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Think of three facial zones in global terms when injecting Botox
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KOLOA, Hawaii – Although the face is generally divided into three zones – upper, middle and lower – it is important to think of these zones in global, harmonious terms when injecting botulinum toxin, a presenter said here.
“You can isolate those three areas, but we want to make certain that whatever we do in one area is complementary to the areas that you aren’t treating,” said Steve Yoelin, MD, an ophthalmologists in Newport Beach, California, during his presentation at the “Principles of Aesthetic Oculoplastics” session at the Hawaiian Eye meeting.
Steve Yoelin
For instance, if augmenting a patient’s lips, the areas around the lips should be addressed before the lips themselves, Yoelin said.
“It looks very odd when you have lips that are very nice, very plump, but the areas around them don’t look very good,” he told attendees. “Think of it like having an old home that needs work and fifty thousand dollars to spend on renovating it. If you decide to put all of the money into making a really nice kitchen, but ignore all the other rooms, what ends up happening is those other rooms begin to look a little peculiar.”
As such, when considering the upper face, it is important to note that hyperfunctional rhytides are the most prominent feature. Also, volume changes in the upper face include deflation of the brow and hollowing of the temples, Yoelin said.
With the lower face, the primary goals are to restore volume, control muscle hypermobility and treat for rhytides. Using fillers in the lower face is generally accepted as the standard of care; however, combining fillers and botulinum toxin where appropriate can be a good alternative, he said.
Also, when treating the lips, shape and volume are both important factors, and when treating the perioral area with botulinum toxin, be sure not to overtreat. Otherwise, mouth incompetence may occur, Yoelin said.
“I have the patient animate prior to injection. Animation guides the placement. Also, muscle strength will help dictate dose. If you know that, you know how to inject toxins,” he said. –by Daniel Morgan
Disclosure: Yoelin is a member of Allergan’s and Medicis’s speaker’s bureau. He is also a contracted researcher and a paid consultant for Allergan.