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Adapting Injection Techniques to Different Regions
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana, Nicholas Moellhoff
The labiomandibular sulcus is an area of great aesthetic interest as its treatment influences not only the oral region but also the midface and the lower face regions. The sulcus is anatomically formed very similarly to the nasolabial sulcus: muscles of facial expression insert into the skin and form a natural boundary. This natural boundary determines the jowl formation posterior to the sulcus and the depth of the pre-jowl sulcus anterior to it. Due to its close muscular interaction with the depressor anguli oris muscle, it affects the position of the corner of the mouth with an increased muscle tone resulting in its depression.
The lower third of the face
Published in Jani van Loghem, Calcium Hydroxylapatite Soft Tissue Fillers, 2020
The Depressor Anguli Oris muscle, the Depressor Labii Inferioris muscle, and the Mentalis muscle are all connected superiorly to the Orbicularis Oris muscle; and inferiorly, the Depressor Angili Oris muscle (DAO) is connected to the Platysma muscle (Figure 16.1).
Lips
Published in Ali Pirayesh, Dario Bertossi, Izolda Heydenrych, Aesthetic Facial Anatomy Essentials for Injections, 2020
Ali Pirayesh, Raul Banegas, Per Heden, Khalid Alawadi, Jennifer Gaona, Alwyn Ray D’Souza
The inferior labial artery is also a branch of the facial artery and generally arises below or at the level of the labial commissure, seldom above it. Its mean diameter ranges 1.2–1.4 mm. As with the superior labial artery, the point at which the inferior labial artery branches from the facial artery and the distance between its origin and the labial commissure exhibits a high variability ranging from 0.5 to 4 cm, with a mean distance of 2–2.5 cm. After branching from the facial artery, it runs tortuously upward to the lower lip, deep to the depressor anguli oris muscle. The artery penetrates the orbicularis oris muscle and runs tortuously along the edge of the lower lip, lying between the muscle and the mucous membrane [10].
An unusual tell sign of botulinum toxin injection in patients with facial flushing: incorporating a new questionnaire in the evaluation of botulinum toxin patients
Published in Journal of Cosmetic and Laser Therapy, 2021
Anthony Ballan, Marwan Nasr, Samer Jabbour
In November 2020, a previously healthy 33-year-old female presented to our clinic for concerns about her glabellar, forehead and lateral orbicularis rhytids and for the treatment of her depressor angulis ori muscles. The patient has never been injected before, she was evaluated for allergies, pregnancy, lactation, chronic conditions, and local inflammations. There were no particularities on physical examination concerning skin conditions. The patient was not assessed for intermittent facial flushing as this was not part of our preprocedural evaluation routine. The practitioner concluded that this patient could benefit from upper face botulinum toxin injections. Therefore, she was injected 62 units of Onabotulinum toxin, divided as following: 20 UI for the glabella, 18 UI for the forehead, and 20 UI for the crow’s feet area, and 2 UI per depressor anguli oris muscle. All injections were done intramuscularly. At 2 weeks follow up, the patient was unsatisfied with the result. Although all her dynamic wrinkles have disappeared, she states that her facial skin tone is no longer homogeneous as white patches inevitably appear after her daily workout, after alcohol consumption and even when she is angry or embarrassed. She describes white patches in the areas corresponding to the botulinum injection points, that suddenly appear and last approximately 2 to 3 hours. Figure 1a,b were taken by the patient 1 hour after her exercise session.