Summary
Introduction
Botulinum toxin has been widely used for upper and
lower face rejuvenation, but for the midface, the
indications are limited to the treatment of hypertropic
orbicularis oculi, bunny lines, nasal flares, nasolabial
folds in selected patients, and nasal tip droop.1,2 The first
consideration for midface rejuvenation is always fillers.3
But aging changes in the midface are not only due to
photodamage and loss of subcutaneous tissue and
cutaneous elasticity but also to the muscles of the facial
expression on overlying skin.
The facial muscles of expression are striated muscles
lying just underneath the skin. They originate on bone
and insert directly into the skin of the face to control
facial expression. When these mimetic muscles contract,
they pull on the skin, moving it and causing wrinkling
Correspondence: Chariya Petchngaovilai, Clinicare, 128 Pahonyotin 2
Payathai, Bangkok 10400, Thailand. E-mail: dr.chariya@gmail.com
Accepted for publication August 12, 2009
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Figure 2 Intradermal injection for the lateral fibers of the Orbicularis oculi, the injection was made along the lateral border of
the muscle, in the temporal area.
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Results
Intradermal injection applied to both the depressor
muscles (Platysma and Orbicularis Oculi) resulted in
midface lifting and rejuvenation, which could be
assessed by pre- and post-treatment photographs. The
cheeks were uplifted with softening of the midcheek
groove and nasolabial fold (Fig. 4a and 4b). Facial recontouring and smooth, shiny, wrinkle-free skin were
also obtained (Fig. 5a and 5b).
(a)
(b)
Figure 4 Before (a) and after (b) treatment, the cheek was uplifted with softening of the nasolabial folds.
(a)
(b)
Figure 5 Before (a) and after (b) treatment resulted in midface lifting and rejuvenation. Facial re-contouring with smooth, shiny, wrinklefree skin.
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(b)
Figure 6 (a and b) In some of the cases, the improvement could be seen immediately after the injection.
Discussion
Generally, the factors to be considered while injecting
botulinum toxin are muscle and skin conditions.
Reconstitution (mL)
Dose by units
Dysport
Botox
7
5
5070
2030
0.81
11.5
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316
References
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1518.
3 Carruthers J, Glogau RG, Blitzer A, and the Facial Aesthetics
Consensus Group Faculty. Advances in facial rejuvenation:
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combination therapies consensus recommendations. Plast
Reconstr Surg 2008; 5: 5S30S.
4 Levy PM. The Nefertiti lift: a new technique for specific
re-contouring of the jawline. J Cosmet Laser Ther 2007; 9:
24952.
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S97104.
7 Benedetto AV. Asymmetrical smiles corrected by botulinum
toxin serotype A. Dermatol Surg 2007; 33: S326.