BACKGROUND There are 7 known serotypes of botulinum neurotoxins (A through G). Currently, commercially available toxins are those in serotypes A and B. This paper will discuss new toxins on the horizon, developments in prolonging and shortening the duration of outcomes, and novel therapeutic indications on the horizon. OBJECTIVE To provide insight into new toxins and new therapeutic modalities surrounding toxins on the horizon. METHODS The authors have reviewed the relevant literature and shared their insights and opinions as to future developments in toxin research and potential clinical applications. CONCLUSION Botulinum neurotoxin type E's faster onset and shorter duration of effect represent true clinical differentiators. Future development of botulinum neurotoxin type E for aesthetic and therapeutic uses will be in areas where fast onset and short duration of effect are desirable. Current challenges with neuromodulators include the need for frequent treatments and lack of reversal agents. Agents to address both challenges and novel indications, including inhibition of melanogenesis, are being developed.
Avascular necrosis (AVN), also known as osteonecrosis, ischemic bone necrosis, or aseptic necrosis, is a progressive bone disease marked by the deterioration of bone tissue due to compromised blood flow in the subchondral region. AVN is typically caused by disruptions in vascular supply, intravascular blockages, or pressure on blood vessels, leading to diminished circulation. This condition predominantly affects the long-bone epiphysis in weight-bearing joints, particularly impacting the femoral head. The ongoing global health challenge posed by the novel coronavirus disease (COVID-19) has raised awareness of its diverse clinical manifestations. While pulmonary dysfunction remains a hallmark, reports of AVN of the hip have emerged in association with COVID-19 infection. Despite existing literature documenting cases of unilateral and bilateral femoral head necrosis associated with COVID-19 infection, it is noteworthy that corticosteroid use has been identified as a significant contributing factor to the development of this condition. Here, we present a case of bilateral AVN of the femoral head in a young individual linked solely to COVID-19 infection. Existing case records show only a handful of instances where COVID-19 has led to avascular necrosis, all involving either older individuals or those with notable risk factors. What sets our case apart is that the patient is young and lacks any significant risk factors. This report aims to propose a credible connection between COVID-19 infection and femoral head osteonecrosis in young patients not exposed to steroid treatment.
BACKGROUND:The platysma muscle's role in lower face dynamics is complex. Multiple insertion points to soft-tissue structures at various levels in the lower face create a multifaceted contraction pattern. To avoid adverse effects in cosmetic procedures when targeting the platysma, its anatomy and physiology must be understood. Clinical observations hint at a bidirectional contraction pattern. METHODS:Eighteen healthy volunteers (13 women and five men) with a mean age of 44.2 ± 10.1 years were enrolled. Skin displacement vector analysis was used on maximal platysma contraction to characterize and calculate the movement of the neck and lower face skin. RESULTS:In all of the participants, a bidirectional movement of the skin was observed: the skin of the lower face and inferior to the jawline moved caudally, whereas the skin of the lower neck moved cephalad. Both movements converged at a line situated at 54% ± 10% and 55% ± 8% of the length between the clavicle and the inferior base of the ear lobe in men and women, respectively ( P = 0.70). CONCLUSIONS:The platysma is a bidirectional muscle with a line of convergence. Whereas the superior portion acts as lip depressor, the lower portion elevates the skin of the upper chest and lower neck. This transition can explain some of the clinically observed adverse effects of neuromodulation of the neck area. It can potentially direct neuromodulation injections to focus above the convergence line to better address lower face descent.
