Ona botulinum toxin A for the middle part of the face in cosmetology (Part 4)

Aging and displacement of the soft tissues of the midcheeks can lead to a deepening of the nasolabial furrow, which in turn accentuates the nasolabial fold. The nasolabial fold deepens as a result of the weakening of the overall support of the structural skeleton and muscles, as well as under the influence of aging and gravitational pull.

The redistribution of soft tissue and fat increases over time and results in a deepening of the vertical sulcus and crease that extends from the nasolabial sulcus of the alar to the lateral commissure of the lips. Deep diagonal creases from the sides of the nose that deepen towards the corners of the mouth are a hallmark of aging. These deep furrows and folds are still very difficult to smooth out.

Onabotulinum toxin A for smoothing nasolabial folds 

In the past, doctors have tried to erase these lines through surgery, but the results have only been scars and failure. Soft tissue filler injections were more effective, by the way, this technology is still considered the most effective in terms of eliminating this problem. Ona botulinum toxin A was also tried to smooth out nasolabial folds, but it was not effective and entailed many complications.

Functional Anatomy  

There is a significant difference in anatomy that creates a nasolabial fold extending from the lateral point of the alar to the area below the lip commissure. In older patients, a combination of any of the following may result in deepening of the nasolabial fold:

• loss of skin density over the nasolabial sulcus;
• excessive skin on the side of the nasolabial sulcus;
• excessive accumulation of fat on the side of the nasolabial sulcus, which is held in place by supporting ligaments;
• lateral ptosis of the buccal and subcheek fat as a result of weakening of the superficial musculoaponeurotic system of the middle upper cheek.

Aging and frequent mimic movements of the causative facial muscles can deepen the vertical furrow that extends from the superior border of the nasolabial angle down and outward towards the commissures of the lips.  

Nasolabial folds are convex (60%), straight (30%) or concave (10%). Given the individual structure of the face, the nasolabial fold can be divided into three parts: the upper, or medial, middle and lateral, or lower part.  

Some believe that the levator lip and alar of the nose most strongly influences the formation of the upper medial part of the nasolabial fold, and the levator lip muscle - on the deepening of the middle part of the nasolabial fold. In most people, the large process of the zygomatic bone and the levator cornus muscle help lift the corner of the mouth and move it sideways and slightly upward when smiling. In this case, they can "move" the skin of the middle part of the cheeks up and sideways, expanding the lower crow's feet down, this process is especially characteristic of those who have inelastic, sluggish skin. Both types of muscles can deepen the nasolabial folds.

Onabotulinum toxin A dosage for smoothing nasolabial folds 

1 unit (maximum 2 units) of onabotulinum toxin A is injected into the middle of the nasofacial angle, to the side of the upper border of the ala of the nose. When the patient is in a reclining position, ask him to snarl or lift his upper lip with force upwards. With the index finger of the non-dominant hand, gently palpate just above the nasofacial angle until the patient feels contraction of the muscle fibers. Aim the needle perpendicular to the skin surface, insert it to a depth of approximately 3-5 mm without touching the bone. Inject 1 or 2 units of onabotulinum toxin A directly into the thickest bulge of the contracting muscle.   

This procedure should only be performed by an experienced specialist whose patient has developed a nasolabial fold as a result of a normal upper lip lift.   

For patients with multiple midcheek wrinkles that appear when smiling or squinting, 1-2 units of onabotulinum toxin A is injected intradermally near the beginning of the zygomatic complex along the lower lateral margin of the zygomatic arch near the lower edge of the orbicularis oculi muscle of the lower eyelid; such an injection may have the additional effect of reducing canthal wrinkles. Depending on the anatomy, face shape and muscle strength, one, two, three or more injections may be required above the center of the zygomatic bulge. 

Onabotulinum toxin A: complications in smoothing nasolabial folds 

Injections into the levator lip muscles in the lower part of the nasolofacial sulcus can result in flattening of the midface and lengthening of the upper lip, obliteration of the philtrum, and narrowing and reduced fullness of the upper lip. Excessive treatment of this area can lead to smile asymmetry and drooping of the upper lip.  

Ona botulinum toxin A injections below the superior alar margin of the nose can weaken the central levator lip muscles and the orbicularis oculi muscle, resulting in the upper lip being unable to elevate, plus becoming elongated.  

Intradermal injection of 1-2 units of onabotulinumtoxin A near the origin of the zygomaticus major, minor, and levator labii, near the lower edge of the lateral orbicularis eye muscle, is often accompanied by decreased upper lip sphincter strength and smile asymmetry.

Attempting to correct midcheek wrinkles and nasolabial folds with onabotulinumtoxin A injections may result not only in flattening of the nasolabial fold, but also in general cheek flatness and upper lip lengthening or lip ptosis, as well as lip asymmetry and poor oral control. sphincter.   

Therefore, the above procedures should not be carried out without informing the patient of the possible risks. And, as in other cases, the procedure should only be carried out by an experienced qualified specialist who perfectly knows the anatomy of the face. 

Based on Prime magazine.