Aesthetic Treatment Research Articles

Medicolegal aspects of medical malpractice claims following aesthetic interventions in Cairo, Egypt

BackgroundMedical malpractice presents a significant challenge to the healthcare system in Egypt and other countries, inflicting both physical and psychological harm on patients. Furthermore, it imposes a financial burden on both patients and physicians. This study aimed to analyze the medicolegal aspects of malpractice claims associated with aesthetic interventions. The study also aims to establish explicit criteria for identifying and differentiating positive cases from negative ones. This study is a retrospective descriptive observational analysis of medical malpractice claims related to aesthetic interventions. The data was obtained from the records of the Cairo Medicolegal Area between 2016 and 2020, encompassing a total of 98 cases in the study.ResultsThe majority of cases were females (89.8%). The age group most significantly affected was between 26 to 35 years old. Plastic surgery accounted for the highest percentage (51%) of alleged cases among medical specialties. Consultants were the most frequently accused physicians (32.7%). Liposuction was the most frequent procedure (31.6%). Most of the malpractices occurred in private hospitals (45.9%). The outcome indicated that permanent infirmity accounted for 10.2%, while mortality constituted 3.1%.ConclusionsThe current study demonstrated that women constitute the predominant demographic in the examined malpractice cases, with plastic surgery being the most common area for alleged claims. The main complaints include disfigurement, dissatisfaction with results, and burn injuries. Aesthetic malpractice is more frequent in private hospitals than in general hospitals, frequently necessitating further treatment due to complications.

Anatomy, Etiology, Management, and Medico-Legal Implications of Botulinum-induced Blepharoptosis.

Botulinum toxin injections, a popular aesthetic treatment, have over 7.4 million beneficiaries in the U.S. Despite their safety record, these injections pose potential complications. It is essential for aesthetic practitioners to manage these complications with the least impact on the patient. Upper eyelid ptosis, though rare, is a significant side effect of botulinum toxin injections. Through our study, we have identified the etiology, anatomy, and therapeutic management of botulinum- induced blepharoptosis. Hence, the goal of this study was to identify the basic aetiology of blepharoptosis and manage this complication, as well as discuss the basis of medico-legal implications involving this popular drug. The complex medico-legal implications of botulinum toxin-induced blepharoptosis call for continuous discourse, education, and clarity on drug-use legal standards. With evolving global and Italian legislation, practitioners must ensure they meet care standards, weighing treatment benefits against potential legal and ethical outcomes. Blepharoptosis is a rare but significant complication of botulinum-type injections. Etiology and thorough anatomy are crucial for avoiding this complication and handling it with the least impact on the patient. Medico-legal implications are currently not fully established, but the basis of aesthetic treatment standards, as well as continuing medical education, will ensure correct medico-legal coverage of such complications.

Knowledge and Perceptions of Dermatological Aesthetic Treatments Among Saudi Adults: A Cross-Sectional Study

Knowledge and Perceptions of Dermatological Aesthetic Treatments Among Saudi Adults: A Cross-Sectional Study

Stimulating children's agency and positioning as subjects through aesthetic experiences in early years classrooms

This qualitative case study investigates how a series of aesthetic interventions on philosophically complex themes, such as death and fear as life experiences, offered to first graders at a multicultural urban school in Norway, stimulate their agency and positioning as subjects. Drawing on video-recorded observations and artefacts produced by the children during the project, we show that their responses were enacted in multiple ways. This included nonverbal mirroring of the adults’ actions with and without further interactional extensions but also responses beyond mirroring where the children drew on multiple semiotic resources such as dialogue, writing, drawn images, and the body, to share their experiences with others. We argue that the interventions can be seen as platforms for both individual and communal enactments of the children's agency through joint, multimodal explorations of complex concepts and what it means for the children to be subject in the world.

Global Registry of Adverse Clinical Events (GRACE©): A Prospective, Multicenter, Observational Cohort Evaluating Complications Associated with Aesthetic Injectables.

A review of Health Canada's post-market surveillance database has revealed that the reporting of adverse events (AEs) following aesthetic injectable treatments is significantly underreported. To increase reporting, investigators have recently developed a novel Electronic Data Capture system: The Global Registry of Adverse Clinical Events (GRACE©). To identify the incidence of AEs associated with aesthetic injectable treatments. Aesthetic clinicians from 10 Canadian sites were recruited. Demographic and clinical data were recorded within the database, which included over 45 patient variables. Throughout the active phase of the trial (duration: 27 months), 123,124 injectable treatments were conducted. One hundred and eleven patients, experiencing a total of 235 AEs, were entered into the portal. This equated to an AE incidence rate of 0.19%, per treatment. Thirty unique products were associated with AEs. In total, there were 112/235 (47.66%) mild, 88/235 (37.45%) moderate, and 35/235 (14.90%) severe AEs. The most common complication (n = 48/235; 20.43%) was swelling, with a prevalence of 0.04%. Of the documented AEs, only 5 were reported to other sources, including 1 case being reported to Health Canada and 4 cases to the respective product manufacturer. The initial feasibility of a registry assessing safety outcomes following injectable treatment has been demonstrated. Findings support that the implementation of the GRACE Portal is an effective outreach strategy for increasing AE reporting by health care professionals. The data represent a more accurate depiction of the safety profile of approved aesthetic injectables in Canada.

Deep learning-based detection of incisal translucency patterns.

The evaluation of incisal translucency in anterior teeth greatly influences esthetic treatment outcomes. This evaluation is mostly subjective and often overlooked among dental professionals. The application of artificial intelligence-based models to detect the incisal translucency of anterior teeth may be of value to dentists in their restorative dental practice, but studies are lacking. The purpose of this study was to assess the accuracy of deep learning models in predicting the translucency patterns of anterior teeth. Approximately 240 Joint Photographic Experts Group (JPEG) images of anterior teeth from participants over 18 years were collected using a smartphone. These images were resized to 224×224 pixels and classified by the presence or absence of translucency. Augmentation techniques enhanced the training dataset, and a 3-model deep learning approach was used: YOLOv5 detected central incisors, Vision Transformers (ViT) identified translucency, and U-Net segmented the translucent areas. The images were split 80 to 20 for training and testing, with performance evaluated using accuracy, precision, recall, F1 score, confusion matrix, and dice scores. YOLOv5 achieved a precision of 1.00 at a confidence threshold of 0.910. The ViT system showed an accuracy of 91.66%, with 58 of 64 images predicting correctly with an F1 score of 94.83%. U-Net segmentation after training with annotated images achieved an accuracy of 91% with a dice score of 0.948. The integration of YOLOv5 for detection, ViT for classification, and U-Net for segmentation demonstrates a comprehensive approach to addressing the classification of incisal translucencies. By leveraging the strengths of deep learning models, high accuracy and precision can be achieved in detecting the incisal translucency patterns of anterior teeth.

Periocular Aging Across Populations and Esthetic Considerations: A Narrative Review.

As the face ages, the skin, fat, muscle, and fascia descend, and the underlying bone, cartilage, and teeth may lose mass. Oculofacial aging is a multifactorial process that is influenced by genetic, environmental, and lifestyle factors. This review summarizes the patterns of oculofacial aging that are observed across populations, including variations in periorbital hollowing, eyelid ptosis, and skin elasticity. Evidence indicates significant variability in aging patterns between sex- and race-based subgroups. Nonetheless, there remains a paucity of research on the progression of aging in some under-studied demographic groups. Signs of oculofacial aging often become apparent to patients well before these changes reach full maturity in later years, leading many to seek early esthetic interventions. Others may present with more advanced signs of aging, motivating a diverse range of therapeutic options. We discuss minimally invasive esthetic interventions to mitigate the signs of aging, which may include botulinum toxin injections, dermal fillers, applied energy-based treatments (e.g., lasers), and emerging techniques such as micro-focused ultrasound and platelet-rich plasma therapies. We review evidence on outcomes related to patient satisfaction and quality of life following esthetic interventions for oculofacial aging. Finally, we outline ethical considerations and challenges faced with the delivery of esthetic surgery, including treatment complications and the influence of social media. This review provides a comprehensive overview of oculofacial aging patterns, its management, and important considerations for the provision of esthetic oculofacial treatment.

Development of a Preoperative Psychological Screening Tool: Piloting the Cosmetic Readiness Questionnaire (Pilot-CRQ).

Patients with psychological risk factors such as body dysmorphic disorder (BDD) and unmanaged mental health concerns are considered at higher risk for dissatisfaction with aesthetic procedures. Identifying these risks before a procedure may decrease the chance of adverse outcomes for patients and practitioners. In this study we aimed to develop a comprehensive psychological screening tool to assess patient's psychological suitability for surgical and nonsurgical aesthetic procedures. Items for the Pilot Cosmetic Readiness Questionnaire (CRQ) were developed by psychologists (n = 3) and then reviewed by plastic surgeons (n = 2) and nonsurgical cosmetic doctors (n = 3). Patient interviews (n = 15) and piloting of the questionnaire (n = 69) provided data regarding the scale's initial psychometric properties. Results supported the reliability and validity of the Pilot-CRQ's subscales of Body Dysmorphia, Psychological Distress, Self-Criticism, Perfectionism, and Lack of Openness. Lack of Openness was a validity scale that examined the degree that respondents might be underreporting symptoms. The CRQ predicted individuals with a BDD diagnosis, as rated by a blinded expert clinical psychologist, with high sensitivity and specificity. These results provide support for the Pilot-CRQ identifying people with BDD and psychological factors related to aesthetic treatment outcomes and provide a strong basis for employing the CRQ in clinical contexts and in future research.

Canada HARMONY Study: Improvements in Patient Satisfaction With Facial Appearance and Psychological Impact of Combined Aesthetic Treatment

Abstract Background Panfacial treatment has the potential to positively impact psychosocial and emotional well-being. Objectives The Canada HARMONY study evaluated the satisfaction and psychosocial impact of comprehensive, multimodal aesthetic treatment of the face and submental area from the patient perspective. Methods Over 12 months, all patients (N=58) sequentially received treatment with hyaluronic acid (HA) fillers, onabotulinumtoxinA, and medical-grade skincare products, and eligible patients (n=13) also received ATX-101. The primary endpoint was the change from baseline on the FACE-Q Satisfaction with Facial Appearance Scale. Secondary endpoints included the following assessments: FACE-Q Expectations of Life Change, Psychological Function, Social Function, Satisfaction with Skin, and Aging Appraisal Scales; Global Aesthetic Improvement Scale (GAIS); and the Periorbital Aesthetic Appearance Questionnaire (PAAQ). Safety was monitored throughout the study. Results Baseline FACE-Q Expectations of Life Change scores indicated realistic treatment expectations. Significant improvements from baseline were observed on the FACE-Q Satisfaction with Facial Appearance, Psychological Function, Social Function, Satisfaction with Skin, and Aging Appraisal Scales (P < 0.0001 for all endpoints). Most patients rated “Much Improved” on the GAIS. The mean PAAQ total score significantly improved from baseline by 32.6 (P < 0.0001). Most patients reported mild to moderate injection site responses, which had a mean time to resolution of <14 days. Conclusions Panfacial aesthetic treatment consisting of HA fillers, onabotulinumtoxinA, and ATX-101 improved patient-reported satisfaction, psychological function, social function, and aging appraisal across validated measures.

Treatment of Facial Ageing with Ozone Therapy: Clinical Case Report

INTRODUCTION: Ozone therapy has been used as an effective alternative for aesthetic treatments and facial aging, as it induces changes in facial cells, stimulates collagen synthesis, activates peripheral circulation and microcirculation, and slows down the processes of oxidation and skin aging. OBJECTIVES: This study aims to evaluate the effects of ozone therapy in treating facial aging through a clinical case report. CASE DESCRIPTION: A case report on the treatment of facial aging with ozone therapy is presented. Six clinical sessions were conducted, with seven-day intervals between them, applying one ml of medical ozone to each demarcated area. The ozone concentration increased over time, starting at five mcg/mL and reaching 12 mcg/mL. RESULTS: The six-session ozone therapy protocol showed promising results in treating facial aging by reducing expression lines and stimulating collagen synthesis. CONCLUSION: Ozone therapy is an effective alternative for the biostimulation of collagen and other mechanisms that improve facial tissue aesthetics, helping to restore the appearance of aging skin.

Establishing Convergent Validity of the Face-Q Aesthetics Module Scales.

FACE-Q Aesthetics scales assess patient-important outcomes following both surgical/nonsurgical facial cosmetic interventions. Convergent validity is the degree to which the scores of one measurement relate to another measuring a similar construct. This study aims to establish the convergent validity of 11 FACE-Q Aesthetics appearance scales using the MERZ Aesthetics scales. Data were collected from an online international sample of participants aged ≥20 years, who presented to a dermatologist or plastic surgeon within the last 12 months for a minimally invasive facial aesthetic treatment. Participants provided demographic and clinical data and completed 11 FACE-Q Aesthetics scales and 12 MERZ Aesthetics scales. Hypotheses regarding the strength of correlations between scales were generated a priori. Adequate convergent validity was based on percentage of correct hypotheses (>75%) and/or correlation ≥0.50 with an instrument measuring a similar construct. 1259 participants were included in this survey. Participants were on average 42.6 (±11.9) years old, and mostly female (72.5%), Caucasian (76.9%), and living in the United States (49.9%) or the United Kingdom (42.9%). FACE-Q Lines Overall, Lower Face and Jawline, Appraisal of Lines - Forehead/Between Eyebrows/Crow's Feet/Lips/Nasolabial Folds/Marionette, and Lips scales demonstrated adequate convergent validity with patient reported MERZ Aesthetics scales. The FACE-Q Face Overall and Cheeks scales did not show adequate convergent validity. This study provides evidence of convergent validity for FACE-Q Aesthetics appearance scales. Establishing validity of these scales remains an iterative process and further studies comparing the FACE-Q to other related measurement tools are required to strengthen this evidence.

Advancements in Minimally Invasive Techniques in Pediatric Dentistry: A Review.

Minimally invasive dentistry (MID) has revolutionized pediatric dental care by emphasizing the preservation of healthy tooth structures, reducing treatment-related trauma, and improving patient compliance. This narrative review explores advancements in MID techniques, including silver diamine fluoride (SDF), resin infiltration, atraumatic restorative treatment (ART), bioactive materials, laser-assisted therapies, and three-dimensional (3D) printing technologies. These approaches prioritize early diagnosis, prevention, and conservative management, aligning with patient-centered and sustainable practices. SDF demonstrates high efficacy in arresting caries progression but presents esthetic challenges due to discoloration. Resin infiltration provides esthetic and noninvasive treatment for white spot lesions, while ART offers cost-effective and child-friendly caries management in resource-limited settings. Bioactive materials support tissue regeneration, and laser technologies enable precise and painless procedures, although their adoption is limited by high costs and training requirements. Emerging tools, such as artificial intelligence and 3D printing, enhance diagnostic accuracy and treatment precision. Despite challenges related to cost, operator training, and infrastructure, MID techniques continue to evolve, offering promising solutions for pediatric dental care. Future research should focus on optimizing materials, improving accessibility, and integrating digital technologies to broaden the impact of minimally invasive approaches. This review highlights MID's transformative role in improving oral health outcomes and ensuring sustainable, patient-focused care for children.

The use of Emerald Laser™ for whole body fat loss, improved cellular health and wellness

This case study explores the use of the Emerald Laser™ for whole-body fat loss, enhanced cellular health, and improved wellness. Aesthetic practices are shifting toward a more holistic approach that integrates aesthetics with wellness, addressing not just appearance but overall health. The study highlights the increasing demand for non-invasive fat loss treatments like low-level laser therapy (LLLT), which provides a safer alternative to traditional methods like surgery or weight loss drugs. The Emerald Laser™ targets fat cells, shrinking them without side effects, while promoting mitochondrial health and cellular regeneration. The case study of a 43-year-old woman demonstrates significant fat loss and improved wellbeing, illustrating the potential for this treatment to enhance both physical appearance and overall health, particularly by reducing inflammation and slowing premature aging. This fusion of aesthetic and wellness treatments reflects a broader trend towards preventative care and holistic health in medical practices.

Lynton: the coolest way to CO2

The Tetra Pro CO2 laser, powered by DEKA's globally evidenced SmartXide technology with over 200-peer reviewed papers, is revolutionising aesthetic and medical laser treatments. Exclusively distributed by Lynton in the UK, Tetra Pro delivers 30% faster treatments, it offers precision and safety with its advanced 40W laser. A standout feature of minimal downtime makes this treatment a lunchtime option for clients whilst still delivering impressive results. From scar reduction to SmartXide Bleph, Tetra Pro is transforming clinics and outcomes with much faster recovery and exceptional results.

Peptides in skincare: their regenerative benefits

This paper explores the growing demand for medical aesthetic treatments and skincare products in the UK, focusing on the role of peptides in addressing both intrinsic and extrinsic skin ageing. The UK skincare market is experiencing rapid growth, driven by increased consumer awareness and interest in clean beauty, wellness, and regenerative medicine. Peptides, with their regenerative properties, are highlighted as key ingredients in medical aesthetic skincare, offering multifaceted benefits such as anti-ageing, antimicrobial, and antioxidant effects. The paper discusses the various types of peptides, including signal, carrier, and antimicrobial peptides, and their mechanisms in promoting skin health, improving collagen production, and supporting a healthy microbiome. Peptide technologies represent a cutting-edge approach in treating skin concerns, making them a promising addition to medical aesthetic treatments.

Update on tooth color measurement by visual and spectrophotometer methods

Introduction: Tooth colour assessment is a crucial aspect in aesthetic dentistry, as it influences the design of restorative and aesthetic treatments. There are various methods for assessing tooth colour, the most common being the visual method and the use of spectrophotometers. Each has advantages and disadvantages that can affect the accuracy and reproducibility of the results.Development: The visual method consists of comparing tooth colour with standardised shade guides. This approach is accessible and easy to implement, but its subjectivity can lead to variations in colour perception between different operators. Factors such as lighting, visual fatigue and environmental conditions can influence the assessment, compromising the consistency of the results. On the other hand, the spectrophotometer offers an objective measurement of tooth colour by quantifying the light reflected by the teeth at different wavelengths. This method provides accurate and repeatable data, eliminating the subjectivity of the visual method. However, its cost and the need for technical training can be limitations in its widespread use.Conclusions: Both methods have a significant role in tooth color assessment. While the visual method is more accessible and practical in clinical settings, the spectrophotometer offers superior accuracy and objectivity. The choice between the two will depend on the specific treatment needs and available resources. For optimal results, it is suggested to consider a combined approach that takes advantage of the strengths of each method.

Topographic Analysis of the Periorbital Region Including Orbicularis Oculi Muscle Based on Ultrasonography Interpretation.

Ultrasonographic examination is easy, fast, safe, and used in various fields; however, its application to the facial area has been limited. Complex anatomical structures are mixed within thin, soft tissues in the facial region; therefore, understanding their structural characteristics is crucial. This study aimed to use ultrasonography to obtain information on the layered structure and soft tissue thickness of the eye area around the orbicularis oculi muscle and provide guidance for clinical practice. Healthy volunteers (33 men and 19 women; mean age: 28.4 years) underwent ultrasonography with nine reference points. The soft tissue thickness, including the orbicularis oculi muscle, was measured on monochromatic images. Ultrasonographic scans were performed at facial landmarks using linear transducers (IO8-17, E-CUBE15, Alpinion Medical System, Seoul, Korea), with images scanned transversely. The thickness was measured using ImageJ (National Institutes of Health, Bethesda, MD, USA). The mean thickness of the orbicularis oculi muscle was 1.56 ± 0.45 mm (range 1.03-2.31 mm). The highest thickness was measured at the points VII (2.31 ± 0.68 mm) and VI (2.15 ± 0.48 mm). The mean depth of the orbicularis oculi muscle was 1.63 ± 0.62 mm (range 0.88-2.80 mm), and the most superficial point was 0.88 ± 0.99, at point VII. This study provides critical anatomical data that can enhance the precision of ultrasound-guided procedures in the periorbital area, allowing clinicians to accurately target the muscle layer and soft tissue structures. By utilizing these findings, practitioners can optimize treatment effectiveness, reduce complications, and improve outcomes in cosmetic procedures such as botulinum toxin injections, filler placements, and other non-invasive facial treatments. The detailed anatomical insights gained from this study will help bridge the gap between anatomical understanding and clinical application, promoting safer and more efficient aesthetic interventions.

Delivering an Inclusive Experience for Patients of All Genders in the Aesthetics Practice: A Roundtable Discussion

Abstract Background Transgender, nonbinary, and gender diverse individuals represent a growing proportion of patients desiring minimally invasive aesthetic treatments to enhance facial appearance. While awareness of the need for gender-affirming care is increasing and resources are available on approaches to injection in gender-diverse individuals, guidance on how to best provide this care is lacking. Objectives To share recommended practices for aesthetic clinicians who wish to treat transgender, nonbinary, and gender diverse individuals or wish to improve gender inclusivity within their aesthetic practices. Methods As part of a continuing medical education activity, the authors participated in a roundtable discussion on how individual practices can support inclusive care for transgender, nonbinary, and cisgender patients. Results A thorough understanding of vocabulary in support of gender diversity can help to improve clinician confidence and the patient experience. Consideration of clinic design, including the use of gender-neutral bathrooms and the display of gender diversity in advertisements or clinic artwork, can also support a gender-inclusive and welcoming environment. The use of correct pronouns and gender-neutral language by all clinic staff and clinicians as well as a thoughtful approach to language used on intake forms may also help to provide an inclusive and safe space for the transgender, nonbinary, and gender-diverse community. Conclusions Inclusive and gender-affirming healthcare improves the mental health and wellbeing of transgender, nonbinary, and gender-diverse populations. Individual aesthetic clinicians can improve inclusivity by considering their advertising, clinic design, intake forms as well as their consultation, treatment, and follow-up practices.

Gaze Patterns During Evaluation of Facial Attractiveness: An Eye‐Tracking Investigation

BackgroundObjective, controlled eye‐tracking measurement of gaze patterns during layperson evaluation of facial attractiveness is currently lacking.ObjectivesTo objectively investigate (1) where on the face laypeople direct their attention when assessing attractiveness compared with a control group, and (2) whether increased fixation on certain facial regions is associated with high attractiveness ratings.MethodsLay observers viewed a cohort of 40 faces with a diverse age, sex, and racial distribution. Observers were either allowed to free‐gaze without a specific task or rate facial attractiveness for 10 seconds per face while their gaze was recorded by an eye‐tracking system.ResultsForty‐seven observers assessed facial attractiveness (mean age 35.1 years (range 21–76), 62% female) and 57 observers free‐gazed at the facial photos without a specific task (mean age 35.5 years (range 22–66), 54% female). Preliminary analysis showed that sex of both the face and observer substantially influence gaze‐attractiveness associations (p < 0.05). Mixed effects analysis suggests that when males assessed female facial attractiveness, increased fixation time at the mouth correlated most strongly with high attractiveness (p = 0.001), whereas when females assessed male faces, increased fixation at the eyes (p < 0.001) and hair (p = 0.002) were most strongly associated with high ratings of attractiveness.ConclusionsIncreased gaze at the mouth in females and eyes and hair in males is associated with significantly higher ratings of attractiveness by observers of the opposite sex. Practitioners may want to pay special attention to these areas when designing an evidence‐based aesthetic treatment plan.Level of EvidenceNA Laryngoscope, 2024

Exploratory Analysis of Upper Facial Muscle Interplay During Emotional Expressions: Magnetic Resonance Imaging (MRI) Insights from Young, Caucasian, Toxin-naïve Individuals.

Understanding the interplay of muscle activity in the upper face is crucial as it can significantly impact the effectiveness and safety of aesthetic treatments. Traditional injection algorithms typically focus on the general 2D and 3D anatomy of muscles, often neglecting the areas where muscles exert the greatest force during facial expressions. To analyze the location of greatest morphological change in upper facial muscles procerus muscle (PM), corrugator supercilia muscle (CSM), orbicularis oculi muscle (OOM) and frontalis muscle (FM) during various facial expressions. A total of 34 healthy young individuals (17 females, 17 males), with a mean age of 23.6±2.4 years [range 20-30], were examined using MRI to assess the length, thickness and width of upper facial muscles (PM, CSM, OOM, FM) for five different facial expressions: repose, anger, joy, surprise, and sadness. Facial muscle thickness is a key indicator of activity during expressions like anger, joy, surprise, and sadness. During anger, the PM and CSM decreased in length and width but increased in thickness, while FM passively contracted to stabilize the expression. The OOM showed increased thickness in its medial, inferior, lateral, and superior portions during various expressions, with specific regions activating differently depending on the expression, such as the medial and lateral parts during surprise and the inferior and lateral parts during joy. The medial third of the CSM was the most active region during contraction. Upper facial muscles - regardless of them agonists or antagonists - act together during facial expressions to stabilize facial expressions, emphasizing the need to assess both groups in neuromodulator treatments. The medial third of the corrugator supercillii shows the most significant MRI changes, making it the primary target for injections.