FIGURE 22-3 Corrugator injection site in Visual Studio .NET

Drawer QR Code JIS X 0510 in Visual Studio .NET FIGURE 22-3 Corrugator injection site

FIGURE 22-3 Corrugator injection site
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FIGURE 22-4 Procerus injection site
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FIGURE 22-5 Angle of injection of the corrugator muscle A Use one hand to isolate the corrugator muscle B Rest the nger of the other hand on the nose as shown in A to stabilize the hand
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forehead, the physician should consider whether she/he wants to enhance the arch of the eyebrow to create a more horizontal eyebrow shape Generally, women prefer a more arched brow because it imparts a more feminine look, while men prefer a more horizontal brow (Table 22-5) The forehead should be injected about every two square centimeters where movement of the muscles is seen on eyebrow elevation It is important not to inject all patients in the same way Forehead injections should be tailored or customized to the patient s forehead size and shape In addition, one must take into consideration the placement of the eyebrow over the superior orbital rim Low brows will become even lower after injections of BTX to the forehead; therefore, forehead injections should be avoided in some patients Alternately, injections can be performed in the higher regions of the forehead in patients with low brows Use the recommendations in this chapter as rough guidelines and vary injection technique to suit the needs of each individual patient s anatomy The major pitfalls with forehead injections are the following: (1) unwanted eyebrow shape (Fig 22-12), (2) brow ptosis, (3) missed areas (Figs 22-13 and 22-14), and (4) drooping eyelids It is important not to overinject the forehead area as this may lead to brow ptosis Additionally, one must take care to avoid the area 1 cm above the eyebrows to reduce the chances of brow ptosis (Fig 22-15) The physician should warn the patient with low forehead wrinkles within this 1-cm area that these wrinkles cannot be treated with BTX, and will remain after treatment as demonstrated in Figs 22-16 and 22-17 Care must be taken to avoid forehead injections in individuals with low-set brows and/or excessive eyelid skin In older patients and patients with excess eyelid skin, overtreatment of the forehead area may result in drooping eyelids Hooding of the upper eyelids by the descending eyebrow tissue results in a neural reflex
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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Female 4 4 4 4 4
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Male 4 4 4
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TABLE 22-5 Masculine and Feminine Characteristics of Brow Shape FEMININE BROWS MASCULINE BROWS Horizontal Lower lid to brow distance Thicker brow
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FIGURE 22-6 Each 4 represents 01 cc of medication that contains either 4 units of Botox or 500 units of Myobloc Women with increased musculature and men often need two extra injection sites as depicted,because they have increased muscle mass (Younger women age 18 to 25 usually need only the three depicted injection sites)
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Arched Longer lid to brow distance Thinner brow
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FIGURE 22-7 Male patient before and after injection of 20 units of Botox
that increases the activity of the frontalis muscle in an effort to keep the vision clear of the descending tissue that would otherwise obstruct vision or interfere with eyelid function39 In this population the upward pulling of the frontalis muscle is needed to raise the baggy upper eye skin These patients are better treated with blepharoplasty first, then with BTX The ideal patient for BTX treatment in the forehead is a young patient (20s 40s) with no excess upper eyelid skin (Figs 22-18 and 22-19) CROW S FEET To treat crow s feet with Botox, inject 01 cc 1 cm lateral to the lateral canthus Then inject 005 cc 1 cm above the first injection and 01 cc 1 cm below as shown in Figs 22-20 and 22-21 If wrinkles progress medially, one can inject 005 cc approximately 1 cm apart along the orbital rim to the midpupillary line When using Dysport, fewer injection sites may be required because of increased diffusion Injecting medial to the midpupillary line does not correct medial wrinkles and can lead to an ectropion; therefore, this area should be avoided Most patients do not notice these wrinkles prior to BTX injections and sometimes mistakenly believe that BTX caused these previously unobserved wrinkles When used properly, BTX can temporarily erase the lateral crow s feet lines (Fig 22-22)
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