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Anatomy of the Midface
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Stephen A. Goldstein, Evan Ransom
The zygomaticus minor muscle may complement the action of the zygomaticus major and levator labii. Interestingly, this muscle is frequently absent (13). In a dissection study, Pessa et al. describe seven patterns of midfacial musculature with the most common pattern being a single zygomaticus major with paired upper lip elevators (levator labii superioris and levator alae nasi) (11). When present, the zygomaticus minor originates medial to the zygomaticus major on the inferomedial aspect of the zygomatic bone and inserts at the lateral most upper lip. Contraction of this muscle raises the upper lip alone, as in a snarl or expression of contempt. The risorius muscle originates at the platysma and masseteric fascia and attaches to the complex of muscles at the angle of the mouth. Like the zygomaticus minor, this muscle is frequently absent (7). Contraction of the risorius results in lateral excursion of the oral commissure and produces a grinning expression or a toothless smile.
Beyond the obvious: Beauty optimization with botulinum toxin
Published in Anthony V. Benedetto, Botulinum Toxins in Clinical Aesthetic Practice, 2017
Arthur Swift, B. Kent Remington, Steve Fagien
Surgical Anatomy Pearls: The risorius muscle originates in a fan-like distribution from the anterior fascia of the masseter and parotid gland to insert horizontally in the modiolus of the periorbital region. In the majority of Asians, the modiolus is actually located below the level of the oral commissure.40 With age, there is a dynamic discord as this muscle dominates the senescent tissue on which it is pulling, causing a widened smile with unsightly back molar show (Figure 8.22). The muscle has also displayed extreme sensitivity to inadvertent spread of BoNT in cases of masseter treatment for lower facial slimming. Nonetheless, moderating its activity with minute doses of BoNT (1–2 u of OnaBTX-A/IncoBTX-A and 3–4 u of AboBTX-A toxin) can be considered in cases of excessive grinning when smiling in the mature patient, or in cases of muscle hyperactivity of the contralateral hemiface in Bell's palsy. Injection is performed subdermally 1 cm below the intersection of a horizontal line drawn from the tragus to the commissure and a vertical line drawn along the anterior masseteric border (Figure 8.23).
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
It contains six muscles: Orbicularis oris: Sphincter muscle surrounding the mouth interdigitated with adjacent muscles. It has two parts: Pars marginalis: Located in the vermillion and acts as a sphincter and in front of the pars peripheralis, which gives the lips its curved shape.Pars peripheralis: Located in the cutaneous lip and has a dilatory function.Buccinator: Originates out of the alveolar processes of the mandible and maxilla and converges towards the modiolus.Risorius: Thin muscle difficult to identify. Its origin and insertion are superficial to the masseter within the dermis. The muscle has no bony origin.Levator anguli oris: Runs superiorly from its insertion to the origin in canine fossa of the maxilla.Depressor anguli oris: Courses inferiorly from modiolus to the origin at oblique line of the mandible lateral to depressor labii inferioris.Zygomaticus major: Anterior to the parotid duct where it pierces the buccinator and runs laterally and obliquely in the cheek region to its origin on the zygomatic arch.
Comparison of preseptal and pretarsal onabotulinum toxin an injection in patients with hemifacial spasm
Published in International Journal of Neuroscience, 2021
Ayşen Tuğba Canbasoğlu Yılmaz, Murat Yılmaz, Mehmet Fevzi Öztekin
Hemifacial spasm (HFS) is a frequently seen craniocervical movement disorder of peripheral origin. In hemifacial spasm unilateral, intermittent, synchronous tonic or clonic contractions of the ipsilateral facial nerve-innervated muscles constitute the clinical picture [1,2]. Although the frequency of hemifacial spasm varies from one population to another, its prevalence is considered to be approximately 10/100,000 and the disease is more common in women (F/M: 2/1) [3]. Generally, spasms begin as increases in the number of blinkings of the orbicularis oculi muscle in the 40 s and 50 s and spread over the forehead, lower half of the face and platysma over the years [1,2]. Involuntary contractions of orbicularis oculi, frontalis, zygomaticus major, zygomaticus minor, levator labi superioris, risorius, orbicularis oris, mentalis muscles and platysma may be observed.
Surgical repair for transverse facial cleft: two flaps with a superiorly rotated single Z-plasty lateral to the commissure
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Pan Zhou, Lin Qiu, Yan Liu, Tianwu Li, Xionghui Ding
After local injection of an epinephrine-salt solution (1/200,000) to reduce bleeding at the operating area, along the line marking by methylene blue, incisions were made. The rectangular vermilion-mucosa flap based on the upper lip was transposed to the excised cleft area of the lower lip, forming the oral mucosa of the fissure (Figure 1(b)). The excessive triangular mucosa and submucous tissue on the superior lip were excised to contain a triangular mucosa flap in the lower lip, forming the commissural vermillion (Figure 1(c)). The buccal and commissural vermilion and mucosa were trimmed and closed with 5-0 absorbable suture. The muscles such as the orbicularis oris and risorius muscles were exposed after dissecting the skin and mucosa, using everting mattress suture with the 5-0 absorbable suture to obtain a continuous muscle loop and avoid getting a local buccal depression (Figure 1(d)). After muscle reconstruction, just near the outside of the new commissure, a single Z-plasty (<4-mm triangles) was performed. We did not perform Z-plasty if the length of the cleft cheek was shorter than 5 mm. The skin was closed with 6–0 absorbable suture in layers.