"Rabbit" wrinkles and drooping of the tip of the nose: correction with abobotulinum toxin

When botulinum toxin type A preparations are injected into the muscle, they block the release of the neurotransmitter acetylcholine, which is necessary for neuromuscular transmission. This contributes to muscle relaxation and, as a result, smoothing expression wrinkles, which significantly improves the appearance and quality of life of the patient. Let's talk on estet-portal.com about "rabbit" wrinkles and correction of the shape of the nose using abobotulinum toxin type A, as well as analyze the anatomical features of the nose area and technical issues.

• The causes of the development of "rabbit wrinkles" and lowering of the tip of the nose: anatomy
• Technique and indications for correction using botulinum toxin

The causes of the development of "rabbit wrinkles" and lowering of the tip of the nose: anatomy

Hypertonicity of the nasal muscle contributes to the formation of horizontal ("rabbit") wrinkles. Although the medial bundles of of the muscle that lifts the upper lip and wing of the nose may also take part in this.

Read also: Anatomy of botulinum therapy: correction of the lower third of the face

The

Nasal muscle is a horseshoe shape as the transverse fibers on the bridge of the nose form a curve, while the lower fibers of the muscle run vertically down the wings of the nose. Contraction of the nasal muscle sets the nose in motion and is also responsible for the lumen of the nostrils.

"Rabbit" wrinkles occur with compensatory activation of the nasal muscle in the case of increased relaxation of the frontalis muscle, the circular muscle and the muscles of the interbrow area. The tip of the nose drops due to increased activity of the muscle that depresses the nasal septum.

Mobility of the tip of the nose is determined by an unpaired, small and short muscle that lowers the nasal septum (m. depressor septi nasi). It originates from the alveolar eminence of the maxillary medial incisor and attaches to the cartilaginous part of the nasal septum. This muscle pulls the nasal septum down.

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Contraction of the muscle that lowers the nasal septum leads to a decrease in the distance between the upper lip and the tip of the nose, while lowering it.

Technique and indications for correction with botulinum toxin

To correct horizontal wrinkles in the nose area, it is recommended to inject abobotulinum toxin at two symmetrical points on each side. Injection points should be located 1 cm above the upper side of the nostrils.

Read also: Working with botulinum toxin in the forehead and nose

5–10 units of the drug is injected into each point: in total - 10–20 units. Injections should be carried out superficially until the appearance of a papule. The needle is inserted perpendicular to the skin surface, at an angle of 45° to the nasal bone.

When correcting transverse wrinkles in the nasal region, injections should not be deep to avoid bleeding.

It is necessary to avoid getting botulinum toxin into blood vessels and damaging the periosteum.

 

 

Fig.1 wrinkles in the back of the nose (A) and raising the tip of the nose (C) - recommended injection points according to M. De Mayo and B. Rzhany

Indications for Nose Reshaping with Abobotulinum Toxin Injections:

• Excessive mobility of the tip of the nose during facial movements
• Age-related ptosis of the tip of the nose: «hooked» form
• "Inflated" nostrils.

Read also: The subtleties of botulinum therapy: abobotulinum toxin correction techniques by Alessio Redaelli

To correct excessive mobility of the nasal tip, the neurotoxin should be injected directly over the transitional fold into the columella (nasal septum) at one central point. Depending on the degree of mimic hyperkinesis, 12–20 units of abobotulinum toxin are administered.

 

 

Fig.2 Nose tip mobility correction: before (A) and after (B) injections of abobotulinum toxin

To correct age-related ptosis of the tip of the nose (hooked nose) with low mobility, inject into the same central point of the columella 8–15 U of abobotulinum toxin.

Read also: How to properly dose and administer botulinum toxin preparations

In order to elevate the tip of the nose, it is recommended to inject botulinum toxin at the base of the columella. The needle is inserted perpendicularly, up to the middle third. Recommended dose for correction – 10 U of abobotulinum toxin.

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Synergistic activity of the muscle lowering the nasal septum and the muscle lifting the upper lip and wing of the nose is common. In this case, there is simultaneous mobility of the tip of the nose, the rise of the wings of the nose with facial expressions and a gingival smile. In order to raise the tip of the nose under such conditions, it is necessary to simultaneously adjust the activity of the listed muscles.

Read also: Correction of mimic wrinkles with botulinum toxin

"Inflated" nostrils are observed with hyperactivity musculus dilatator naris. For correction, 6–10 units of abobotulinumtoxin are injected into the area of ​​the wings of the nose on each side: this will reduce the width of the nose. If the injections are shifted laterally, there is a risk of botulinum toxin diffusion into the levator lip muscle and its denervation: as a result, ptosis of the upper lip.

Botulinum therapy is an effective means of correcting transverse "rabbit wrinkles" in the back of the nose and correcting its shape. The specialist needs to deeply understand all anatomical features of the formation of such cosmetic defects in order to correctly navigate at the injection points of abobotulinumtoxin. It is also worth explaining to the patient that neurotoxin injections are a medical manipulation, performed according to indications and have a rehabilitation period.

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