Aesthetic procedures using botulinum toxin and hyaluronic acid fillers are intended primarily for the correction of the upper third of the face. However, practitioners are now increasingly using these techniques to model the lower face.
The safety and success of such procedures largely depend on knowledge of the structure and functions of the area in question, as well as understanding the correct approach to work in each anatomical area. Dr. Zohaib Ullah (Zohaib Ullah) talks about the features of the use of injection techniques for correction of the lower part of the face.
Assessment of the condition of the lower part of the face: main changes
To assess patients, estheticians often use an approach based on the horizontal division of the face into upper, middle, and lower parts (Fig. 1). Any changes in the middle third (for example, the volume of the cheeks) further affect the condition of the lower part of the face. With aging, as you know, changes affect not only the skin, but also the underlying tissues (muscles, fat pads, bone tissue).
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As with gravity, any loss of volume or tissue laxity in the midsection will result in severe deformation of the structure of the lower face and loss of its aesthetic appeal.
The lower part of the face can be divided into perioral, maxillary and submental zones, which in turn are also divided into subzones (Fig. 2).
Possibilities of injections of HA fillers and botulinum toxin for the correction of the lower part of the face
Botulinum toxin type A and HA fillers can be used to correct various imperfections in the lower face. Botulinum toxin injections provide muscle relaxation and limitation of muscle movement, while dermal fillers are used for volumizing and soft tissue support.
In general, botulinum toxin and dermal fillers are safe in the hands of an experienced and knowledgeable practitioner. Knowledge of anatomy, insertion technique, careful history taking and, of course, patient selection remain key factors influencing the outcome of the procedure.
Key factors influencing the outcome of the procedure remain knowledge of anatomy, insertion technique, careful history taking and, of course, patient selection.
Fillers and botulinum toxin in the perioral area
Lips – the main component of the perioral region, which is most often associated with injections of dermal fillers to replenish volumes lost with age. This area is extremely delicate and leaves almost no room for error, since the width of the introduction of the product is at best 1 & ndash; 2 mm. Accordingly, there is a high probability of the filler being injected into the underlying muscles.
It is important to warn the patient that due to the ability of HA to attract water, dermal fillers often result in swelling. With improper injection, complications are possible in the form of hematomas, nodules. Long-term complications, including granulomas, are rare.
Botulinum toxin is used to smooth out radial wrinkles/wrinkles around the lips. Superficial injection of the toxin into the area of perioral wrinkles allows the doctor to reduce the depth and often smooth out the wrinkles, thereby improving the final aesthetic result.
Toxin doses that are too high or the toxin is injected incorrectly can lead to paralysis of the lips, so care must be taken during this procedure and only small amounts of the drug should be administered.
Read also: How to avoid complications with botulinum toxin therapy
Age-related increase in the depth of wrinkles at the corners of the mouth can lead to the appearance of a typical "sad smile". This zone is controlled by the muscle that lowers the corner of the mouth, and is deformed as a result of sagging and flabbiness of the surrounding tissues. Injections of botulinum toxin into the drooping corner of the mouth muscle can reduce the appearance of wrinkles at the corners of the mouth, as well as marionette lines.
Additional correction of this area with a dermal filler provides not only stabilization of the wrinkles of the corners of the mouth, but also the volumization of marionette wrinkles, which often appear in this area during the aging process.
Influence of the masticatory muscle on the condition of the lower part of the face
Difficulties in the correction of jowls are due to a combination of changes in the middle third of the face, including flabbiness of the skin, loss of volume of soft and structural changes in bone tissues. Therefore, it is important to apply a combined approach to the rejuvenation of the middle and lower thirds of the face.
Dermal fillers are used to volumize the cheeks and rejuvenate the area. Hypertrophy of the masseter muscle – another common problem that makes the jaw appear wider. Hypertrophy of the masseter muscle – not only aesthetic, but also a medical problem. Injections of botulinum toxin into the masticatory muscle provide relaxation and a subsequent reduction in its volume (up to 30%).
As for complications, there is a possibility of damage to the mandibular branch of the facial nerve, changes in bite force, speech disorders (in case of an overdose of the drug), as well as muscle pain, facial asymmetry and excessive protrusion of the zygomatic arch.
Read also: Safely inserting fillers: how to prevent possible complications
Chin area: main problems and features of correction
There are two main problems with the chin – the presence of a dimple, which is caused by the features of the mental muscle, and a lack of volume due to the congenital features of the bone. Chin area correction – a great example of how botulinum toxin and HA fillers work together.
Superficial injections of botulinum toxin into the chin wrinkles not only smooth out the lines on the skin, but also make the area more even and smooth.
The key factors in minimizing the risk of complications after injections of botulinum toxin and HA fillers are the accuracy of injection, care, correct dosage and knowledge of anatomy.
An excellent aesthetic result can be obtained by volumizing and contouring the chin with dermal fillers. The accuracy of the introduction of the product is extremely important – in order to avoid trauma to the neurovascular bundle located in the chin area, it is necessary to inject the filler periosteally. This not only reduces the risk of complications, but also provides reliable stabilization, lifting and severity of this zone.
Adapted from Aesthetics
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