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Abstract Introduction The purpose of this study is to establish the efficacy of Yonsei point in the treatment of a gummy smile in a White South African population. The accurate surface anatomy criteria in relation to the underlying musculature for the administration of Botulinum toxin injections in the treatment of gummy smile was determined. Materials and Methods Nineteen (10 males and 9 females) cadavers were selected for facial dissection. Facial profile photographs were taken before and after dissection. The before and after photographs were overlayed to determine where the pin positions should be on the dissected cadaver to determine the Yonsei point. The levator labii superioris (LLS), LLS alaeque nasi (LLSAN), zygomaticus minor, and zygomaticus major muscles were measured using a protractor and ruler, which accounted for the manual measurements. Digital measurements were measured by importing dissected images into ImageJ. Circles with a 2 cm diameter (1 cm radius) were constructed to determine whether the Yonsei point could successfully influence muscles fibers. Results Digital and manual measurements show comparable results with high correlation and reliability. Results showed that the White South African population had narrower facial musculature angles as compared with the Korean population. Conclusion Based on the selected sample, the Yonsei point is an ineffective injection site for the successful treatment of gummy smile in a White South African population.

Introduction: The purpose of this study is to establish the efficacy of Yonsei point in the treatment of a gummy smile in a White South African population. The accurate surface anatomy criteria in relation to the underlying musculature for the administration of Botulinum toxin injections in the treatment of gummy smile was determined. Materials and Methods: Nineteen (10 males and 9 females) cadavers were selected for facial dissection. Facial profile photographs were taken before and after dissection. The before and after photographs were overlayed to determine where the pin positions should be on the dissected cadaver to determine the Yonsei point. The levator labii superioris (LLS), LLS alaeque nasi (LLSAN), zygomaticus minor, and zygomaticus major muscles were measured using a protractor and ruler, which accounted for the manual measurements. Digital measurements were measured by importing dissected images into ImageJ. Circles with a 2 cm diameter (1 cm radius) were constructed to determine whether the Yonsei point could successfully influence muscles fibers. Results: Digital and manual measurements show comparable results with high correlation and reliability. Results showed that the White South African population had narrower facial musculature angles as compared with the Korean population. Conclusion: Based on the selected sample, the Yonsei point is an ineffective injection site for the successful treatment of gummy smile in a White South African population. [ABSTRACT FROM AUTHOR]

Background: Botulinum toxin (BoNT) or Botox injections are popular non-surgical and non-invasive option to optimize and change an individual’s facial appearance and achieve rejuvenation. Pyridostigmine is an acetylcholinesterase inhibitor important in clinical practice. This study evaluated the toxic effect of BoNT to demonstrate the efficacy of anticholinesterase inhibitor pyridostigmine. Methods: We conducted an experimental interventional study to evaluate the antidote effect of pyridostigmine against BoNT. Forty rabbits (skeletally mature males, body weight 1000–2000 g) were included in the study. The rabbits were injected with Clostridium botulinum type A neurotoxin complex (BoNT or Botox), which was reconstituted with 0.9% sterile sodium chloride to a concentration of 100 U/2.5 mL. Animals were divided randomly into four groups (10 in each) as follows: Group 1 (control group), group 2 (pyridostigmine-treated group), group 3 (BoNT only group), and group 4 (BoNT + pyridostigmine treated group). Results: In the control group, there was statistical difference between the rabbits’ weight (P=0.03). The left muscle was significantly heavier than the right (P=0.025). In the pyridostigmine only group, the rabbits’ weight had a high statistical difference during four weeks of the study (P=0.002). In the BoNT injection group, weight had high statistically significant difference four weeks of the study (P=0.033), which was more in first week (1.55±0.2 kg) and then subsequently decreased in the fourth week (1.345±0.13 kg). The mean weight of the rabbits’ right quadriceps muscle was 6.573±1.3 g, which was significantly lower than the mean weight of the rabbits’ left quadriceps muscle (8.09±1.2 g, P=0.0001). Conclusions: To the best of our knowledge, this is the first study conducted in Iraq to investigate the antidote effect of pyridostigmine against BoNT injections. Pyridostigmine and saline caused increased weight of rabbits in comparison to rabbits that received BoNT injections. Pyridostigmine can act as strong antidote against Botox toxicity.

Background The demand for cosmetic procedures has increased significantly due to their positive effects on self-satisfaction. However, individuals often underestimate the potential complications associated with these procedures, driven by a strong desire for transformation. Therefore, this study aimed to evaluate the Madinah community's awareness of cosmetic procedures and plastic surgery, as well as to assess the risks, complications, and clinical outcomes associated with these procedures. Materials and methods A non-probability consecutive sampling method was employed to select study participants, including every patient who met the inclusion criteria until the target sample size was reached, between March and June 2023. An intervener-based questionnaire survey was conducted to assess participant's understanding of the severity and associated risks of cosmetic procedures and plastic surgery. The minimum required sample size was determined to be 82 using OpenEpi version 3 software. Data were analyzed using t-tests, chi-square tests, and analysis of variance (ANOVA) as appropriate. Results The study included 82 participants, with 48.80% aged between 18 and 30 years and only 3.7% of them were male. The majority were of Saudi nationality (86.60%). While most participants (82.9%) were aware of cosmetic procedures and their risks, 28% lacked knowledge about potential complications, highlighting a notable knowledge gap. Some of the participants reported underlying health conditions such as obesity (8.5%), diabetes (3.7%), asthma (3.7%), and hypertension (2.4%), along with family histories of hereditary diseases (37.8%) and allergies (15.9%). The most common complications were facial swelling (63.41%), bruising (51.22%), rashes (30.49%), and subcutaneous blood pooling (19.51%). Less frequent complications included infections (15.85%) and reduced facial expressions (9.76%). Conclusion The study revealed that most participants demonstrated an overall awareness of the potential complications associated with cosmetic procedures. The commonly recognized complications of cosmetic facial procedures included swelling, bruising, rash, subcutaneous blood pooling, and infection. However, no specific factors related to the planning of facelift procedures were identified., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Approval was obtained from Al-Rayan National College of Medicine, Medical Research Ethics Review Board, Al Rayan Medical Colleges issued approval HA-03-M-122-039. Institutional review board approval was granted by the Research Ethics Review Board at Al Rayan Medical Colleges (Approval No. HA-03-M-122-039). Written consent was obtained from all participants, all of whom were over 18 years old. Data were collected through an online questionnaire available in both English and Arabic. Validation was based on a previously conducted study (Sorensen CP, Urman C: Cosmetic complications: rare and serious events following botulinum toxin and soft tissue filler administration. J Drugs Dermatol. 2015, 14:486-91). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Babikir et al.)

Background: Non-Surgical Facial Aesthetics (NSFA) encompasses a range of minimally invasive procedures. Complications associated with NSFA often present to local Emergency Departments. There is no representation of NSFA in the undergraduate curriculum. Medical students appear to have little to no exposure to NSFA during their training.The main aims of this study were to gain an insight into the views of final year medical students in pursuing a career in NSFA and assessing their understanding of NSFA competence and complications of common procedures. Method: ology: An online survey was completed by 148 medical students across two English Universities. 106/148 (71.6%) of students were from University A and 42/148 (28.4%) were from University B. Results: 47.6% (70/148) of medical students would consider pursuing a career in NSFA after graduating from medical school. 76.3% (87/148) and 80.7% (92/148) of students were not aware of the complications associated with the administration of dermal fillers and Botox injections respectively. Most medical students felt a single day training program in NSFA was sufficient to administer non-surgical rhinoplasty 67.8% (99/148) dermal fillers 67.1% (98/148) and Botox injections 68.5% (100/148). Conclusion: Despite a large proportion of medical students considering a career in NSFA the majority were unaware of the common complications. Incorporation of NSFA into undergraduate curriculum should improve enhance patient safety, effective management of complications and augment future learning and career progression. This may be achieved by through signposting, student-selected components and as part of structured head and neck teaching.

Background The use of botulinum toxin (BT), commonly known as Botox, has become increasingly popular for cosmetic purposes, particularly in treating wrinkles and facial rejuvenation. While the efficacy of botulinum toxin in achieving desired aesthetic outcomes is well-established, it is also important to consider the level of public knowledge and awareness regarding this potent neurotoxin. This study investigates the knowledge and attitude towards botulinum toxin use in cosmetic injections in the Arar population. Methods This cross-sectional study utilized a self-report questionnaire distributed via social media platforms, employing randomized sampling from May to July 2024. The target population included adults aged 18 and older, regardless of gender, living in the city of Arar, Saudi Arabia. The data were collected through an online self-administered survey using a Google Forms questionnaire template, which was translated into the appropriate language. The collected data was analyzed using descriptive and inferential statistics. Results A total of four hundred and ten (410) participants responded to this study. The maximum number of participants, 149 (36.3%), were in the age group of 20-25 years, while the minimum number of participants, 6 (1.5%), was in the age group of 50-55 years. The results also showed that 341 (83.2%) of participants were females and 69 (16.8%) were males; 262 (63.9%) participants were aware of Botox treatment used in cosmetic clinics. Concerning the most prevalent non-surgical cosmetic treatments, 29 (7%) answered dental procedures, and 19 (4.6%) mentioned its use in pain. Conclusion This study found that 262 (63.9%) of the study population showed knowledge about botulinum toxins used in cosmetic injections. The majority of them were young individuals, females, or unmarried people. Only 83 (20%) were aware of the adverse effects of botulinum toxin. This low level of awareness about the potential risks associated with the use of botulinum toxins for cosmetic purposes is concerning and suggests the need for improved education and information dissemination., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Local Committee of Bioethics at Northern Border University issued approval 48/24/H. Local Committee of Bioethics (HAP-09-A-043) at Northern Border University issued the decision no. (48/24/H). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alenezi et al.)

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is an autoimmune disease that involves GFAP autoantibodies in the cerebrospinal fluid (CSF) and serum. Clinical manifestations exhibit diverse symptoms affecting various brain regions and spinal cord. Diagnosis challenges persist due to the absence of standardized criteria, yet steroid therapy shows promise despite varied responses. Herein we present the case of a 30-year-old male with meningoencephalomyelitis symptoms, later diagnosed with autoimmune astrocytopathy. Treatment involved plasmapheresis, corticosteroids, and mycophenolate mofetil, with a positive outcome. Neurourological complications, including acute urinary retention, prompted catheterization, and urodynamic studies revealed detrusor overactivity. Timely intervention enabled the restoration of bladder function, underscoring the importance of specialized care in complex neurologic conditions for improving patients' quality of life (QoL). This case emphasizes the significance of early neurourological intervention and the role of specialized centers in delivering tailored care for better patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tsikopoulos et al.)

This report describes the case of a patient who presented to the Emergency Department (ED) with a one-week history of difficulty in breathing, generalized weakness, dysphagia, and difficulty in walking. She had self-administered 100 units of onabotulinumtoxin A (BoNT-A) by injection into her face two weeks prior for cosmetic purposes. This case study highlights the rare but potential complication of systemic botulism., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tay et al.)

Neuralgia is characterized by chronic pain resulting from damage or diseases in the somatosensory system, including nerves responsible for transmitting sensory information. Current treatments for neuropathic pain, which is a type of neuralgia, have limited success rates and can cause unwanted side effects. Since 1989, botulinum toxin-A (BTX-A), derived from the potent neurotoxin Clostridium botulinum , has been used to treat neuropathic pain in humans. BTX-A has shown analgesic effects by inhibiting the release of neurotransmitters involved in pain transmission. This review aims to evaluate the effectiveness of BTX-A in various types of neuralgia. The research question guiding this review is whether BTX-A is safe and effective in reducing pain in different types of neuralgias. To conduct this review, a literature search was performed using the PubMed, Medline, and PubMed Central databases. The search strategy included relevant keywords related to BTX-A, neuralgia, and neuropathic pain. After screening titles, abstracts, and full texts, a total of 30 articles were included in the review. These studies examined the efficacy of BTX-A in various conditions such as postherpetic neuralgia (PHN), auriculotemporal neuralgia (ATN), occipital neuralgia (ON), leprosy-induced neuropathic pain (LIN), focal painful neuropathies, complex regional pain syndrome (CRPS), trigeminal neuralgia (TN), and neuropathic pain associated with spinal cord injury. However, further research is needed to enhance our understanding of the optimal use of BTX-A in specific neuralgias. It is important to acknowledge the limitations of the included studies. Nevertheless, BTX-A might be considered a viable treatment option for neuralgia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Dekhne et al.)

In this literature review, we will evaluate the effectiveness of OnabotulinumtoxinA (Botox) and anti-calcitonin gene-related peptide (anti-CGRP) in the treatment of migraine headaches. Both therapies are frequently prescribed for managing and preventing migraines and have received Food and Drug Administration (FDA) approval. The mechanism of action, side effects, compliance, cost-effectiveness, and migraine treatment provided by these two medicines were compared in the analysis of several studies. Many studies found that as Botox was administered by a doctor every three months and had fewer side effects than anti-CGRP, which is self-administered every month, it was more compliant than anti-CGRP. After examining the data, Botox is believed to be the most effective therapy. Although both therapies are efficient, this article compares them to determine which is the best management strategy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Pallapothu et al.)

In recent years, there has been an increase in demand for gluteal augmentation and reshaping surgeries with intramuscular implants which are becoming increasingly popular. Until now, this surgery was mainly performed under general anesthesia, but recently locoregional anesthesia techniques, such as tumescent local anesthesia, are being applied more and more. Today, the use of ultrasound for locoregional anesthesia and analgesia allows us to perform techniques that are increasingly precise and burdened with lower risks. In this report, we present a novel two-step ultrasound-guided technique combining a botox injection in the gluteus maximus four weeks before surgery and tumescent anesthesia with a cluneal nerve block. Furthermore, the combination of anesthetic and analgesic techniques can guarantee a better result both in terms of surgical execution of the intervention and in reducing pain and improving patient comfort in the postoperative period., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Fajardo Perez et al.)

Both calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) and OnabotulinumtoxinA (botox) are used in the prevention of chronic migraines. However, it is not clear which is more effective overall. This review will compare the efficacy, side effects, cost-effectiveness, and other factors between CGRP mAbs and botox. We searched Pubmed and Google Scholar using the keywords migraines, CGRP mAbs, botox, efficacy, side effects, aura. All articles, including case-control/cohort studies, case series, case reports, randomized control trials, traditional/systematic reviews, were analyzed. CGRP mAbs and botox both reduce the frequency of migraines in patients. Patients have reported they decreased migraines' frequency and intensity in several studies after being given each medication. While CGRP mAbs are more recent medications, botox has been studied for more than a decade as a migraine preventative. Both drugs have minor short-term side effects, but some CGRP mAbs may cause persistent constipation too. CGRP mAbs are self-injected every month, and botox is physician-injected every three months, making it easier to stay compliant. While both medications are expensive, botox has a lower cost over time. Botox is more effective prophylaxis of migraines based on the articles that were reviewed. While both CGRP mAbs and botox are efficacious and tolerable, botox has been studied longer, has fewer side effects, is more cost-effective, and is easier to comply with., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Siddiqui et al.)

Background Sialorrhea is a common comorbidity among children with neurologic disorders. Botulinum toxin injections and surgical procedures are recommended for the management of pathological sialorrhea in patients who fail conservative management or with concerns for salivary aspiration. The following review evaluates outcomes following botulinum toxin injections and surgical interventions for sialorrhea over a 10-year period with a focus on treatment options and outcomes for patients with anterior and posterior drooling. Methods The study included all patients less than 25 years of age who underwent a procedure for drooling (Current Procedural Terminology (CPT) codes 42440, 42450, 42509, 42510, 64611 matched with the International Classification of Diseases (ICD)-9 and ICD-10 codes 527.7 and K11.7) from January 1, 2006 to December 31, 2015. A chart review collected demographics, drooling medication use, and type of drooling (anterior, posterior, both). Outcome variables included pre- and post-procedure number of bibs, parent-reported outcomes, post-intervention drooling medication requirement, post-procedure length of stay, and complications. Results Seventy-one patients were included in our analysis, with 88 total procedures performed. The average age at first intervention was 8.9 years; 43 patients were male and 40 patients had cerebral palsy. Thirty-one patients experienced posterior drooling or anterior/posterior drooling. These patients were more likely to undergo surgery as the first invasive intervention. The most commonly performed interventions were botulinum toxin injections (28 patients, 39%) and sublingual gland excision (SLGE) with submandibular duct ligation (SMDL) (36 patients, 51%). Improvement following injections was noted in 56% of patients versus 73% of patients following any surgical intervention. Conclusion Management of drooling is complex with 18 different procedures performed over 10 years. Surgical interventions, specifically SLGE with SMDL and submandibular gland excision (SMGE), result in substantial improvement; these are commonly performed as the first intervention in patients with posterior drooling. By reviewing our experience, we hope to guide management decisions and help manage patient and caregiver expectations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Weitzman et al.)