This study demonstrates that FCT is an effective treatment option to reduce horizontal dynamic forehead wrinkles. The novel, non-toxin based approach produces immediate results with nothing left behind in the patient. The treatment itself is well-tolerated and yields high satisfaction rate among patients.
After piercing the parotid fascia, the temporal branch of the facial nerve divides into three rami, namely the anterior, middle, and posterior rami7,8. The anterior ramus innervates orbicularis oculi and corrugator supercilii muscles. The middle branch innervates the ipsilateral frontalis muscle and the posterior branch innervates the anterior and superior auricular and tragus muscles. The course of the temporal branch of the facial nerve in the temple region varies significantly between individuals and as a result, the number of FCT cycles required in each temple cannot be accurately predicted7-9. The FCT treatment time is also longer when compared with neurotoxin treatments, especially on the patient’s first visit. It is during the first visit that the physician ‘maps’ out the unique branching pattern for the patient by assessing each FCT cycle and recording the cycles that gave a positive result. When the same patient returns for the next treatment, only the positive cycles are repeated. Hence, by the patient’s second visit for FCT, the length of the treatment is significantly shortened. Typically, the first treatment takes approximately 1 hour while repeat treatments take less than 30 minutes. Apart from its varied course, the depth of the rami in the temple region can also be affected by the thickness of subcutaneous fat and temporal parietal fascia8,9. As the thickness of the subcutaneous fat layer tends to be directly related to the temple contour, FCT treatment is only suitable for patients with flat or concave temples9.
FCT is not a new concept. However, myoscience, Inc. has refined the therapy for use targeting peripheral nerves and, in this case, the facial nerve for aesthetic purposes. As with all treatments, safety is key. The mechanisms of axon degeneration and regeneration are well understood and as long as FCT is not causing third or fourth degree degenerations, permanent effects to the nerve can never be achieved10. With the boiling point of nitrous oxide being -88.5°C, it is impossible to cause injuries to the target nerves beyond second degree (Wallerian) degeneration with FCT4,10. The adverse effects reported with FCT during this study were minimal and comparable to other needle-based treatments. The reported adverse effects were bruising, swelling, redness of the treated area, and short-lived pain associated with swelling.
As demonstrated in this study, direct application of FCT on the temporal branches of the facial nerve will result in temporary reduction in dynamic facial wrinkles. Current treatments for dynamic wrinkles involve the use of neurotoxins which inhibit nerve signalling, sometimes with undesirable side-effects11. The requirement of periodic neurotoxin injections have also resulted in immune-resistance for some aesthetic indications11. FCT offers a toxin-free alternative to relax specific groups of muscles with reproducible results and without the risk of long-term side-effects.
A flexible alternative
An added advantage of FCT treatment is flexibility — physicians are able to tailor the treatment to the extent of the individual’s desire (Figure 3). Some patients want to preserve certain natural movements and physicians can help guarantee this by involving the patient in mid-treatment evaluation. Indeed, one participant in this study wanted only mild improvement in horizontal dynamic forehead lines and was satisfied with an improvement score of 1 (which was not considered to be a significant improvement according to our set definition) (Table 1). As the axon regenerates at a rate of 1–2 mm per day, muscle contractility and associated dynamic wrinkles will return gradually within 16 weeks post-FCT treatment.
Using FCT platform technology, physicians now have a gentle, safe and elegant device to temporarily inhibit the motor nerves responsible for forehead and glabellar dynamic wrinkles. With twice the population of neurotoxin users being averse to neurotoxin injections, FCT offers an effective alternative to help fulfil the aesthetic demand for treatment of dynamic wrinkles.