الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
One of the most common aesthetic procedures used is the administration of Botulinum toxin type A for the treatment of facial rhytids. Botulinum toxin is an exotoxin extracted from the bacterium Clostridium Botulinum.
The Botulinum toxin is injected into a muscle and it acts by blocking synaptic firing at the neuromuscular junctions, and so paralyzing the muscle until new synapses are formed. In this study we will inject the botulinum toxin into the corrugator supercilii muscle (part of the depressors of the eyebrows) to treat the vertical glabellar rhytids (frown lines).
Botulinum toxin injection using palpation method is the most commonly used technique. Another less used injection technique is electromyography-guided injection of Botulinum toxin.
Electromyography is a technique that measures and records the electrical activity within muscles. It is usually used as a diagnostic tool to assess the health of the muscular tissue and its neural supply. Alternatively, we can also utilize it to guide intra-muscular administration of medications and to measure the amplitude of muscle activity and contraction.
In this study, we compared the Electromyography guided technique of injection to the conventional palpation method of injection of Botulinum toxin for treatment of glabellar frown lines. We utilized Electromyography both as an injection-guidance tool for Botulinum toxin injection as well as an assessment and follow-up tool for the effect of Botulinum toxin. We also assessed the clinical severity of facial rhytids by using the validated static and dynamic Merz scales of glabellar frown lines.
This prospective interventional comparative split-face study was conducted on 15 subjects (30 Corrugator muscles), a right and a left. Each Corrugator muscle was divided into two parts, a body and a tail, and treated separately (60 muscle parts).
All the study subjects were females with a mean age of 46.27 ± 6.31 with a range from 33 to 59 years. The majority of subjects (60%) were 45 years and older. 40% of subjects were younger than 45 years. All subjects were followed-up preoperatively, at two weeks and at three months post operatively. All 15 subjects started and completed the study.
The study results reveled that:
• All subjects showed a “Complete” interference pattern on the initial pre-operative EMG waveform with maximal voluntary contraction, which signifies healthy muscular tissue and excludes myopathies and neuropathies in the targeted muscles prior to the study.
• The interference pattern envelope amplitude means of all studied muscles decreased with statistical significance at 2 weeks and 3 months in relation to the pre-operative readings. This indicates successful neurotoxin treatments and duration of efficacy lasting the entirety of the study (3 months).
• Body: The interference pattern envelope amplitude means were lower for the left corrugator bodies (Electromyography-guided) at both periods of post-operative assessment. This decrease was statistically significant at 2 weeks and statistically insignificant at 3 months.
• Tail: The interference pattern envelope amplitude means were lower for the left corrugator tails (Electromyography-guided) at both periods of post-operative assessment. This decrease was not statistically significant both times.