双平面A型肉毒毒素注射改善颈阔肌条索的临床应用

Biplanar botulinum toxin type A injection for alleviating platysmal bands

目的研究A型肉毒毒素双平面注射方法改善颈阔肌紧张、肌肉条索显著、颈部外观宽大,实现颈部年轻化和美学的临床效果。方法回顾性分析2022年11月至2023年5月,中国医学科学院整形外科医院面颈整形科、成都八大处医疗美容医院整形外科采用A型肉毒毒素微滴注射法治疗的颈阔肌条索显著影响美观患者的临床资料。注射前嘱患者用力咧嘴以标记颈阔肌条索。用13 mm长的30 G注射针头将浓度为20 U/ml肉毒毒素,以锁骨端为起点向头侧沿条索走行注射至肌肉层,间隔1.5 cm单点注射1 U。更换3 mm长的30 G注射针头,将浓度为10 U/ml肉毒毒素沿条索走行注射至皮内深层,单点注射0.5 U。术后对患者进行随访,调查患者满意度,分为十分满意、满意、不满意、十分不满意4个等级;由第三方医师采用观察者总体美容改善量表(GAIS)对治疗前后的患者照片进行评分(1~5分),分值越低表示较术前改善越显著;采用Geister颈阔肌条索评分法对治疗前后的颈阔肌条索突出度进行评估(0~4分),分值越高表示条索突出越严重。正态分布计量资料以±s表示。结果共纳入19例患者,其中男3例,女16例,平均年龄36.1岁(33~42岁)。术后随访1~5个月,平均1.3个月,患者主观满意率为100%(19/19);第三方医师的GAIS评分为(1.12±0.33)分,17例达显著改善,2例为中等改善;Geister颈阔肌条索评分从术前的(3.65±0.33)分降至术后的(0.76±0.44)分。治疗后早期,5例患者出现颈部注射区局部淤血,1周后恢复;2例患者主诉注射过程和注射后局部疼痛,3 h后明显缓解;2例患者出现颈部轻度乏力症状,但颈部活动均正常;1例患者出现轻度咀嚼无力。以上不良症状均在4周内自行完全缓解。所有患者无口角偏斜、发声困难、面瘫、过敏等其他并发症。结论颈阔肌肌内注射结合皮内深层注射A型肉毒毒素的方法可有效改善颈阔肌条索,实现颈部动态外观显著改善。

ObjectiveTo investigate the clinical outcome of biplanar botulinum toxin type A injection in alleviating platysmal bands.MethodsFrom November 2022 to May 2023,the clinical data of patients with platysmal bands treated by botulinum toxin type A injection in Department of Face and Neck Plastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences,and Department of Plastic Surgery,Chengdu Badachu Cosmetic Hospital were retrospectively analyzed.The platysmal bands were marked,while patients were grinning,before injection.Using a 13 mm 30 G needle,20 U/ml botulinum toxin was injected into the muscle layer along the bands from the clavicle direction.The dose was 1 U at a single point every 1.5 cm.Using a 3 mm 30 G needle,10 U/ml botulinum toxin was injected into the deep surface of dermis along the bands with a single point dose of 0.5 U.Effects were evaluated by overall subjective satisfaction of patients,which were categorized into 4 grades:very satisfied,satisfied,dissatisfied,very dissatisfied.In addition,accessment by a third-party physician with global aesthetic improvement scale(GAIS)(1-5 points,the lower the score,the more significant the improvement is)and Geister platysmal band scale(0-4 points,the higher the score,the more severe the platysmal band is).Normal distribution data was represented by Mean±SD.ResultsA total of 19 patients were included,including 3 males and 16 females,with the average age of 36.1 years.After a mean follow-up of 1.3 months(1-5 months),the overall subjective satisfaction was 100%(19/19).The GAIS score of third-party physicians was 1.12±0.33.100%(19/19)of patients received a rating over moderate improvement(significant improvement in 17 cases and moderate improvement in 2 cases).The Geister platysmal band score decreased from preoperative 3.65±0.33 to postoperative 0.76±0.44.No serious complications were found except 5 cases of local congestion and 2 cases of injection pain,which were relieved in 1 week and 3 hours respectively.2 cases felt mild neck weakness,but neck activity was not affected.The adverse symptoms all completely resolved spontaneously within 4 weeks.All patients have no mouth deviation,difficulty speaking,facial paralysis,allergies,or other noticeable complications.ConclusionThe injection of botulinum toxin type A in dual-plane of platysmal intramuscular layer and deep intradermal layer can effectively alleviate platysmal bands and achieve neck rejuvenation.