Retrograde vs spot botulinium toxin facial injection.

BACKGROUND: In this study we have based our research on botulinium toxin injection via targeted neuromuscular end plate zones, specifically in muscles with diffuse distribution of the latter. The muscular surface anatomical variety was also taken into consideration with thorough pre-injection examination of every subject. METHOD: With consideration of the facial muscles anatomical variation and neuromuscular bundle distribution, we have applied the method of retrograde botulinium toxin injection on a series of 10 patients on the right side of the face with the left side as a control side, it was injected in a regular perpendicular manner in order to conclude the efficacy of targeted motor end zone injection. Using an auto-injecting syringe, we have delivered 6 Allergan units per zone (frontalis, glabellar lines of corrugator supercilii and orbicularis oculi crow's feet). RESULTS: On control day 8 we have noticed a more prominent effect mainly on the level of the orbicularis oculi muscle and the corrugator supercilii muscle on 9 out of 10 patients. Nine patients out of 10 needed the delivery of an additional 6 Allergan units per zone on the control side's glabellar lines and crow's feet rhytids. Where 1 out of 10 patients needed the reinjection of the control side on the glabellar lines zone. CONCLUSION: The musculature of the face varies when it comes to neuromuscular plate distribution. Muscles with scattered distribution patterns show an optimal response to botulinum toxin injections when delivered in a retrograde manner. This has allowed us to achieve of optimal results while minimizing injection sites and hence pain, the use of lower dosage and hence treatment cost, as well as lowering the unwanted product dissemination to the neighboring mimic muscles.

Cervicomental angle definition in the youthful patient (less than 40 years).

In clinical practice nowadays, one is faced with a group of patients still in their youth, demanding a more defined cervicomental angle. This specific group, aging less than 40 years of age, while the classical approach in this population addresses the osseous structures as per genioplasty or mental prosthesis, and for soft tissue definition, they frequently undergo submental liposuction. We noticed that in certain cases this is not enough and the patients can be still dissatisfied, these patients can highly benefit from our technique using the digastric corset in order to restore this congenital absence of cervicomental angle definition. This technique addresses and treats the anatomical malposition of the floor of the mouth, resulting in cervicomental angle widening in the youthful individual. In this technical note we will state the anatomical detail explaining its specific indication and benefit, specifically in this age group.