Botulinum Toxin for Facial Harmony

Altamiro Flávio

• Publisher: Quintessence Publishing Co, Inc
• Year: 2019
• eBook ISBN: 9780867159981
• Topic: Medicine
• Subtopic: Dentistry

The mastery of dentistry brings esthetic knowledge of the face that is applicable to more than just the teeth. In the process of performing a complete facial analysis, the practitioner can identify asymmetries and concerns localized to an area—such as the forehead, eyebrows, nose, or lower face—and offer Botox therapy to increase facial harmony. This book outlines the many clinical uses for Botox, with detailed illustrations and case presentations to support each procedure. The first part of the book covers systematic facial analysis, photographic documentation, and how to plan treatment. Special attention is paid to the anatomy and physiology of the face and the identification of injection points. Detailed treatment instructions for dosage, syringe type, and needle size are included for each procedure, as well as guidelines on how to evaluate results anthropometrically to determine whether esthetic treatment goals have been met. This stunning book will change the way you approach facial analysis and widen your esthetic treatment options for patients.

CHAPTER

03

Muscles: Injection Technique and Location

Because the insertion plane of botulinum toxin (BTX) is intramuscular, it is fundamental that clinicians know the location and depth of each facial muscle. Once this information has been studied, the muscles can be drawn on the face of a volunteer as an exercise to help the clinician “own the knowledge” (Fig 3-1). The correct position of muscles can be found by using facial expressions, palpation, and facial esthetic references (Box 3-1).

Fig 3-1 Muscles drawn on the face.

Box 3-1 Methods of locating the facial muscles

FACIAL EXPRESSIONS	PALPATION	ESTHETIC REFERENCES
The muscles of facial expression are not covered by a fascia; they originate and/or insert directly into the skin, thereby pulling the skin during muscle contraction. In order to find these muscles, patients are asked to make a specific facial expression that makes their position predictable.	The muscles of mastication are covered by a fascia that isolates them from the skin. Therefore, they do not cause skin wrinkles and/or mimicry. During contraction, their volume is noticeable through palpation.	Some muscles are not noticeable through palpation or facial expressions. A better way to find them would be to make drawings over the bones and other anatomical structures. Doing so will create esthetic references that will help to locate the muscles.
Muscles: occipitofrontalis, procerus, corrugator supercilii, orbicularis oculi, nasalis, orbicularis oris, depressor anguli oris, platysma	Muscles: temporalis, masseter; use palpation as a complementary method to find the depressor anguli oris	Muscles: depressor septi nasi, levator labii superioris alaeque nasi, levator labii superioris, levator anguli oris, zygomaticus major and minor, mentalis

Scan this QR code to access videos demonstrating how to mark injection points for all the muscles illustrated in this chapter.

How Does BTX Affect Facial Muscles?

Some muscles are named for their function. Therefore, an easy way to comprehend the effect of BTX on a muscle is to understand that BTX creates the action opposite to the muscle name. For example, after BTX injection, the action force of the depressor labii inferioris muscle will be reduced so that the muscle will depress to a lesser extent. The final result will be an increased horizontal position of the lower lip from its actual position. Figure 3-2 shows another example.

Fig 3-2 Action of BTX on the depressor anguli oris muscle.

Dosing by Muscle

A common doubt among novices is the appropriate amount of toxin to inject in each facial muscle. A helpful way to organize these dosages is to separate them by type of muscle. There are two different types of facial muscles: the muscles responsible for mastication and the muscles responsible for facial expression. Because the masticatory muscles are larger, longer, and stronger due to their function, they require larger doses of toxin. On the other hand, the muscles of facial expression are thinner, shorter, and weaker because their only function is to contract the skin. Thus, they require smaller doses of toxin.

There is no such thing as an exact number of units to be injected in each case. In...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Foreword by Christian Coachman
• Foreword by Paulo V. Soares
• Preface
• 01 Basic Principles of Botulinum Toxin
• 02 Facial Analysis and Photographic Documentation
• 03 Muscles: Injection Technique and Location
• 04 Clinical Cases
• Index
• Backcover