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Muscles for Facial Expressions

Muscles for Facial Expressions

The craniofacial muscles are a collection of approximately 20 thin skeletal muscles situated beneath the skin of the face and scalp. These muscles, primarily responsible for the vast array of human facial expressions, originate from the bones or fibrous structures of the skull and extend outwards to connect with the skin. While most skeletal muscles in the body are enveloped in thick fascia, facial muscles generally have a more delicate fascial covering, with the buccinator muscle being a...

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Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

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Harnessing the Bidirectional Feature of the Frontalis Muscle: The Super-High Injection Technique.

Lehao Wu¹, Hengyuan Ma¹, Binghang Li¹

¹Department of Plastic Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College, Plastic Surgery Hospital and Institute, No.33 Badachu Rd, Shijingshan District, Beijing, 100144, People's Republic of China.

Aesthetic Plastic Surgery

|September 22, 2025

Summary

A new super-high botulinum neurotoxin (BoNT) injection technique effectively reduces forehead wrinkles while preserving brow position and movement. This method offers a safe alternative to traditional forehead rejuvenation, avoiding complications like brow ptosis.

Keywords:

3D stereophotogrammetry Botulinum toxin Brow ptosis Forehead lines Frontalis muscle

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Area of Science:

Aesthetic Medicine
Dermatology
Plastic Surgery

Background:

Botulinum neurotoxin (BoNT) is a common treatment for forehead rejuvenation.
Conventional pan-frontalis injections risk brow ptosis and altered brow dynamics.
Understanding the frontalis muscle's C-line is key to targeted BoNT delivery.

Purpose of the Study:

To evaluate the efficacy and safety of a novel super-high BoNT injection technique.
To assess wrinkle reduction and preservation of brow position and movement.
To compare this technique against traditional pan-frontalis approaches.

Main Methods:

Forty-one participants received BoNT injections above the C-line.
Three-dimensional stereophotogrammetry measured brow position and movement.
Forehead Wrinkle Scale (FWS) scores and patient satisfaction were analyzed.

Main Results:

Significant reduction in both static (51%) and dynamic (63%) forehead wrinkles.
Marginal decrease in brow position with preserved brow movement range.
100% patient satisfaction with no reported brow ptosis or eyelid heaviness.

Conclusions:

The super-high BoNT injection technique effectively reduces forehead wrinkles.
This method preserves brow dynamics and offers a safe alternative to pan-frontalis injections.
Anatomically guided injections provide a viable option for forehead rejuvenation.