TY  - JOUR
T1  - ELectromyographic differences between normal upper and lower facial muscles and the influence of onabotulinum toxin a
AU  - Winn BJ, Sires BS
Y1  - 2013/05/01
N1  - 10.1001/jamafacial.2013.692
JO  - JAMA Facial Plastic Surgery
SP  - 211
EP  - 217
VL  - 15
IS  - 3
N2  - Importance 
                  Empirically determined doses of onabotulinum toxin A for aesthetic treatments are as much as 5 times higher for the upper than for the lower facial muscles.Objective 
                  To use electromyography (EMG) to determine objectively whether the disparity between doses is due to intrinsic differences between the muscle groups' responses to onabotulinum toxin A or to variable amounts of paralysis required to achieve the desired aesthetic outcomes.Design 
                  We collected EMG data before and at 2 to 4 weeks and 3 months after 8- and 2-U onabotulinum toxin A injections to the corrugator and depressor anguli oris muscles, respectively.Setting 
                  A private oculofacial plastic surgery practice.Participants 
                  Twenty-six subjects recruited from February 1 through April 1, 2009.Interventions 
                  Electromyography recordings and cosmetic onabotulinum toxin A injections.Main Outcome Measures 
                  Mean motor unit (MU) durations and maximal amplitudes at baseline and 2 to 4 weeks and 3 months after injection.Results 
                  Baseline mean MU amplitudes were similar for the corrugator and depressor anguli oris muscles. At 2 to 4 weeks after injection, 78% MU and 64% maximal amplitude reduction for the corrugator muscle were detected, but only 54% MU and 18% maximal amplitude reduction for the depressor anguli oris (P = 2.7 × 10−8 and P = 1.3 × 10−14, respectively). At 3 months, function was partially recovered for both muscle groups.Conclusions and Relevance 
                  Onabotulinum toxin A causes a similar dose-dependent reduction in MU and maximal voluntary amplitudes for muscles of the upper and lower face. The dose disparity appears to result from differences in the amount of paralysis required to achieve desirable aesthetic results.Level of Evidence 
                  2.
SN  - 2168-6076
M3  - doi: 10.1001/jamafacial.2013.692
UR  - http://dx.doi.org/10.1001/jamafacial.2013.692
ER  -