Objectives: To understand the mechanism of levator ptosis after toxin treatment of the glabella
Introduction: Levator ptosis is the most common complication after toxin treatment of the glabella. The orbicularis retaining ligament (ORL) provides a barrier between the forehead region contains the corrugated (and procures) muscles and the orbital cavity containing the levator palpebral muscle, so no toxin should be able to reach the levator. However, the terminal branches of the Ophthalmic artery make holes in the ORL through which toxin can travel into the orbital cavity. Bleeding and subsequent pressure application can push the toxin through the holes in the ORL towards the levator muscle.
Materials / method: We assessed 1291patients who underwent toxin injections in the glabella and measured arterial injury with Doppler.
We previously described a technology allowing to visualize the arterial anatomy in Augmented Reality (AR) and used this prior to toxin injections in the glabella in 350 patients
Results: Without AR visualization, 38% of patients had arterial injury after toxin injection is the glabella. The Supratrochlear Artery was most often injured (46%), followed by the Supraorbital Artery (37%) and the Dorsal Nasal Artery (17%).
With AR visualization, only 14% of patients had arterial injury.
Conclusion: Arterial injury and pressure application can explain the mechanism of levator ptosis after toxin injection. Arterial injury is very common after toxin injections is the glabella and can explain the relatively high incidence of levator ptosis.
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