never been used in forensics or studied for its potential usefulness in forensics.
No one ever talked about the variability of forehead morphology among individuals or how can forehead and/or its impression
potentially be used for forensic individual identification.

Drs. Carruthers, Fagien, and Matarasso are executive editors of this supplement. This statement is sponsored by an unrestricted educational grant from Allergan, Inc., Irvine, Calif. The members of the Botox Consensus Group are listed in the Appendix at the end of this article. Off-Label Statement: It should be noted that the results reported in this article refer to the Allergan formulation of botulinum toxin type A (Botox, Botox Cosmetic, Vistabel) and cannot be generalized to other formulations or serotypes of botulinum toxin. Botulinum toxin type A is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adult patients less than or equal to 65 years of age. All other uses are considered off-label. The full prescribing information should be viewed prior to using any products discussed here.

A rotation flap can be defined as the transfer of tissue through an arc into an adjacent defect site. This type of local flap is particularly suited for triangular defects adjacent to transferable skin. Advantages include simplicity, excellent blood supply through a large pedicle, and minimal tissue redundancy. The ideal rotation flap should avoid distortion of adjacent anatomic landmarks and should rest under minimal tension. These goals are best accomplished by precise planning of the flap dimensions around the defect. Although many authors have recommended clinically useful guidelines of flap height relative to defect diameter, this study mathematically analyzes the ideal relationship.

Rectal temperature is recommended by the National Athletic Trainers' Association as the criterion standard for recognizing exertional heat stroke, but other body sites commonly are used to measure temperature. Few authors have assessed the validity of the thermometers that measure body temperature at these sites in athletic settings. To assess the validity of commonly used temperature devices at various body sites during outdoor exercise in the heat. Observational field study. Outdoor athletic facilities. Fifteen men and 10 women (age = 26.5 +/- 5.3 years, height = 174.3 +/- 11.1 cm, mass = 72.73 +/- 15.95 kg, body fat = 16.2 +/- 5.5%). We simultaneously tested inexpensive and expensive devices orally and in the axillary region, along with measures of aural, gastrointestinal, forehead, temporal, and rectal temperatures. Temporal temperature was measured according to the instruction manual and a modified method observed in medical tents at local road races. We also measured foreh...

The subperiosteal midface-lift has benefited from significant technological advances in medicine. The endoscope now allows extensive subperiosteal undermining of facial soft tissue through minimal access incisions. Improved understanding of facial anatomy and the facial aging process now allow repositioning and remodeling of the soft tissue envelope with excellent aesthetic results. The subperiosteal midface-lift by a temporal approach is a procedure designed to rejuvenate the middle third of the face. After subperiosteal detachment, the soft tissues of the cheek, jowls, lateral canthus, and inferior orbital rim can be lifted to reestablish their youthful relationship with the underlying skeleton. It is a technique that produces satisfactory cosmetic results in most cases, causing malar augmentation, nasolabial fold improvement, and mild jowl improvement. We describe our preferred technique in detail and discuss its indications, complications, advantages, and limitations.

Background Azzalure â (Galderma SA), a newly approved European botulinum neurotoxin type A (BoNT-A), is derived from Dysport TM (Ipsen Ltd.), which has a 20-year history of product consistency and has been widely used for various aesthetic and therapeutic applications. Azzalure â and Dysport TM are collectively referred to as BoNT-A (Speywood Unit) after the unit of their activity, and are distinct from other commercial BoNT-A preparations.

Problem creases of the face such as frontal lines and frown lines, crow's feet, deep nasolabial and perioral folds, and cervical bands may be caused by the aging process, excessive exposure to the sun, disease, or genetic disposition. The condition may become aggravated by habitual hyperkinesia of certain mimetic muscles like the frontalis, corrugators, orbicularis oculi, levatores labii superioris, zygomatici, and the platysma. The diagnosis is established clinically by electromyography and selective muscle and nerve blocks. In these cases we advocate regulation of the mimetic hyperkinesia through selective myotomy, myectomy, and neurotomy of the responsible mimetic muscles (mimetic modulation). These procedures may be performed exclusively or in combination with a blepharoplasty, rhytidectomy, or other procedure. Our experience with 60 patients over the past five years (medium = 3.5 years) is presented. Problems and complications such as paresthesia and hypesthesia, partial paresis and asymmetry, incomplete correction, and recurrences are discussed. We believe that mimetic modulation is a valuable concept in treating problem creases and thereby improves the results of the aesthetic surgery of the face.

To identify surface landmarks that can serve as reference points to the underlying musculature in the treatment of glabellar rhytids. Fifty cadaver hemibrows were dissected to assess the location, disposition, and relationships of the brow muscles, along with their variations at each of several consistent locations. Particular attention was paid to the corrugator supercilii, frontal belly of the frontalis, and procerus muscles. The information gained here may be applied to the pharmacological or surgical treatment of glabellar rhytids. Knowledge of the frequent location of the muscles involved, relative to easily identifiable surface landmarks, allows a more precise approach.

BACKGROUND Different formulations of botulinum toxin type A (BoNTA) may have different diffusion characteristics.OBJECTIVE The objective was to compare the diffusion characteristics of two formulations of BoNTA.MATERIALS AND METHODS A total of 20 patients with forehead hyperhidrosis received four injections of BoNTA in their forehead (one medial and lateral injection of one formulation randomly assigned to one forehead side, one medial and lateral injection of the other formulation to the other forehead side). Patients received 3 U/injection of BoNTA1 (BOTOX, Allergan, Inc.) and were randomly assigned to receive BoNTA2 (Dysport, Ipsen Ltd.) at a dose ratio of 1:2.5, 1:3, or 1:4. The area of anhidrosis was highlighted using iodine and starch and determined by software from standardized photography.RESULTS During the 6 months after treatment, the area of anhidrosis was larger with BoNTA2 in 93% (195/210) of medial-medial or lateral-lateral comparisons of the two products and at all dose ratios. The smaller area of anhidrosis with BoNTA1 did not compromise its efficacy in inhibiting contraction of frontalis muscle.CONCLUSION BoNTA2 has a greater area of diffusion in the forehead than BoNTA1, even with identical injection volumes. This may hinder accurate localization of clinical effect, thereby increasing the potential for adverse effects.

Background Frontal fibrosing alopecia is a distinctive form of scarring alopecia presenting with frontal and temporoparietal recession of the hairline. Its etiology remains unknown, and there are no universal treatment guidelines. We conducted a retrospective cohort study to define the clinical findings and treatment outcomes of 62 patients with frontal fibrosing alopecia, one of the largest cohorts to date. Methods Data analysis from case notes was performed on 62 patients with a diagnosis of frontal fibrosing alopecia seen from January 2004 to March 2012. Results Except for one male, all patients in this cohort were females (80% postmenopausal) and mostly Caucasians (81%). Age at onset was between 18 and 81 years. While 35% reported no symptoms, the majority (65%) had itching, pain, or burning sensations. All patients had frontal hairline recession, and 81% had complete or partial loss of eyebrows. Perifollicular erythema and perifollicular hyperkeratosis occurred in 73% and

Traditional methods of reconstruction of the hair-bearing scalp can provide incorrect directional hair growth and may require secondary procedures to complete. We present a case of reconstruction of the anterior hairline after tumour resection in an infant. Lessons learned from the case have led to a novel method for a single stage reconstruction of the anterior hairline using pedicled superficial artery flaps.

Various physiologic and biochemical shifts can follow meditation. Meditation has been implicated in impacting free radical activity. Ultraweak photon emission (UPE, biophoton emission) is a constituent of the metabolic processes in a living system. Spectral analysis showed the characteristics of radical reactions. Recording and analysing photon emission in 5 subjects before, during and after meditation. UPE in 5 subjects who meditated in sitting or supine positions was recorded in a darkroom utilising a photomultiplier designed for manipulation in three directions. Data indicated that UPE changes after meditation. In 1 subject with high pre-meditation values, UPE decreased during meditation and remained low in the postmeditation phase. In the other subjects, only a slight decrease in photon emission was found, but commonly a decrease was observed in the kurtosis and skewness values of the photon count distribution. A second set of data on photon emission from the hands before and af...

Forehead-brow rhytidoplasty has evolved from a procedure primarily advocated for brow ptosis, to one in which a group of deformities are routinely addressed. It has also become evident that the surgical results stem from wide undermining with release of the periosteum and the concomitant alteration of the forehead muscles and not necessarily from skin lifting using elevation/excision ratios. Therefore, with the introduction of endoscopically assisted techniques to plastic surgery, the indications for a long forehead incision and its untoward sequelae have to be reconsidered. The anatomic basis for minimally invasive forehead-brow rhytidoplasty and three types of procedures are discussed. These include Type 1---complete, endoscopically assisted forehead-brow rhytidoplasty; Type II--segmental, in conjunction with facelift surgery; and Type Ill--isolated, frownmuscle modification. The role of fixation (external support, internal suspension, or excision techniques) is described. Results suggest that these options provide a worthwhile alternative to traditional "open" techniques in certain circumstances, although some relevant questions remain unresolved.