Many people have diagonal lines on the nose that radiate from the bridge of the nose near the root of the nose down to the wings of the nose and deepen when talking, smiling, laughing or when a person frowns. These wrinkles are formed as a result of contraction of the transverse nasal muscles. Their depth and pattern may vary on different sides of the face. They are anatomically distinct (both in placement and origin) from the horizontal wrinkles, which extend perpendicularly across the root of the nose and are formed as a result of the downward pull of the proud muscles.
Onabotulinum toxin A for rabbit wrinkles
When such radial divergences of longitudinal wrinkles from the upper sides of the bridge of the nose occur as a compensatory maneuver after the treatment of frown lines with onabotulinum toxin A, they are called "Botox marks". However, if these wrinkles on the glabella occur naturally, they are called "rabbit wrinkles". There are people with inelastic, flaccid, stretched skin that lifts the skin and soft tissue of the middle part of the face when they squint hard, resulting in deep wrinkles at the bridge of the nose.
For such patients, whose bridge of the nose is formed due to contraction of the transverse muscles, and due to the lifting and flexion of the subzygomatic and lateral skin of the nose, injections of onabotulinum toxin A do not help. If wrinkles on the glabella are not noticeable during the removal of brow wrinkles, but appear after the first ones are eliminated with the help of onabotulinumtoxin A (Botox marks), they must be eliminated 2-3 weeks after the procedures with onabotulinumtoxin A.
Onabotulinum toxin A dosage
When the patient is in a sitting or reclining position, 2-5 units of onabotulinum toxin A should be injected subcutaneously or intramuscularly into the sides of the bridge of the nose, below the root of the nose, and in front of and above the nasofacial angle. The needle should be placed over the angular vessels and the levator muscles of the upper lip. The soft tissue is extremely thin and rich in blood vessels in this area. It is very important not to insert the needle too low into the side walls of the nose and into the nasolofacial sulcus.
The dose of onabotulinumtoxin A depends on the overall depth and location of wrinkles, as well as the strength of the transverse nasal muscles. A dose of 3-5 units may be needed on each side of the bridge of the nose, an additional 2-4 units may be needed to permanently eliminate wrinkles on the nose in people who spend a lot of time outside and constantly squint.
Results of using onabotulinum toxin A for smoothing rabbit wrinkles
For patients who lift the skin of the cheeks and under the cheekbones towards the root of the nose, thus forming wrinkles along the nose, ona botulinum toxin A will not help. Ona botulinum toxin A injections are effective only in eliminating wrinkles formed as a result of contractions of the transverse nasal muscle. As a rule, this effect lasts at least 3-4 months or until the wrinkles between the eyebrows remain smoothed.
Onabotulinum toxin A: complications
If onabotulinumtoxin A is injected too low along the walls of the nose, it can spread to the levator lip muscles, which can lead to asymmetry and even ptosis of the upper lip, including obturator muscle weakness and functional problems. If the orbicularis palpebralis muscle is weakened by the spread of onabotulinum toxin A, this can lead to epiphora (lacrimation retention). Double vision is also possible if onabotulinumtoxin A enters the medial rectus muscle.
Intense massage of the injection site of onabotulinum toxin A can lead to its spread beyond the boundaries of the target zone and have the above serious consequences, even if the dosage and technique of administration of the drug were correct. There is no antidote for such side effects, so the patient will just have to be patient until they disappear. It is also advisable to consult an ophthalmologist.
Angular veins and arteries are found in the nasofacial angle, and injections given too low along the walls of the nose and too deep into the skin can cause intravascular injection of onabotulinum toxin A or vascular injury, followed by ecchymosis (veins) or hematomas (arteries). There is no information on the side effects of intravascular administration of less than 10 units of onabotulinum toxin.
Read also: "Onabotulinumtoxin for the middle part of the face in cosmetology (part 1)"
Based on Prime magazine.
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