CME/CE: ABOUT FACE: Navigating Neuromodulators and Injection Techniques for Optimal Results

April 2020 | Volume 19 | Issue 4 | Supplement Individual Articles | 300 | Copyright © April 2020


Published online March 31, 2020

Steve G. Yoelin , Shino Bay Aguilera , Joel L. Cohen , Michael H. Gold , Joely Kaufman , Corey S. Maas

aSteve Yoelin, MD, Medical Associates, Newport Beach, CA
bShino Bay Cosmetic Dermatology and Laser Institute, Fort Lauderdale, FL
cAboutSkin Dermatology and DermSurgery, AboutSkin Research, Greenwood Village and Lone Tree, CO; University of California, Irvine, Irvine, CA
dGold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN
eSkin Associates of South Florida; University of Miami Miller School of Medicine, Coral Gables, FL
fThe Maas Clinic Facial Plastic and Aesthetic Surgery, San Francisco and Lake Tahoe, CA; University of California, San Francisco, San Francisco, CA

ABOUT CASE 4

Treatment of the Lower Face
From the Files of Corey S. Maas, MD, FACS

A 65-year-old white female presented complaining about the aged appearance of her lower face and neck, including prominent platysmal bands, perioral lines, and a downturned mouth. A total of 102 U of aboBTXA was injected at 4 sites over the upper lip into each depressor anguli oris and the vertical platysmal bands (Figure 5A). Alternative treatments would be 34 total units of onaBTXA and praBTXA or 42 total units of incoBTXA. Figure 5B shows her appearance after treatment.




Discussion
Dr Maas: Injection of BTXA is very effective for improving the appearance of prominent vertical platysmal bands and the cervicomental angle. Lateral platysmal bands do not affect the cervicomental angle and typically do not have to be injected unless the patient is bothered by their appearance.

Injection into the vertical platysmal bands is generally quite safe. Excessively high doses and injecting too deep might risk creating problems with swallowing and neck flexion.30

BTXA injection into the depressor anguli oris addresses downward turn of the oral commissures. Clinicians can avoid complications, such as problems with lip function and symmetry, by injecting lateral to the oral commissure and along the jawline.

Low doses of BTXA are used when treating radial lip lines to avoid causing oral incompetence. For rejuvenation of the lower face, I generally consider BTXA as an adjunct to fillers rather than as a substitute. In patients with subtle defects, however, BTXA by itself can provide a nice improvement.

ABOUT CASE 5

Lower Face Contouring With Masseter Injections
From the Files of Corey S. Maas, MD, FACS

A 31-year-old Asian female sought contouring of her lower face to lessen its broad appearance. She was treated with 80 U of onaBTXA administered as 10 U/site into 4 sites on each side of the face (Figure 6A). Alternative treatments would be 240 U of aboBTXA, 100 U of incoBTXA, and 80 U of praBTXA. Figure 6B shows the outcome after treatment.