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Advanced Injection of Botulinum Toxin in the Nasal Muscles: A Novel Dynamic Change in Facial Expression

  • Innovative Techniques
  • Facial Surgery
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Abstract

Background

Among the nasal muscles, the levator labii superior alaeque nasi (LLSAN) acts as a transitional muscle that conjugates with other nasal and perinasal muscles. Thus, when treating the nasal region with Botulinum toxin (BTX), it is important to understand local nasal muscular dynamics and how they can influence the muscular dynamics of the entire face.

Methods

This is a retrospective analysis of cases treated by an injection pattern encompassing the face, including nasal muscles. Photographs were taken at rest and during motion (frontal and oblique views), before and after treatment.

Results

A total of 227 patients have been treated in the last 18 months with the following results: eyebrow tail lifting, softness of crow’s feet, improvement of the drooping of the tip of the nose, and shortening of the lip philtrum when smiling. We present cases illustrating the use of this approach.

Conclusions

Treating the facial muscles globally (including the frontal, corrugators, procerus, orbicularis oculi, platysma, DAO, and nasal muscles) can improve the smile and facial expressions. This is believed to occur because the elevated portion of the upper lip muscle becomes stronger as the nasal part of the LLSAN is paralyzed.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Funding

The authors received no financial support for this study, authorship, or publication.

Author information

Authors and Affiliations

  1. Instituto Lapidare, Balneário Camboriú, SC, Brazil

    Helena Hotz Arroyo Ramos

  2. Instituto Lapidare, Balneário Camboriú, Brazil

    Virginia Amaral

  3. Brasília, Brazil

    Luanda Pinheiro de Oliveira Afonso

  4. Vitoria, Brazil

    Juliana Carlos Medeiros Campagnaro

  5. Santa Casa de Vitória, Vitoria, Brazil

    Hannah Cade Guimarães Gazzinelli

  6. São Paulo, Brazil

    Guilherme Muzy

  7. Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil

    Ada Regina Trindade de Almeida

Authors
  1. Helena Hotz Arroyo Ramos
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  2. Virginia Amaral
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  3. Luanda Pinheiro de Oliveira Afonso
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  4. Juliana Carlos Medeiros Campagnaro
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  5. Hannah Cade Guimarães Gazzinelli
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  6. Guilherme Muzy
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  7. Ada Regina Trindade de Almeida
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Corresponding author

Correspondence to Helena Hotz Arroyo Ramos.

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Conflict of interest

A.R.T. de Almeida has been a consultant to Allergan Inc. and Merz and participated in clinical trials for Allergan and Galderma. The other authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article.

Ethical Approval

All procedures were performed in accordance with the ethical standards of the institution and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

All patients provided written consent for the use of their images.

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Ramos, H.H.A., Amaral, V., de Oliveira Afonso, L.P. et al. Advanced Injection of Botulinum Toxin in the Nasal Muscles: A Novel Dynamic Change in Facial Expression. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-023-03751-y

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