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Anat Cell Biol 2023; 56(4): 409-414

Published online December 31, 2023

https://doi.org/10.5115/acb.23.054

Copyright © Korean Association of ANATOMISTS.

Botulinum neurotoxin injection for treating plunged nose and post-rhinoplasty: anatomical perspectives of depressor septi nasi, nasalis, leveator labii superioris alaeque nasi muscle

Kyu-Ho Yi1,2 , Ji-Hyun Lee3 , Seon-Oh Kim4 , Hyewon Hu1 , Hyung-Jin Lee5 , You-Jin Choi6 , Tae-Hwan Ahn7 , Hee-Jin Kim1

1Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, 2Maylin Clinic (Apgujeong), Seoul, 3Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam, 4Aura Clinic, Seoul, 5Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 6Department of Anatomy, College of Medicine, Konkuk University, Chungju, 7Fresh Facial Aesthetic Surgery and ENT Clinic, Seoul, Korea

Correspondence to:Hee-Jin Kim
Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul 03722, Korea
E-mail: hjk776@yuhs.ac

Received: February 24, 2023; Revised: May 10, 2023; Accepted: May 24, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Botulinum neurotoxin (BoNT) injection for the treating plunged nose, post-rhinopasty and hyaluronic filler migration is common procedures in clinical settings. However, the lack of thorough anatomical understanding makes it difficult to locate the nose region muscles. The anatomical considerations concerned with BoNT injection into the nasalis, levator labii superioris alaeque, and depressor septi nasi muscles were reviewed in this study. The injection spots have been presented for the nasalis, levator labii superioris alaeque, and depressor septi nasi muscles, with the recommended injection technique for each muscle. We have suggested the ideal injection sites in association with outer anatomical landmarks of the nose region. Moreover, these proposals would support a more accurate procedure of BoNT injection in relieving plunged nose, preventing post-rhinoplasty deviation, and migration of the hyaluronic acid filler.

Keywords: Nasalis, Levator labii superioris alaque nasi, Depressor septi nasi, Botulinum neurotoxin, Plunged nose

Botulinum neurotoxin (BoNT) prevents neural communication by blocking the release of acetylcholine at the neuronal muscular junction, thereby obstructing muscle contraction [1-9]. Practitioners frequently use BoNT for aesthetic purposes, mainly to eliminate facial wrinkles by weakening the facial muscles [10-20]. Persons with well-developed nasalis and depressor septi nasi muscles (DSN) have a plunged nose tip; a plunged nose exaggerates when one smiles. This nose tip can be elevated by paralyzing the associated muscles with BoNT (Fig. 1).

Figure 1. The primary aesthetic worries plunged nose tip for many individuals. The appearance in absence of facial expression (A). The plunged nose appears when smiling (B).

Another indication of using BoNT injection in the nose is after hyaluronic acid filler injection into the nose; hyaluronic acid dermal fillers, restores the volume while BoNT inactivates the muscle [21, 22]. Thus, the combination of BoNT with soft tissue augmentation is a highly effective multi-step treatment for contouring and reshaping the nose [21, 22].

The DSN and nasalis muscles are known to affect the outcome of rhinoplasty. The relapse of a deviated nose after rhinoplasty could be due to implant or graft migration [23, 24]. To avoid a deviated nose and asymmetry, the roles of the postoperative patient are not to use excessive facial expressions and avoid chewing solid food [25, 26].

When treating the nose region with BoNT, side effects such as diplopia and upper lip ptosis may be caused by unintended blocking of the rectus inferioris or rectus medialis and levator labii superioris alaeque nasi, respectively. Other critical complications may include chewing and speaking struggles due to diffusion of BoNT into nearby muscles such as the orbicularis oris. For a better treatment outcome, the procedure should be initiated at a less significant dosage. If the preferred effects are not achieved, an additional dose of BoNT can be used. Moreover, an increase in the dose and multiple injections of BoNT creates antibodies that can lead to inadequate treatment outcomes [27-30]. Numerous previous studies on BoNT injection have elaborated on the anatomy of the muscles [14-16, 18, 31-38].

The purpose of this study was to suggest safe and effective BoNT injection points and injection techniques for treating plunged nose tip, post-rhinoplasty and migration of hyaluronic acid filler injection in the nose.

The nasalis muscle can be divided into alar and transverse parts. The transverse part of the nasalis muscle is a triangular-shaped muscle that starts from the maxillary canine fossa and inserts into the lateral nasal cartilage. On the other hand, the alar part of nasalis muscle is a square-shaped muscle that originates from the maxillary lateral incisor and inserts into the minor alar cartilage. The transverse part of the nasalis muscle narrows the nostrils by contraction of the nasal aperture, while the alar part of the nasalis muscle widens the nostrils.

The levator labii superioris alaeque nasi muscle (LLSAN) originates from the maxillary frontal process and inserts into the nasal ala and upper lip. The LLSAN can be divided into superficial and deep layers. The superficial layer continues inferiorly to the superficial layer of the levator labii superioris muscle and the deep layer runs deep to the levator labii superioris muscle.

The DSN is located deep within the lip. It originates from the incisive fossa of the maxilla, inserts into the mobile portion of the nasal septum, and intermingles with the deep muscle fibers of the orbicularis oris muscle. This muscle pulls down the tip of the nose to enlarge the nostrils (Fig. 2). This muscle also shortens the upper lip during smiling.

Figure 2. The schematic representation of the lateral (A) and inferior (B) views of the depressor septi nasi muscle. The purple shaded muscle is part of depressor septi nasi muscle that connects the orbicularis oris muscle.

Treating plunged nose, post-rhinoplasty, and hyaluronic acid filler injections can be improved through BoNT injections into the DSN, LLSAN, and nasalis muscles. The DSN originates from the nasal spine and inserts into the tip of the nose, pulling down and plunging the nose tip during smiling. LLSAN inserts into the ala nasi, pulling it superolaterally. The nasalis is involved in nose movement because it is responsible for pressing, widening, or narrowing the nares. Therefore, injections into the DSN, LLSAN, and nasalis are required for satisfactory treatment outcomes.

Four units (4 U) of BoNT are injected deeply after the needle tip touches the bone, into the subnasale inferior towards the columella (targeting the DSN). This is followed by superficially injecting 2 U of BoNT 1 cm above the medial end of the supra-alar crease (targeting the transverse part of nasalis muscle). Additionally, a deep injection of 2 U is administered into the lower part of the LLSAN on each side. The location for targeting the lower part of LLSAN is 1 cm lateral to the middle of the nasal alar crest (Fig. 2).

The contouring of the nose is an important correction technique of plastic reconstructive surgery and aesthetic settings. To treat and alter the shape of the nose, BoNT treatment alone, or combined therapy with rhinoplasty and/or hyaluronic acid filler injection in the nose is often conducted.

A plunged nose is also an aging sign that causes drooping of the nasal tip and increasing prominence of the dorsal hump. There is a comparative shortening of the lower third of the face and comparative lengthening. This is due to the loss of support of the lateral cartilage, leading to drooping of the nose tip, and highlighting the nose dorsum convexity [39]. To alleviate this problem, BoNT injection is commonly administered in the nose to correct the aging plunged nose. In contrast, in persons with well-developed nasalis and depressor septi nasi muscles, the nose tip can be elevated by paralyzing these muscles with BoNT. In 2013, Cigna et al. [40] performed a double-blinded prospective study on the effect of BoNT on the plunged nose tip and found that the nose tip was elevated and the philtrum lengthened after BoNT was injected into the depressor septi nasi muscle.

In addition, combination therapy with BoNT and hyaluronic acid dermal filler injections is often performed. The consecutive treatment with BoNTs following filler injection has been shown to increase the durability of tissue retention of the filling agent and prevent the migration of fillers [21, 22, 31, 32, 34, 41-46]. The BoNT and dermal fillers may contour the nose appearance through double inactivation of the involved muscles and reflation. With dermal fillers, the volume of nose is restored and BoNT inactivates muscle movements. Although dermal filler should be principally regarded for elevation of the nose tip, BoNT helps stabilize and maintain the structure of the dermal filler by reducing absorption and preventing migration through nasal muscle contraction [25, 26].

In plastic and reconstructive surgery of the nose, the nasalis and DSN are well known to influence the outcome of rhinoplasty. The reappearance of a deviated nose can occur after corrective rhinoplasty is performed due to implant and graft migration [23, 24]. BoNT efficiently inactivates the nose muscles after corrective rhinoplasty to prevent the recurrence of deviation due to the movements of the nose and facial muscles [39, 47, 48]. Particularly, the DSN links the motion of the nose and lips by intermingling two separate muscular structures. Therefore, several articles have been published on cutting the connecting part of the orbicularis oris muscle and depressor septi nasi after nose plastic and reconstructive surgery [39]. Rohrich et al. [39] proved the importance of this muscle in an anatomic study with dissected cadavers to classify DSN . They classified DSN into three types and reported that the DSN showed a distal insertion of the orbicular oris muscle in 62% of cases (Fig. 3) [49-51].

Figure 3. Injection point for the plunged nose, post- rhinoplasty, hyaluronic acid filler injection. The injection amount for each point for targeting transverse part of nasalis muscle (yellow dot), alar part of nasalis muscle (blue dot), and depressor septi nasi (red dot). Each points can be injected in botulinum neurotoxin units of 2, 2, and 4. ESAC, end of the supra-alar crease.

A broad and precise anatomical knowledge of the nose region muscles is essential for a satisfactory treatment with the lowest possible doses of BoNT. We have reviewed the anatomical structures and proposed injection techniques for the nose region muscles for treating plunged nose tip, post-rhinoplasty and migration of hyaluronic acid dermal filler injection. As BoNT injection procedure is frequently performed in the nose region, side effects such as paralysis of adjacent muscles and lip ptosis have been reported [39].

In summary, 4 U of BoNT is injected deeply after the needle tip touches the bone into the subnasale inferior to the columella (targeting the DSN). This is followed by superficially injecting 2 U to 1 cm above the medial end of the supra-alar crease (targeting the transverse part of the nasalis muscle). Additionally, deep injection of 2 U was administered into the lower part of the LLSAN on each side. The lower part of the LLSAN was targeted 1 cm lateral to the middle of the nasal alar crest. This study proposes BoNT injection points in the nose region to provide an anatomical guide for practitioners.

The authors sincerely thank those who donated their bodies to science for anatomical research. The results of such research can potentially increase mankind's overall knowledge, which can improve patient care. Therefore, these donors and their families deserve our highest gratitude. The authors thank Eun-Byul Yi from Eonbuk elementary school for illustrations.

This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 1711138194, KMDF_PR_20200901_0109-01).

Conceptualization: KHY, HJK. Data acquisition: JHL. Data analysis or interpretation: SOK, HH. Drafting of the manuscript: HJL, YJC. Critical revision of the manuscript: THA. Approval of the final version of the manuscript: all authors.

  1. Dessy LA, Mazzocchi M, Rubino C, Mazzarello V, Spissu N, Scuderi N. An objective assessment of botulinum toxin A effect on superficial skin texture. Ann Plast Surg 2007;58:469-73.
    Pubmed CrossRef
  2. Childers MK. Targeting the neuromuscular junction in skeletal muscles. Am J Phys Med Rehabil 2004;83(10 Suppl):S38-44.
    Pubmed CrossRef
  3. Yi KH, Cong L, Bae JH, Park ES, Rha DW, Kim HJ. Neuromuscular structure of the tibialis anterior muscle for functional electrical stimulation. Surg Radiol Anat 2017;39:77-83.
    Pubmed CrossRef
  4. Rha DW, Yi KH, Park ES, Park C, Kim HJ. Intramuscular nerve distribution of the hamstring muscles: Application to treating spasticity. Clin Anat 2016;29:746-51.
    Pubmed CrossRef
  5. Lee JJ, Yi KH, Kim HS, An MH, Seo KK, Chang-Hun H, Kim HJ. A novel needle-free microjet drug injector using Er:YAG LASER: a completely new concept of transdermal drug delivery system. Clin Anat 2022;35:682-5. Erratum in: Clin Anat 2022; 35:1152.
    Pubmed CrossRef
  6. Lee HJ, Lee JH, Yi KH, Kim HJ. Intramuscular innervation of the supraspinatus muscle assessed using Sihler's staining: potential application in myofascial pain syndrome. Toxins (Basel) 2022;14:310.
    Pubmed KoreaMed CrossRef
  7. Yi KH, Lee JH, Kim GY, Yoon SW, Oh W, Kim HJ. Novel anatomical proposal for botulinum neurotoxin injection targeting lateral canthal rhytids. Toxins (Basel) 2022;14:462.
    Pubmed KoreaMed CrossRef
  8. Lee HJ, Lee JH, Yi KH, Kim HJ. Sonoanatomy and an ultrasound scanning protocol of the intramuscular innervation pattern of the infraspinatus muscle. Reg Anesth Pain Med 2023;48:175-9.
    Pubmed CrossRef
  9. Kim HM, Ree YS, Park MS, Kim JS, Ahn JH, Yi KH. Clinical guideline: deoxycholic acid injection for submental fat reduction. The Aesthetics 2022;3:7-11.
    CrossRef
  10. Yi KH, Lee JH, Hu HW, Park HJ, Bae H, Lee K, Kim HJ. Novel anatomical guidelines for botulinum neurotoxin injection in the mentalis muscle: a review. Anat Cell Biol 2023 Feb 17 [Epub]. https://doi.org/10.5115/acb.22.266
    Pubmed KoreaMed CrossRef
  11. Yi KH, Lee JH, Hu HW, Choi YJ, Lee K, Lee HJ, Kim HJ. Novel anatomical proposal for botulinum neurotoxin injection targeting depressor anguli oris for treating drooping mouth corner. Anat Cell Biol 2023 Feb 21 [Epub]. https://doi.org/10.5115/acb.22.258
    Pubmed KoreaMed CrossRef
  12. Yi KH, Lee JJ, Hur HW, Bae H, Kim HJ. Hyaluronic acid filler injection for deep nasolabial folds: a novel intraoral approach. Clin Anat 2022;35:820-3.
    Pubmed CrossRef
  13. Yi KH, Lee JH, Lee K, Hu HW, Lee HJ, Kim HJ. Anatomical proposal for botulinum neurotoxin injection targeting the platysma muscle for treating platysmal band and jawline lifting: a review. Toxins (Basel) 2022;14:868.
    Pubmed KoreaMed CrossRef
  14. Yi KH, Lee HJ, Seo KK, Kim HJ. Botulinum neurotoxin injection guidelines regarding flap surgeries in breast reconstruction. J Plast Reconstr Aesthet Surg 2022;75:503-5.
    Pubmed CrossRef
  15. Yi KH, Lee HJ, Lee JH, Seo KK, Kim HJ. Application of botulinum neurotoxin injections in TRAM flap for breast reconstruction: intramuscular neural arborization of the rectus abdominis muscle. Toxins (Basel) 2021;13:269.
    Pubmed KoreaMed CrossRef
  16. Yi KH, Lee HJ, Choi YJ, Lee K, Lee JH, Kim HJ. Anatomical guide for botulinum neurotoxin injection: application to cosmetic shoulder contouring, pain syndromes, and cervical dystonia. Clin Anat 2021;34:822-8.
    Pubmed CrossRef
  17. Yi KH, Lee JH, Hu HW, Kim HJ. Novel anatomical guidelines on botulinum neurotoxin injection for wrinkles in the nose region. Toxins (Basel) 2022;14:342.
    Pubmed KoreaMed CrossRef
  18. Yi KH, Lee JH, Kim HM, Kim HJ. The botulinum neurotoxin for pain control after breast reconstruction: neural distribution of the pectoralis major muscle. Reg Anesth Pain Med 2022;47:322-6.
    Pubmed CrossRef
  19. Yi KH, Lee JH, Hu HW, Kim HJ. Anatomical proposal for botulinum neurotoxin injection for glabellar frown lines. Toxins (Basel) 2022;14:268.
    Pubmed KoreaMed CrossRef
  20. Yi KH, Lee HJ, Hur HW, Seo KK, Kim HJ. Guidelines for botulinum neurotoxin injection for facial contouring. Plast Reconstr Surg 2022;150:562e-71e.
    Pubmed CrossRef
  21. Coleman KR, Carruthers J. Combination therapy with BOTOX and fillers: the new rejuvnation paradigm. Dermatol Ther 2006;19:177-88.
    Pubmed CrossRef
  22. Fagien S, Brandt FS. Primary and adjunctive use of botulinum toxin type A (Botox) in facial aesthetic surgery: beyond the glabella. Clin Plast Surg 2001;28:127-48.
    Pubmed CrossRef
  23. Lee W, Ahn TH, Cheon GW, Lee MJ, Yang EJ. Comparative analysis of botulinum toxin injection after corrective rhinoplasty for deviated nose and alar asymmetry. J Cosmet Dermatol 2021;20:451-6.
    Pubmed CrossRef
  24. Cerkes N. The crooked nose: principles of treatment. Aesthet Surg J 2011;31:241-57.
    Pubmed CrossRef
  25. Nettar K, Maas C. Facial filler and neurotoxin complications. Facial Plast Surg 2012;28:288-93.
    Pubmed CrossRef
  26. Klein AW. Complications, adverse reactions, and insights with the use of botulinum toxin. Dermatol Surg 2003;29:549-56; discussion 556.
    Pubmed CrossRef
  27. Hsu TS, Dover JS, Arndt KA. Effect of volume and concentration on the diffusion of botulinum exotoxin A. Arch Dermatol 2004;140:1351-4.
    Pubmed CrossRef
  28. Kinnett D. Botulinum toxin A injections in children: technique and dosing issues. Am J Phys Med Rehabil 2004;83(10 Suppl):S59-64.
    Pubmed CrossRef
  29. Lepage D, Parratte B, Tatu L, Vuiller F, Monnier G. Extra- and intramuscular nerve supply of the muscles of the anterior antebrachial compartment: applications for selective neurotomy and for botulinum toxin injection. Surg Radiol Anat 2005;27:420-30.
    Pubmed CrossRef
  30. Pingel J, Nielsen MS, Lauridsen T, Rix K, Bech M, Alkjaer T, Andersen IT, Nielsen JB, Feidenhansl R. Injection of high dose botulinum-toxin A leads to impaired skeletal muscle function and damage of the fibrilar and non-fibrilar structures. Sci Rep 2017;7:14746.
    Pubmed KoreaMed CrossRef
  31. Yi KH, Lee KL, Lee JH, Hu HW, Lee K, Seo KK, Kim HJ. Guidelines for botulinum neurotoxin injections in piriformis syndrome. Clin Anat 2021;34:1028-34.
    Pubmed CrossRef
  32. Yi KH, Lee JH, Lee DK, Hu HW, Seo KK, Kim HJ. Anatomical locations of the motor endplates of sartorius muscle for botulinum toxin injections in treatment of muscle spasticity. Surg Radiol Anat 2021;43:2025-30.
    Pubmed KoreaMed CrossRef
  33. Yi KH, Lee HJ, Lee JH, Lee KL, Kim HJ. Effective botulinum neurotoxin injection in treating iliopsoas spasticity. Clin Anat 2021;34:431-6.
    Pubmed CrossRef
  34. Yi KH, Lee HJ, Seo KK, Kim HJ. Intramuscular neural arborization of the latissimus dorsi muscle: application of botulinum neurotoxin injection in flap reconstruction. Toxins (Basel) 2022;14:107.
    Pubmed KoreaMed CrossRef
  35. Yi KH, Lee JH, Hur HW, Lee HJ, Choi YJ, Kim HJ. Distribution of the intramuscular innervation of the triceps brachii: clinical importance in the treatment of spasticity with botulinum neurotoxin. Clin Anat 2023 Jan 6 [Epub]. https://doi.org/10.1002/ca.24004
    Pubmed CrossRef
  36. Yi KH, Rha DW, Kim HJ, Hu KS. Reply. Muscle Nerve 2016;54:513-4.
    Pubmed CrossRef
  37. Yi KH, Rha DW, Lee SC, Cong L, Lee HJ, Lee YW, Kim HJ, Hu KS. Intramuscular nerve distribution pattern of ankle invertor muscles in human cadaver using Sihler stain. Muscle Nerve 2016;53:742-7.
    Pubmed CrossRef
  38. Yi KH, Lee JH, Kim HJ. Intramuscular neural distribution of the serratus anterior muscle: regarding botulinum neurotoxin injection for treating myofascial pain syndrome. Toxins (Basel) 2022;14:271.
    Pubmed KoreaMed CrossRef
  39. Rohrich RJ, Huynh B, Muzaffar AR, Adams WP Jr, Robinson JB Jr. Importance of the depressor septi nasi muscle in rhinoplasty: anatomic study and clinical application. Plast Reconstr Surg 2000;105:376-83; discussion 384-8.
    Pubmed CrossRef
  40. Cigna E, Sorvillo V, Stefanizzi G, Fino P, Tarallo M. The use of botulinum toxin in the treatment of plunging nose: cosmetic results and a functional serendipity. Clin Ter 2013;164:e107-13.
  41. Kim JW, Choi YJ, Lee HJ, Yi KH, Kim HJ, Hu KS. Anatomic study of the dorsalis pedis artery, first metatarsal artery, and second metatarsal bone for mandibular reconstruction. J Oral Maxillofac Surg 2015;73:1627-36.
    Pubmed CrossRef
  42. Yi KH, Lee KL, Lee JH, Hu HW, Kim HJ. Guidance to trigger point injection for treating myofascial pain syndrome: intramuscular neural distribution of the quadratus lumborum. Clin Anat 2022;35:1100-6.
    Pubmed CrossRef
  43. Yi KH, Choi YJ, Cong L, Lee KL, Hu KS, Kim HJ. Effective botulinum toxin injection guide for treatment of cervical dystonia. Clin Anat 2020;33:192-8.
    Pubmed CrossRef
  44. Yi KH, Kim HJ. Is variation in posterior tibial veins a risk factor for deep-vein thrombosis?. Clin Anat 2021;34:829-34.
    Pubmed CrossRef
  45. Yi KH, Lee JJ, Hur HW, Kim HJ. Anatomical consideration of deep calf veins: application to catheter-directed thrombolysis. Surg Radiol Anat 2021;43:2071-6.
    Pubmed KoreaMed CrossRef
  46. Yi KH, Lee HJ, Choi YJ, Lee JH, Hu KS, Kim HJ. Intramuscular neural distribution of rhomboid muscles: evaluation for botulinum toxin injection using modified Sihler's method. Toxins (Basel) 2020;12:289.
    Pubmed KoreaMed CrossRef
  47. Daniel RK, Glasz T, Molnar G, Palhazi P, Saban Y, Journel B. The lower nasal base: an anatomical study. Aesthet Surg J 2013;33:222-32. Erratum in: Aesthet Surg J 2013;33:619.
    Pubmed CrossRef
  48. Sundaram H, Signorini M, Liew S, Trindade de Almeida AR, Wu Y, Vieira Braz A, Fagien S, Goodman GJ, Monheit G, Raspaldo H. Global aesthetics consensus: botulinum toxin type A--evidence-based review, emerging concepts, and consensus recommendations for aesthetic use, including updates on complications. Plast Reconstr Surg 2016;137:518e-29e.
    Pubmed KoreaMed CrossRef
  49. De Souza Pinto EB, Da Rocha RP, Filho WQ, Neto ES, Zacharias KG, Amâncio A, Braz de Camargo A. Anatomy of the median part of the septum depressor muscle in aesthetic surgery. Aesthetic Plast Surg 1998;22:111-5.
    Pubmed CrossRef
  50. Benlier E, Top H, Aygit AC. A new approach to smiling deformity: cutting of the superior part of the orbicularis oris. Aesthetic Plast Surg 2005;29:373-7; discussion 378.
    Pubmed CrossRef
  51. Preceruti P. Importance of the depressor septi nasal muscle in rhinoplasty: anatomic study and clinical application. Plast Reconstr Surg 2001;107:1081-2.
    Pubmed CrossRef

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