Applied Anatomy for Botulinum Toxin Injection in Cosmetic Interventions
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USE OF BOTULINUM TOXIN IN OTORHINOLARYNGOLOGY (A D’SOUZA AND CL NG, SECTION EDITORS)
Applied Anatomy for Botulinum Toxin Injection in Cosmetic Interventions Ayman D’Souza 1
&
Chew Lip Ng 2
# The Author(s) 2020
Abstract Purpose of Review To provide the reader with a clear overview of facial anatomy as it relates to injection of botulinum toxin. Recent Findings The review suggests the presentation of multiple combinations of facial musculature, with the forehead, glabellar, and nasal base areas as particular areas of variation. Differences in musculature result in different wrinkling patterns; with age, these changes first become apparent in the upper face, particularly in the forehead and glabellar area. Summary Botulinum toxin is well suited to achieve the optimal outcome: it is popular, safe, and non-invasive and presents with few adverse effects. Though limited, when adverse effects do arise these are primarily related to poor injection technique, often fuelled by poor anatomical knowledge. For clinicians to achieve the best outcomes with botulinum toxin use, an understanding of the facial muscles’ anatomy, actions, and interactions is key. This paper discusses the broad and intricate detail regarding the key target muscles of botulinum toxin, based on both literature review and cadaveric dissection carried out by the authors. Keywords Botulinum toxin . Facial anatomy . Forehead region
Introduction Botulinum toxin (BoNT) is a popular therapeutic and cosmetic drug, used for a wide variety of medical and cosmetic procedures. Botulinum toxin type A was used for 7,437,378 cosmetic procedures in the USA in 2018, a 3% rise from that in 2017, and 845% rise since 2000 (https://www.plasticsurgery. org/documents/News/Statistics/2018/plastic-surgerystatistics-report-2018.pdf). It is both minimally invasive and fast-acting, resulting in high satisfaction rates, with 96% of patients indicating they would be happy to receive treatment again (https://www.statista.com/statistics/281434/ This article is part of the Topical collection on Use of Botulinum Toxin in Otorhinolaryngology * Ayman D’Souza
satisfaction-among-patients-of-top-us-nonsurgical-cosmeticprocedures/). Similar trends are evident in the rest of the world. As well as leading to unsatisfactory results, poor understanding of facial anatomy can lead to suboptimal outcomes and complications, which may present legal risks to clinicians. Whilst not a fatal mistake, this leads to severe and undesirable side effects for patients, with muscular paralysis lasting weeks to months; BoNT spread to nearby muscles can also cause delocalisation of effects [1]. In some cases, longer term complications can arise. However, there exists a general scarcity of systematic literature concerning the specific common adverse effects of cosmetic BoNT use [2••]. Clinicians with a clear knowledge of anatomy relating to target muscles during injection are likely to have lower complication rates.
Chew Lip Ng [email protected]
Concepts Underlying BoNT Use
1
Bromley, UK
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