‘Spock,’ ‘Joker,’ & ‘Mephisto’ eyebrows – avoidance techniques for aesthetic surgeons

SpockAesthetic surgeons in the business of facial wrinkle reduction have noted that if one weakens the glabella muscle with injections of AbobotulinumtoxinA without also weakening the frontalis muscle, unwanted side effects can occur. Known in the trade as ‘Spock,’ ‘Joker,’ or ‘Mephisto’ eyebrows. These side effects can be avoided by also injecting the fontalis muscle with AbobotulinumtoxinA.

Detailed explanations are provided in the Aesthetic Surgery Journal, Volume 32, Issue 1, Supplement Pp. 8S – 29S, ‘Current Aesthetic Use of AbobotulinumtoxinA in Clinical Practice: An Evidence-Based Consensus Review’

Steering Committee: Corey Maas, MD, FACS; Michael A. C. Kane, MD; Vivian W. Bucay, MD, FAAD; Consensus Committee: Shawn Allen, MD; David J. Applebaum, MD; Leslie Baumann, MD; Sue Ellen Cox, MD; Julius W. Few, MD; John H. Joseph, MD; Z. Paul Lorenc, MD, FACS; Amir Moradi, MD; Mark S. Nestor, MD, PhD; Joel Schlessinger, MD; Technology Consultants: Mitchell Wortzman, PhD; Ira Lawrence, MD; Xiaoming Lin, RN, MS; and Diane Nelson, RN, MPH. [see note 1 below]

“Many patients desire complete immobilization of the glabellar complex to abolish all dynamic wrinkles, although some may wish to retain partial function. Injections should be made intramuscularly and usually perpendicular to the skin surface. Care should be used to avoid injecting superior to the target muscles, which can cause brow ptosis by weakening the frontalis. Injecting within 1 cm of the bony margin of the orbit or near the supraorbital notch can cause eyelid ptosis by weakening the levator palpebrae superioris; this complication can be alleviated with apraclonidine eye drops. If the frontalis is not weakened at the same time as the glabella, excessive brow elevation can occur. This effect, variously called ‘Spock,’ ‘Joker,’ or ‘Mephisto’ eyebrow, can be reversed by injecting approximately 5 U abobotulinumtoxinA or 2 U onabotulinumtoxinA into the frontalis above the point of highest eyebrow elevation.”

Notes:

[1] The paper’s authors provide a list of disclosures regarding their industry involvement  – see below, ‘Disclosures’.
[2] The Aesthetic Surgery Journal also provides information on ‘Spock Ears’ [see photo above]Treatment of Prominent Ears with an Implantable Clip System: A Pilot Study’

Disclosures:

“Dr Maas is a paid researcher for Colbar LifeScience Ltd, Allergan Inc (Irvine, California), Medicis Inc (Scottsdale, Arizona), and Mentor LLC (Santa Barbara, California); a consultant for Merz Aesthetics Inc (San Mateo, California) Aesthetics Inc (San Mateo, California), Allergan Inc (Irvine, California), Mentor LLC (Santa Barbara, California), and Johnson & Johnson Inc (New Brunswick, New Jersey); a member of the speakers bureau for Merz Aesthetics Inc (San Mateo, California), Allergan Inc (Irvine, California), Integra Life Science Inc (Plainsboro, New Jersey), Lumenis Inc (Santa Clara, California) Inc (Santa Clara, California), Medicis Inc (Scottsdale, Arizona), and Johnson & Johnson Inc (New Brunswick, New Jersey); and a stockholder of Merz Aesthetics Inc (San Mateo, California), Allergan Inc (Irvine, California), Lumenis Inc (Santa Clara, California) Inc (Santa Clara, California), Medicis Inc (Scottsdale, Arizona), Mentor LLC (Santa Barbara, California), and Johnson & Johnson Inc (New Brunswick, New Jersey); Dr Kane is a paid advisor or consultant for Allergan Inc (Irvine, California) Inc, Merz Aesthetics Inc (San Mateo, California), Medical Inc, Medicis Inc (Scottsdale, Arizona), QMed LLC (Charlotte, North Carolina), and Stiefel Laboratories Inc (Triangle Park, North Carolina) Laboratories; a speaker or member of a speakers bureau for Allergan Inc (Irvine, California), Medicis Inc (Scottsdale, Arizona), QMed LLC (Charlotte, North Carolina), and sanofi-aventis Inc (Bridgewater, New Jersey); and a paid researcher for Coapt Systems Inc (Palo Alto, California), Medicis Inc (Scottsdale, Arizona), and Revance Therapeutics Inc (Newark, California) Therapeutics; he owns stock, stock options, or bonds from Allergan Inc (Irvine, California), Medicis Inc (Scottsdale, Arizona), and Revance Therapeutics Inc (Newark, California). Dr Bucay is a paid advisor or consultant for Medicis Inc (Scottsdale, Arizona), Allergan Inc (Irvine, California), Merz Pharmaceuticals LLC (Greensboro, North Carolina) Pharmaceuticals LLC, Syneron Medical Ltd (Irvine, California) Medical, Johnson & Johnson Inc (New Brunswick, New Jersey) Consumer Companies Inc, Johnson & Johnson Inc (New Brunswick, New Jersey) Pharmaceutical Research & Development, Valeant Pharmaceuticals North America, INC (Montreal, Quebec, Canada), Biopelle Division of Ferndale Laboratories Inc (Ferndale, Michigan), Novartis Pharmaceuticals Corporation Inc (Parsippany, New Jersey) Pharmaceuticals Corporation, and Elemé Medical Inc (Merrimack, New Hampshire) and a speaker or member of a speakers bureau for Medicis Inc (Scottsdale, Arizona), Allergan Inc (Irvine, California), Biopelle Division of Ferndale Laboratories Inc (Ferndale, Michigan), Elemé Medical Inc (Merrimack, New Hampshire), and Syneron Medical Ltd (Irvine, California) Medical Ltd. Dr Allen is a paid researcher and member of the speakers bureau for Medicis Inc (Scottsdale, Arizona). Dr Applebaum is a paid speaker and trainer for Medicis Inc (Scottsdale, Arizona). Dr Baumann is a paid researcher and advisory board member for Medicis Inc (Scottsdale, Arizona) and a researcher for Allergan Inc (Irvine, California). Dr Cox is a paid advisory board member, consultant, and researcher for Allergan Inc (Irvine, California) and Medicis Inc (Scottsdale, Arizona) and a paid researcher for Revance Therapeutics Inc (Newark, California). Dr Few is a paid advisor or consultant for Mentor LLC (Santa Barbara, California) Corporation, Allergan Inc (Irvine, California), Medicis Inc (Scottsdale, Arizona), Galderma Laboratories INC (Fort Worth, Texas)Laboratories, Merz Pharmaceuticals LLC (Greensboro, North Carolina) Pharmaceuticals, and Johnson & Johnson Inc (New Brunswick, New Jersey) Pharmaceutical Research & Development and a speaker or a member of a speakers bureau for Palomar Medical Technologies Inc (Burlington, Massachusetts). Dr Joseph is a paid national trainer, speaker, advisor, research and development board member, and paid researcher for Medicis Inc (Scottsdale, Arizona) and a researcher for the US Food and Drug Administration (Silver Spring, Maryland). Dr Lorenc is an advisor or consultant for Medicis Inc (Scottsdale, Arizona) and Johnson & Johnson Inc (New Brunswick, New Jersey) Pharmaceutical Research & Development. Dr Moraldi is a paid speaker, consultant, and advisory board member for Allergan Inc (Irvine, California), Medicis Inc (Scottsdale, Arizona), Skin Medica Inc (Carlsbad, California), and Merz Aesthetics Inc (San Mateo, California) Aesthetics Inc (San Mateo, California)-Merz Pharmaceuticals LLC (Greensboro, North Carolina) and a speaker-trainer for Sciton Inc (Palo Alto, California). Dr Nestor is a paid advisory board member for Medicis Inc (Scottsdale, Arizona), Galderma, Genentech Inc (San Francisco, California), Merz Pharmaceuticals LLC (Greensboro, North Carolina), and Beiersdorf Inc (Wilton, Connecticut); a consultant for Medicis Inc (Scottsdale, Arizona), Galderma, Ulthera Inc (Mesa, Arizona), Transdermal Technologies Inc (Palm Beach Gardens, Florida), and Erchonia Medical Inc (McKinney, Texas); a paid researcher for Medicis Inc (Scottsdale, Arizona), Galderma, Ulthera Inc (Mesa, Arizona), Transdermal Technologies Inc (Palm Beach Gardens, Florida), and Erchonia Medical Inc (McKinney, Texas); and a speaker for Ulthera Inc (Mesa, Arizona). Dr Schlessinger is a paid advisory board member or consultant for Abbott Pharmaceutical Inc (Waorcester, Massachusetts), Allergan Inc (Irvine, California), Amgen Inc (Thousand Oaks, California), Artes Biotechnology GmbH (Langenfeld, Germany), sanofi-aventis Inc (formerly Dermik; Bridgewater, New Jersey) (Bridgewater, New Jersey); Galderma, Genentech Inc (San Francisco, California), GSK/Stiefel Laboratories Inc (Triangle Park, North Carolina), Kythera Biopharmaceuticals Inc (Calabasas, California), Medicis Inc (Scottsdale, Arizona), Mentor LLC (Santa Barbara, California), Merz Pharmaceuticals LLC (Greensboro, North Carolina), Novartis Pharmaceuticals Corporation Inc (Parsippany, New Jersey), Obagi Medical Products Inc (Long Beach, California), and Ortho Pharma (Johnson & Johnson Inc (New Brunswick, New Jersey)); a researcher for 3M Pharma, Abbott Pharma, Allergan Inc (Irvine, California), Amgen Inc (Thousand Oaks, California), Astellas Pharma Inc (Northbrook, Illinois), Barrier Therapeutics Inc (Plainsboro, New Jersey), Biogen Idec Inc (Weston, Massachusetts), Janssen Biotech (formerly Centocor) Inc (Horsham, Pennsylvania), Clay-Park Labs Inc (Bronx, New York), Collagenex Pharmaceuticals Inc (Newtown, Pennsylvania), Stiefel Laboratories Inc (formerly Connetics; Triangle Park, North Carolina), sanofi-aventis Inc (formerly Dermik; Bridgewater, New Jersey), Laboratories Inc (Bridgewater, New Jersey); Bridgewater, New Jersey) Laboratories Inc (Bridgewater, New Jersey), Dow Pharmaceutical Sciences Inc (Petaluma, California), Lumenis Inc (Santa Clara, California) Inc (Santa Clara, California), Galderma, Genentech Inc (San Francisco, California), GSK/Stiefel Laboratories Inc (Triangle Park, North Carolina), Glenmark Pharmaceuticals Ltd (Andheri [E], Mumbai), HealthPoint Biotherapeutics Ltd (Fort Worth, Texas), Amgen Inc (Thousand Oaks, California) Inc (formerly Immunex; Thousand Oaks, California), Kythera Biopharmaceuticals Inc (Calabasas, California), Medicis Inc (Scottsdale, Arizona), Mentor LLC (Santa Barbara, California), Merz Pharmaceuticals LLC (Greensboro, North Carolina), Novartis Pharmaceuticals Corporation Inc (Parsippany, New Jersey), Novum Pharmaceutical LLC (Pittsburgh, Pennsylvania), Nucryst Pharmaceuticals Corp (Wakefield, Massachusetts), Ortho Pharma (Johnson & Johnson Inc (New Brunswick, New Jersey)), Penederm Inc (Foster City, California), Perrigo Inc (Allegan, Michigan), Pfizer Inc (New York, New York), QLT Inc (Vancouver, British Columbia, Canada), Regeneration Pharmaceuticals Inc (New York, New York) AG, Sandoz GmbH (a Novartis company; Holzkirchen, Germany), Merck (formerly Merck (formerly Schering-Plough) Inc (Whitehouse Station, New Jersey)) Inc (Whitehouse Station, New Jersey), Stiefel Laboratories Inc (Triangle Park, North Carolina) Labs, and UBC/Vitae; and a stockholder in Allergan Inc (Irvine, California), Revance Therapeutics Inc (Newark, California), Excel Cosmeceuticals Inc (Bloomfield Hills, Michigan), Medicis Inc (Scottsdale, Arizona), and Obagi Medical Products Inc (Long Beach, California). Dr Wortzman is an employee and shareholder of Medicis Inc (Scottsdale, Arizona). Dr Lawrence, Ms Lin, and Ms Nelson are employees of Medicis Inc (Scottsdale, Arizona).”






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