Advancing the Evidence on Glabellar Contraction Patterns-A Prospective Multicenter Study on Its Clinical Relevance for Glabellar Neuromodulator Injections
Abstract
Background: Glabellar neuromodulator injections are frequently guided by skin surface contraction patterns, assuming that visible rhytids reflect underlying muscular anatomy. However, emerging anatomical and imaging evidence has questioned the clinical relevance of pattern-based treatment adaptations.
Objective: To prospectively evaluate whether different glabellar contraction patterns influence clinical and patient-reported outcomes when a standardized, anatomy-based, FDA-approved 5-point injection algorithm is applied.
Methods: This prospective, multicenter clinical study enrolled 125 patients treated across five independent centers. Patients were classified into five previously described glabellar contraction patterns (V-shape, U-shape, converging arrows, omega, and inverted omega) based on standardized photographs during maximal frowning. All patients received neuromodulator injections following the same standardized 5-point technique using either onabotulinumtoxinA or abobotulinumtoxinA with dose equivalence. Clinical outcomes were assessed using the Glabellar Line Severity Scale (GLSS) at baseline, 15 days, and 90 days, while patient-reported outcomes were evaluated with the Global Aesthetic Improvement Scale (GAIS) at 90 days. Statistical analyses included non-parametric group comparisons and multivariate ordinal logistic regression.
Results: A total of 119 patients completed the study. A significant improvement in GLSS was observed at 15 days (p 0.05). Multivariate…
How strong is the evidence?
Evidence Hub reads this as a clinical trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 125 participants or records.
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