Frown Lines Research Articles

Anatomical Injection Guidelines for Glabellar Frown Lines Based on Ultrasonographic Evaluation.

When botulinum neurotoxin (BoNT) is injected to treat glabellar frown lines, the corrugator supercilia muscle (CSM) and procerus muscles are the main targets. Although there have been many studies on the treatment of glabellar frown lines, no study has confirmed the dynamic movement under ultrasonography (US). This study examined and evaluated dynamic muscle movements under US, thereby providing more effective BoNT injection guidelines for glabellar frowning. Glabellar frowning was categorized as either Type A or B. Type A is the general frowning pattern in which vertical wrinkles are made by contracting the CSM and procerus muscles (81%, n = 13). On US images, the procerus muscle thickens and the bilateral CSMs contract. Type B is an upward frowning pattern demonstrating upward elevation of vertical wrinkles due to hyperactive contraction of the frontalis muscle during frowning (19%, n = 3). On US images, the hypoechoic frontalis muscle thickens, forming horizontal forehead lines. After BoNT injection into the CSM and frontalis muscle but not the procerus muscle, Type B patterns showed improvements in the vertical crease and horizontal forehead line. Both types showed improvement in glabellar frown lines after conventional injection, but the horizontal forehead line did not improve in Type B. Type B wrinkles improved after additional injections into the frontalis muscle. This study provided novel anatomical findings related to the injection of glabellar frown lines with BoNT. Preliminary analysis and optimized procedures using US will enable more effective and safer injections.

Overview of DaxibotulinumtoxinA for Injection: A Novel Formulation of Botulinum Toxin Type A.

Botulinum toxin type A (BoNTA) products are widely used for therapeutic and aesthetic indications, but there is a need for longer-lasting treatments that maintain symptom relief between injections and reduce the frequency of re-treatment. DaxibotulinumtoxinA for Injection (DAXI) is a novel BoNTA product containing highly purified 150-kDa core neurotoxin and is the first to be formulated with a proprietary stabilizing excipient peptide (RTP004) instead of human serum albumin. The positively charged RTP004 has been shown to enhance binding of the neurotoxin to neuronal surfaces, which may enhance the likelihood of neurotoxin internalization. DAXI produces robust, extended efficacy across both aesthetic and therapeutic indications. In an extensive glabellar lines clinical program, DAXI showed a high degree of efficacy, a consistent median time to loss of none or mild glabellar line severity of 24 weeks, and median time until return to baseline of up to 28 weeks. In adults with cervical dystonia, DAXI at 125 U and 250 U significantly improved Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total scores, with a median duration of efficacy of 24 and 20 weeks, respectively, which compares favorably with the 12–14 weeks’ duration reported for approved BoNTA products. Overall, DAXI was well tolerated, and the consistent extended duration of effect suggests that DAXI has the potential to improve the management of both aesthetic and therapeutic conditions.

IncobotulinumtoxinA Demonstrates Safety and Prolonged Duration of Effect in a Dose-Ranging Study for Glabellar Lines.

To further explore clinical trial results indicating increasing doses of botulinum toxin A prolong duration of effect, a 2-stage, phase 2, randomized, double-blind study investigated the duration of effect and safety of incobotulinumtoxinA (INCO; Xeomin®, Bocouture®) doses higher than the US Food and Drug Administration-approved 20 units (U) for glabellar frown lines (GFL). The stage 1 primary efficacy and safety results were reported previously. Here, we report the results of the final analysis (stage 1 and 2), including primary and secondary efficacy and safety endpoints. A total of 241 subjects with moderate-to-severe GFL were randomized to receive a single treatment with 20 (N=61), 50 (N=60), 75 (N=61), or 100U (N=59) INCO. The primary efficacy endpoint was duration of ≥ 1-point improvement from baseline assessed by investigator at maximum frown on the Facial Wrinkle Scale. The median duration of effect was 175 days for the 20U group (95% CI 142, 185), 185 days for the 50U group (95% CI 182, 205), 210 days for the 75U group (95% CI 182, 217), and 215 days for the 100U group (95% CI 183, 237). The incidence of treatment-related adverse events was low across all doses and there were no treatment-related serious adverse events. These results demonstrate that all INCO doses were well tolerated, consistent with the known safety profile of 20U, and increasing dose prolongs the duration of effect for GFL. J Drugs Dermatol. 2021;20(10):1052-1060. doi:10.36849/JDD.6377THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

Antidepressant-Like Properties of Intrastriatal Botulinum Neurotoxin-A Injection in a Unilateral 6-OHDA Rat Model of Parkinson's Disease.

Parkinson’s patients often suffer from depression and anxiety, for which there are no optimal treatments. Hemiparkinsonian (hemi-PD) rats were used to test whether intrastriatal Botulinum neurotoxin-A (BoNT-A) application could also have antidepressant-like properties in addition to the known improvement of motor performance. To quantify depression- and anxiety-like behavior, the forced swim test, tail suspension test, open field test, and elevated plus maze test were applied to hemi-PD rats injected with BoNT-A or vehicle. Furthermore, we correlated the results in the forced swim test, open field test, and elevated plus maze test with the rotational behavior induced by apomorphine and amphetamine. Hemi-PD rats did not show significant anxiety-like behavior as compared with Sham 6-OHDA- + Sham BoNT-A-injected as well as with non-injected rats. However, hemi-PD rats demonstrated increased depression-like behaviors compared with Sham- or non-injected rats; this was seen by increased struggling frequency and increased immobility frequency. Hemi-PD rats intrastriatally injected with BoNT-A exhibited reduced depression-like behavior compared with the respective vehicle-receiving hemi-PD animals. The significant effects of intrastriatally applied BoNT-A seen in the forced swim test are reminiscent of those found after various antidepressant drug therapies. Our data correspond with the efficacy of BoNT-A treatment of glabellar frown lines in treating patients with major depression and suggest that also intrastriatal injected BoNT-A may have some antidepressant-like effect on hemi-PD.

Botulinum Toxin Type A for Glabellar Frown Lines: What Impact of Higher Doses on Outcomes?

Botulinum toxin serotype-A (BoNT-A) preparations are widely used to improve the appearance of wrinkles. While effective and well tolerated, patients require retreatment over time to re-establish the effects. There is growing interest from patients as to whether higher doses can prolong response without significantly increasing side effects. We reviewed the efficacy and safety evidence for high-dose BoNT-A treatment of glabellar lines, by evaluating high-dose studies published since 2015. Toxins approved for glabellar line treatment in the US or Europe were considered. “High-dose” indicated doses above the licensed dose for each BoNT-A preparation. Five studies met the inclusion criteria and most were randomized, double-blind trials; designs and population sizes varied. Findings suggested that higher-dose BoNT-A treatment is feasible and may improve response duration without increased safety issues. Around 9 months’ median duration was achieved with a 2–2.5-fold increase of the abobotulinumtoxinA on-label dose, or with a 5-fold increase in incobotulinumtoxinA dose. A 2–4-fold increase of the onabotulinumtoxinA on-label dose yielded a median duration of around 6 months. Importantly, patient satisfaction and natural look remained with increasing abobotulinumtoxinA doses. While more data are needed, these findings may lead to more effective, individually tailored treatment plans to meet patient expectations.

Room without Room

Room without Room

Where and how to use botulinum toxin on the face and neck – Indications and techniques

Botulinum toxin (BT) is a proteinaceous substance that is derived from the bacterium Clostridium botulinum. It was initially used for the treatment of strabismus by Dr. Alan Scott in the late 1970s after which, it was regularly being used for the cosmetic correction of benign essential blepharospasm by the Carruthers couple. Jean Carruthers while treating one such patient noticed an improvement in the glabellar furrows with an effect on the brow of the patient as well. By the late 1980s through the 1990s, BT was used rampantly as an off-label indication to treat glabellar frown lines. In 2002, the US Food and Drug Administration approved the use of BT type A for the treatment of glabellar furrows. This changed the global scene of facial rejuvenation, heralding a new era. Ever since then, BT has proved to be effective and safe for the treatment of dynamic facial rhytides and is currently being used for various indications. These indications and techniques have evolved with a better understanding of the face and neck musculature and their interactions and actions as well as efficacy of the BT formulations. The authors present an overview of the various cosmetic indications of BT for the face and neck along with the approach to injection techniques for various muscle groups involved.

Respecting upper facial anatomy for treating the glabella with neuromodulators to avoid medial brow ptosis-A refined 3-point injection technique.

Current injection algorithms for treating the glabella rely on a five- or seven-point injection technique with possible medial eyebrow ptosis and lateral eyebrow elevation as undesirable outcomes. The objective of this study was to investigate the efficacy and safety profile of a refined 3-point injection technique targeting horizontal and vertical glabellar lines. A total of n=105 patients (27 males and 78 females) with a mean age of 40.90±9.2years were investigated. The injection technique relied on targeting the muscular origin of the procerus and the corrugator supercilii muscles exclusively. The time of effect onset and the injection-related outcome 120days after the treatment was evaluated using the 5-point glabellar line severity scale. The onset of the neuromodulator effect was on average 3.5±1.5days. There was no statistically significant difference in the amplitude of movement before or 14days after the treatment with 2.99±4.4mm vs. 3.39±3.6mm (p=0.149) for the medial head of the eyebrow and with 3.18±4.7mm vs. 3.33±4.3mm (p=0.510) for the lateral head of the eyebrow, respectively. Incorporating anatomic concepts into clinical practice for glabellar frown line neuromodulator treatments with the investigated 3-point injection technique resulted in the absence of adverse events like eyebrow ptosis, upper eyelid ptosis, medial eyebrow ptosis, and lateral frontalis hyperactivity. This technique demonstrated efficacy throughout the 4-month study period.

Onabotulinumtoxin Type A Dosage for Upper Face Expression Lines in Males: A Systematic Review of Current Recommendations.

Botulinum toxin injection is the most commonly performed minimally invasive aesthetic procedure in men. Despite various recommendations by experts on the use of onabotulinumtoxin type A in the literature, distinct guidelines for its use in males and females do not exist. The aim of this study was to delineate safe and effective doses for the use of onabotulinumtoxin type A in males for correction of upper facial expression lines. PubMed (MEDLINE), Embase, the Cochrane database, and Google Scholar were searched from 2002 to 2019 inclusive. Three researchers independently assessed trials for inclusion, extracted data, checked for accuracy, and assessed the evidence with AGREE II. Average dosing recommended for the treatment of upper face expression lines was specific to glabellar frown lines, crow's feet, and horizontal forehead lines. Changing trends and gender variation was noted in each of the studies. Six of the 11 recommendations suggest the need to alter dosing in male patients, although do not give separate recommendations. There is an urgent need for up-to-date recommendations for the use of onabotulinumtoxin type A in upper face expression lines of male patients.

Remembering in the Second Shift

Remembering in the Second Shift

IncobotulinumtoxinA demonstrates safety and prolonged duration of effect in a dose-ranging study for glabellar lines

Background To further explore clinical trial results indicating increasing doses of botulinum toxin A prolong duration of effect, a 2-stage, phase 2, randomized, double-blind study investigated the duration of effect and safety of incobotulinumtoxinA (INCO; Xeominr, Bocouturer) doses higher than the US Food and Drug Administration-approved 20 units (U) for glabellar frown lines (GFL). The stage 1 primary efficacy and safety results were reported previously. Here, we report the results of the final analysis (stage 1 and 2), including primary and secondary efficacy and safety endpoints. Methods A total of 241 subjects with moderate-to-severe GFL were randomized to receive a single treatment with 20 (N=61), 50 (N=60), 75 (N=61), or 100U (N=59) INCO. The primary efficacy endpoint was duration of g 1-point improvement from baseline assessed by investigator at maximum frown on the Facial Wrinkle Scale. Results The median duration of effect was 175 days for the 20U group (95% CI 142, 185), 185 days for the 50U group (95% CI 182, 205), 210 days for the 75U group (95% CI 182, 217), and 215 days for the 100U group (95% CI 183, 237). The incidence of treatment-related adverse events was low across all doses and there were no treatment-related serious adverse events. Conclusions These results demonstrate that all INCO doses were well tolerated, consistent with the known safety profile of 20U, and increasing dose prolongs the duration of effect for GFL. J Drugs Dermatol. 2021;20(10):1052-1060. doi:10.36849/JDD.6377THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

Facial Expression Wrinkles and Their Relaxation by a Synthetic Peptide

Expression wrinkles form over time due to repeated facial movements such as smiling and frowning. They have an imprint on facial skin in areas such as the corner of the eyes, where they take the form of crow’s feet, the forehead and the glabella, where they appear as frown lines, and around the mouth, as marionette lines. In the study presented here, we recruited two sets of volunteers. An older group of 57 volunteers aged 50 to 65 years, and a group of eight younger volunteers aged 21–35 who were the biological daughters of eight of the older volunteers. Using VISIA CR, we took images of the volunteers in relaxed, angry and smiling mode to assess similarities in expression wrinkle patterns. In addition, the older volunteers were split into a placebo group and an active group who applied a formulation of 4% of a cosmetic product containing the peptide diaminobutyroyl benzylamide diacetate (DABBA) for four weeks. Wrinkles were assessed by image analysis, expert grading and Primoslite measurements. Our study found striking similarities in the facial wrinkle patterns of mothers with relaxed faces and daughters with angry or smiling faces. We found a decrease in visible wrinkles in the group of older volunteers applying DABBA. We created a facial map for graded wrinkles showing these changes. Volunteers using the active formulation showed significantly less wrinkle area and length on the forehead when frowning compared to the placebo group (p < 0.05).

Small Needle Knife-Assisted Aluronic Acid Combined with Botulinum Toxin Injection in the Treatment of Glabellar Frown Line

Small Needle Knife-Assisted Aluronic Acid Combined with Botulinum Toxin Injection in the Treatment of Glabellar Frown Line

Safety, Tolerability, and Efficacy of Repeat-Dose Injections of IncobotulinumtoxinA in the Treatment of Upper Facial Lines: Results from a Prospective, Open-Label, Phase III Study

In aesthetic practice, wrinkles in the upper face are commonly treated with repeat-dose injections. The objective of this study was to investigate the safety, tolerability, and efficacy of repeat-dose injections of incobotulinumtoxinA in the combined treatment of moder-ate to severe upper facial lines (UFL) [glabellar frown lines (GFL), horizontal forehead lines (HFL), and lateral periorbital lines (LPL)]. Healthy subjects (&ge;18 years) with moderate to severe GFL, HFL, and LPL on the Merz Aesthetics Scales (MAS) at maximum contrac-tion were administered 54 to 64 U of incobotulinumtoxinA (GFL, 20 U; HFL, 10 to 20 U; LPL, 24 U) in up to four, 120-day treatment cycles. Adverse events (AE) were recorded for each cycle until 120 &plusmn; 7 days after treatment. Investigator-assessed MAS scores were evaluated for each treated area at maximum contraction on day 30 [responder = score of &ldquo;none&rdquo; (0) or &ldquo;mild&rdquo; (1)]. Subject-assessed scores for overall appearance of the upper face of &ldquo;much improved&rdquo; or &ldquo;very much improved&rdquo; were noted at day 30 of each treatment cycle on the Global Impression of Change Scale (GICS). Overall, 140 subjects were treated, and 125 subjects completed the study. Mean injected units per injection cycle ranged from 56.3 U to 57.7 U. During the four-cycle study period 17.1% of total treated subjects experienced a treatment emergent adverse event (TEAE). TEAEs of special interest were documented for 9 subjects (6.4%), in 6 of these subjects (4.3%) the TEAEs were related to treatment. No clinically significant mean changes in laboratory and vital-sign values were observed from screening to final-treatment visit. Over the study interval, a response rate of &gt; 80% on the investigator-assessed MAS was reported for all treated areas except HFL. Greater than 80% of subjects in cycles 1, 3, and 4 and 78.5% of subjects in cycle 2 reported ratings of &ldquo;much improved&rdquo; or &ldquo;very much improved&rdquo; on the GICS for the overall appearance of the upper face. Incobotu-linumtoxinA for the repeat-dose treatment of UFL is safe and well tolerated with a stable safety profile, without new formation of neutralizing antibodies and has excellent efficacy during prolonged administration. J Drugs Dermatol. 2020;19(5):461-469. doi:10.36849/JDD.2020.5013.

A Phase I/II Randomized, Double Blind, Active-controlled, Single Center Clinical Trial for Evaluation of Safety and Efficacy of ATGC-110, An Intramuscularly Administered Clostridium Botulinum Neurotoxin Type A, in Adult Patients With Moderate to Severe Glabellar Frown Lines

A Phase I/II Randomized, Double Blind, Active-controlled, Single Center Clinical Trial for Evaluation of Safety and Efficacy of ATGC-110, An Intramuscularly Administered Clostridium Botulinum Neurotoxin Type A, in Adult Patients With Moderate to Severe Glabellar Frown Lines

A Randomized, Controlled Study Comparing Subbrow Blepharoplasty and Subbrow Blepharoplasty Combined with Periorbital Muscle Manipulation for Periorbital Aging Rejuvenation in Asians.

Improving periorbital aging is, currently, of great concern. The previous literature has reported some surgical methods for periorbital aging. The purpose of this study was to compare subbrow blepharoplasty (SBB) with subbrow blepharoplasty combined with periorbital muscle manipulation (SBB-pm) with regard to improving periorbital aging. A prospective, randomized, controlled study was designed to evaluate and compare the effects of two different surgical techniques on upper lid relaxation, brow shape and periorbital wrinkles. Patients were divided into two groups. Group 1 underwent resection of excess skin; group 2 underwent a modified technique that involved resection of an elliptical island of skin, separation of the corrugator supercilii muscle and dissection of the orbicularis oculi muscle, followed by suturing it to the orbital periosteum and cross-fixation with itself. The upper eyelid and eyebrow height, periorbital wrinkle score and patient satisfaction were measured preoperatively and postoperatively. This study included 70 patients (140 eyes). At 1month, 3months, 6months and 12months after surgery, group 2 was superior to group 1 with regard to the improvement in upper eyelid relaxation at the medial limbus, middle pupil and lateral canthus. The eyebrow assumed a low and flat appearance in group 1. The eyebrow showed a low and flat appearance and then returned to the preoperative level in group 2. When comparing the two surgical techniques, the authors found statistically significant differences in regard to changes in crow's feet and glabellar frown lines. Two patients in group 2 experienced forehead numbness after surgery, which resolved by the 6-month follow-up. Patients in group 2 were significantly more satisfied with their surgery than patients in group 1. SBB-pm is more effective than SBB for improving upper eyelid relaxation and preventing secondary brow ptosis after surgery as well as for alleviating periorbital wrinkles, although it is accompanied by transient forehead numbness. 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.

Year One

Year One Robert Yune (bio) Mendeleev made another set of predictions that were even more dramatic. His periodic table contained a number of blank spaces. Mendeleev declared that these blank spaces must correspond to elements as yet undiscovered. —Gregory N. Derry, "Nature's Jigsaw" He is six years old, watching his grandfather read the newspaper. This is their summer routine: Jason in Batman pajamas, grandfather in a wool suit, even in August. The oscillating fan, seemingly straining through the thick air, turns to sputter another weak breeze. Jason's grandfather is a retired geology professor. As always, he has efficiently gathered his morning together: a coffee mug sits near his right hand like a loyal pet, and his breakfast—a perfect rectangle of shredded wheat—sits centered in its bowl, soaking up milk. Laid atop the bowl, the newspaper soaks up the old man's attention. This means Jason can watch without being seen. He's drawn to the way his only grandfather purposefully strides through the world. Somehow, his stocky frame, frown lines, and wispy white hair draws smiles from women: waitresses, nurses, joggers in the park, Jason's mother and grandmother. There's something unusually expressive about the man's face as he lays the paper beside his bowl and begins the crossword. During this silent duel of wits, his white eyebrows dance a symphony of bewilderment, fury, and begrudging praise. "Pattern recognition," he occasionally mutters, and Jason nods solemnly. The old man's efficiency extends to language. When Jason shows off his athletic skills in the backyard, his grandfather exclaims the same word. Ball rolled through your legs? "Finesse!" Frisbee sailed onto the roof? "Finesse!" To date, repeating the word has yielded minimal effect. To date, Jason has not thought to ask what the word means. Soon, though, when Jason decides to listen, he'll understand finesse before he can define it: by then, the repetition will be bolstered by the old man's examples, pantomimes, metaphors. Decades from now, Jason will realize his grandfather was one of few adults who held the full memory of their childhoods—not just the events, but how it felt to be that young. The smallness, the fear rising up through the wonder. That's why the man lets his grandson watch him, uses the newspaper as a window and not a curtain. To six-year-old Jason perched at the edge of a stool in the sweltering kitchen, the news is upside down—or at least the headlines are. The articles themselves are too distant to read. Even if he understood each word, the outside world would remain huge and terrifying. But knowing his grandfather can track the grand design of things—that's why the boy watches so carefully. The knowledge just might rub off. Call it wisdom through osmosis. Later that evening, Jason seizes the newspaper and tackles the word search. His grandfather helps. "Pattern recognition," he mutters in approval when the boy circles a new word. For Christmas, Jason [End Page 92] receives a telescope and his grandfather teaches him the names of constellations. Jason's dad promises a visit to the planetarium, but they never go. _____ He is seventeen years old and finds himself stranded on a strange island called college. His peers seem excited to be here—in this city, on campus, in this freshman orientation. Nobody seems interested in comic books. Nobody mentions Firestorm. Surely, Jason thinks, someone leading an orientation at Columbia tells the freshmen that Spider-Man took classes there. That seems like a legitimate brag. What would his peers at the University of Pittsburgh think if they knew that one of the most powerful superheroes in the DC universe is enrolled here? At least in the comics. Firestorm's costume is a bright yellow tunic emblazoned with an exploding atom. His hair is flames, as are his fists. In real life, the closest thing to a superhero is the version of Jason that appears in his college application essay. That Jason is impeccable, an alchemist who turned guidance counselors into cheerleaders. Jason—the real one slumped in the back of the classroom—can't shake the feeling that any moment...

Minimally Invasive Corrugator Resection and Backfill Using Self-made Modified Liposuction Needle in the Treatment of Moderate and Severe Glabellar Frown Lines

Objective To exploring a new minimally invasive method for the removal of moderate and severe glabellar frown lines. Method The corrugator supercilii muscles were subjected to blunt cutting and vacuum suction by using a self-made modified liposuction needle,and the obtained muscle particles were backfilled subcutaneously into the depression area between eyebrows to expand the wrinkles. Results Seventeen cases were followed up for six to twelve months after the operation.The glabellar wrinkles disappeared or became flatter in all patients. Conclusion The minimally invasive corrugator resection and backfill by using self-made modified liposuction needle can effectively remove the glabellar frown lines without forming scar.

Three-Dimensional Territory and Depth of the Corrugator Supercilii: Application to Botulinum Neurotoxin Injection.

This study aimed to determine the three-dimensional (3D) territory and depth of the corrugator supercilii muscle (CSM) using a 3D structured-light scanner. Thirty-two hemifaces from Korean and Thai embalmed cadavers were used in this study, and 35 healthy young Korean subjects also participated. A 3D analysis of the CSM territory and depth was performed using a structured-light 3D scanner. The most frequently observed locations of the CSM identified in the cadaver were confirmed in healthy young subjects using a real-time two-dimensional B-mode ultrasonography system. The CSM was present in all of the cadavers and healthy young subjects at the intersection point between the vertical line passing through the medial canthus and the horizontal line passing through the glabella (Point #6). The CSM was located on the medial side of the lateral limbus in most cases. The most-medial and most-lateral origin points were at depths of 5.7 ± 1.4 mm (mean ± SD) and 6.6 ± 1.4 mm, respectively; the corresponding depths of the insertion points were 5.4 ± 1.4 mm and 5.6 ± 2.1 mm, respectively. The origin and insertion points of the CSM were at similar depths. The injection depth should be around 4 mm for botulinum neurotoxin (BoNT) injections into the CSM. Point #6 could be regarded as an effective target point for managing the glabellar frown line and preventing palpebral ptosis when injecting BoNT into the CSM. Clin. Anat., 33:795-803, 2020. © 2019 Wiley Periodicals, Inc.

A study of skin characteristics with long-term sleep restriction in Korean women in their 40s.

Previous studies have demonstrated increased pore size and darkening skin color with total sleep deprivation. There are many studies of skin characteristics with short-term sleep restriction, but there are few studies on skin characteristics when sleep is restricted more than three consecutive days. This study evaluated skin changes with sleep limited to 4hours per night for six nights. The study included 32 Korean women in their 40s. Skin hydration, desquamation, barrier recovery, texture, gloss, transparency, elasticity, crow's feet, frown lines, and color were measured. Individual sleep time was monitored by smartwatches. Subjects slept 8hours per night for six nights in week one and 4hours per night for six nights in week two. Skin hydration was significantly reduced after 1day of sleep deprivation, and it continued to decrease. Skin gloss, desquamation, transparency, elasticity, and wrinkles were significantly aggravated after 1day of sleep deprivation. Skin texture was significantly aggravated on the fourth day of sleep restriction. Elasticity was most affected by reduced sleep, with a standardized coefficient of -.320, indicating a significant decrease over time as compared to other characteristics. Skin hydration was gradually decreased with sleep restriction. Skin texture did not change after only 1day of sleep restriction. It is a new finding that elasticity decreases more than other skin characteristics with prolonged sleep restriction.