Transcript Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to

From: Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to Inject
Arch Dermatol. 2002;138(9):1180-1185. doi:10.1001/archderm.138.9.1180
Figure Legend:
Injecting within 1 cm of the middle to lateral aspects of the brow, medial to the temporal fusion line, can cause brow ptosis. In rare
cases, eyelid ptosis can occur.
Date of download: 4/8/2017
Copyright © 2017 American Medical
Association. All rights reserved.
From: Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to Inject
Arch Dermatol. 2002;138(9):1180-1185. doi:10.1001/archderm.138.9.1180
Figure Legend:
Brow ptosis can be partially corrected by weakening the corresponding brow depressors with small quantities of toxin. For instance,
the Carruthers technique entails placement of 10 U of toxin between the brows and 3 to 5 U under each lateral aspect of the brow.
An injection into the lateral brow depressors can make the eye appear more open, lift the brow, and accentuate the eyebrow arch.
Date of download: 4/8/2017
Copyright © 2017 American Medical
Association. All rights reserved.
From: Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to Inject
Arch Dermatol. 2002;138(9):1180-1185. doi:10.1001/archderm.138.9.1180
Figure Legend:
When injecting glabella frown lines, forceful injections toward the medial canthus can cause eyelid ptosis. Although medial canthus
injections are not desirable, injecting the orbicularis under the lateral brow is the correct placement for a lift of the lateral aspect of
the brow.
Date of download: 4/8/2017
Copyright © 2017 American Medical
Association. All rights reserved.
From: Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to Inject
Arch Dermatol. 2002;138(9):1180-1185. doi:10.1001/archderm.138.9.1180
Figure Legend:
Downward curl of the corners of the lips may be treated by injections at the jaw edge lateral to the first fold. Injecting the orbicularis
oris may cause idiosyncratic lip movement.
Date of download: 4/8/2017
Copyright © 2017 American Medical
Association. All rights reserved.
From: Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to Inject
Arch Dermatol. 2002;138(9):1180-1185. doi:10.1001/archderm.138.9.1180
Figure Legend:
The lines of the lip and the cobblestoning of the chin can be improved with small quantities of toxin. Cobblestoning can be improved
by a single injection of 5 to 10 U directly into the point of the chin with massage.
Date of download: 4/8/2017
Copyright © 2017 American Medical
Association. All rights reserved.
From: Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to Inject
Arch Dermatol. 2002;138(9):1180-1185. doi:10.1001/archderm.138.9.1180
Figure Legend:
A "quizzical" or "Jack Nicholson" look can occur if active frontalis muscles are not injected. This can be corrected by injecting 3 U of
toxin 2 cm above each brow and medial to the temporal fusion line.
Date of download: 4/8/2017
Copyright © 2017 American Medical
Association. All rights reserved.
From: Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to Inject
Arch Dermatol. 2002;138(9):1180-1185. doi:10.1001/archderm.138.9.1180
Figure Legend:
Two ways to inject safely and effectively. A, Carruthers eyebrow lift and forehead treatment. B, Klein forehead and glabella
treatment. In both cases, place injections outside the bony rim of the orbit.
Date of download: 4/8/2017
Copyright © 2017 American Medical
Association. All rights reserved.
From: Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to Inject
Arch Dermatol. 2002;138(9):1180-1185. doi:10.1001/archderm.138.9.1180
Figure Legend:
Do not inject everywhere at once. Diffusion and overlap can result in diminished expressivity or brow ptosis.
Date of download: 4/8/2017
Copyright © 2017 American Medical
Association. All rights reserved.
From: Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to Inject
Arch Dermatol. 2002;138(9):1180-1185. doi:10.1001/archderm.138.9.1180
Figure Legend:
Injection for "bunny lines" should be on the lateral aspect of the nasal wall, not on the medial aspect of the cheek. Injecting the
upper cheek deeply below the zygoma can induce a Bell palsy–like appearance.
Date of download: 4/8/2017
Copyright © 2017 American Medical
Association. All rights reserved.
From: Botulinum A Exotoxin for Hyperfunctional Facial LinesWhere Not to Inject
Arch Dermatol. 2002;138(9):1180-1185. doi:10.1001/archderm.138.9.1180
Figure Legend:
Large volumes should not be injected directly at the lateral canthus because diffusion can rarely cause diplopia, strabismus, and
even eyelid droop.
Date of download: 4/8/2017
Copyright © 2017 American Medical
Association. All rights reserved.