BOTULINUM Toxin lower face- Dr Rabia Ghafoor.pdf

Botox lower face

1. BOTULINUM TOXIN
LOWER FACE
DR. RABIA GHAFOOR
ASSISTANT PROFESSOR DERMATOLOGY
JINNAH POSTGRADUATE MEDICAL CENTRE KARACHI

2. Dr Sakina SadiqMalik
MBBS, FCPS, SCE (UK), MHPE (Riphah)
Dr Sakina SadiqMalik
MBBS, FCPS, SCE (UK), MHPE (Riphah)
No conflict of interest
to declare……

3. Outline Of Presentation
•Masseter
•DAO
•Mentalis
•Orbicularis Oris
ANATOMY
INDICATIONS
TECHNIQUE
WHAT TO AVOID
COMPLICATIONS

4. Masseter
•It is one of the
strongest muscle of
the body
•It is the a muscle of
mastication along with
temporalis.

5. Indications
•BRUXISM
ois the tightening and grinding of teeth while awake or asleep. Sleep-related
bruxism is a common condition that affects 15–40% of children and 8–10% of
adults
•TMJ dysfunction
ois characterized by jaw muscle and joint pain. It can also cause the jaw
to feel stiff and jaw locking and clicking.
•Jaw pain and clenching is a common problem that affects 5–
12% of the population.
•Tension Headache

6. •Facial Aesthetics
oMasseter gives face square shape which is masculine feature.
oBTX cause sliming of face giving more soft feminine look

7. ANATOMY
A. Superior: Ear lobe to angle
of mouth.
B. Posterior: 1cm from tragus.
C. Anterior: 1cm behind the
anterior border of the MM,
this can be felt by asking the
patient to clench and
palpating the border.
D. Inferior: 1cm above the
inferior margin of the
mandible

8. MASSETER BOTOX
•Mark a lie from angle of oral commissure
to tragus of ear.
•Localize angle of mandible
•As patient to clench teeth to localize
anterior border of masseter.
•Mar a quadrangle according to points.
•Toxin is injected at 3 or 4 points 1c away
from anterior border in the thicestpart
of muscle
•Dose is 15 to 30 Units.
•Injected in both superficial and deep
parts to avoid paradoxical bulging of
muscle.
TY -JOUR, AU -Lee, Edward Botulinum Toxin Type A for Treatment of Masseter Hypertrophy: Volumetric Analysis of Masseter Muscle Reduction over Time
-Archives of Aesthetic Plastic Surgery

9. Anatomy

10. Complications
•Masseter has superficial and
deep parts. Both parts need to
be injected otherwise may lead
to bulging masseter.
•Over injection may lead to
weakening and difficult
mastication
•Sunenchees

11. Depressor AnguliOris(DAO)
•DAO muscle originates from the
oblique line of the mandible and
inserts into the modiolus.
•Excessive contraction leads to
drooping of angle of
lips(Marionette line) giving sad
of depressed appearance.

13. Injection technique (DAO)
•Mark 1cm lateral and inferior to
angle of mouth.
•Inject 2 to 4 units intradermally.
•Avoid deep or medial injection
as risk of injecting depressor
labiiinferior.
•DLI injection will cause difficulty
in sipping and an asymmetric
smile.

14. Mentalis
•Mentalis muscle is lower lip
levator
•Hyperactive mentalis causes
pebbled or dimpled chin
called cobble stone chin.

15. ANATOMY
•Originates from the alveolar
bone inferior to the lateral
incisor and attaches medially
towards the skin, forming a
dome-shaped chin.

16. Injection technique -Mentalis
•As patient to aniatethe
expression which leads to
dimpled chin.
•Inject 1cm below mental sulcus
at 2 points , one on each side of
central dimple of chin.
•Dose : 2Units per muscle in
females , 3 to 5 units in males

18. What to Avoid
•Avoid injecting too high, which
leads to diffusion in orbicularis
orisand causes lip ptosis or
drooling.
•Avoid injecting too lateral into
depressor labiiwhich will cause
asymmetric smile.
•Kidney bean chin

19. •Lateral diffusion of
toxin to Depressor
labii

20. •Kidney bean chin

21. Perioral Rhytides
•Vertical lip lines, bar code lines,
or smoker’s lines.
•Due to excessive contraction of
orbicularis oris.
•Play a major role in lower face
aesthetics.

22. •Toxin is injected superficially at
or above the vermillion border.
•Dose ranges from 1 to 2 U per
injection site.

23. Natalie Semchyshynand Roberta D. Sengelmann, Botulinum Toxin A Treatment of
Perioral Rhytides, Dermatologic Surgery,2003,29.490–495},

24. Side effects
•Difficulty in pronouncing b and p , so avoided in public speakers and
singers.
•Avoid too lateral injections as may cause drooping of corners of
mouth.