Skip to main content
Top
Published in: Aesthetic Plastic Surgery 8/2024

08-01-2024 | Botulinum Toxin | Innovative Techniques

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

Authors: Helena Hotz Arroyo Ramos, Virginia Amaral, Luanda Pinheiro de Oliveira Afonso, Juliana Carlos Medeiros Campagnaro, Hannah Cade Guimarães Gazzinelli, Guilherme Muzy, Ada Regina Trindade de Almeida

Published in: Aesthetic Plastic Surgery | Issue 8/2024

Login to get access

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.
Appendix
Available only for authorised users
Literature
4.
go back to reference Lorenc ZP, Smith S, Nestor M, Nelson D, Moradi A (2013) Understanding the functional anatomy of the frontalis and glabellar complex for optimal aesthetic botulinum toxin type A therapy. Aesthet Plast Surg 37:975–983CrossRef Lorenc ZP, Smith S, Nestor M, Nelson D, Moradi A (2013) Understanding the functional anatomy of the frontalis and glabellar complex for optimal aesthetic botulinum toxin type A therapy. Aesthet Plast Surg 37:975–983CrossRef
5.
go back to reference de Maio M, DeBoulle K, Braz A, Rohrich RJ (2017) Facial assessment and injection guide for botulinum toxin and injectable hyaluronic acid fillers: focus on the midface. Plast Reconstr Surg 140:540e–550eCrossRefPubMed de Maio M, DeBoulle K, Braz A, Rohrich RJ (2017) Facial assessment and injection guide for botulinum toxin and injectable hyaluronic acid fillers: focus on the midface. Plast Reconstr Surg 140:540e–550eCrossRefPubMed
6.
go back to reference Lee W, Ahn T-H, Cheon GW, Lee M-J, Yang E-J (2021) Comparative analysis of botulinum toxin injection after corrective rhinoplasty for deviated nose and alar asymmetry. J Cosmet Dermatol 20:451–456CrossRefPubMed Lee W, Ahn T-H, Cheon GW, Lee M-J, Yang E-J (2021) Comparative analysis of botulinum toxin injection after corrective rhinoplasty for deviated nose and alar asymmetry. J Cosmet Dermatol 20:451–456CrossRefPubMed
7.
go back to reference de Almeida ART, Romiti A, Carruthers JDA (2017) The facial platysma and its underappreciated role in lower face dynamics and contour. Dermatol Surg 43:1042–1049CrossRefPubMed de Almeida ART, Romiti A, Carruthers JDA (2017) The facial platysma and its underappreciated role in lower face dynamics and contour. Dermatol Surg 43:1042–1049CrossRefPubMed
9.
go back to reference Saban Y, Andretto AC, Hammou JC, Polselli R (2008) An anatomical study of the nasal superficial musculoaponeurotic system: surgical applications in rhinoplasty. Arch Facial Plast Surg 10:109–115CrossRefPubMed Saban Y, Andretto AC, Hammou JC, Polselli R (2008) An anatomical study of the nasal superficial musculoaponeurotic system: surgical applications in rhinoplasty. Arch Facial Plast Surg 10:109–115CrossRefPubMed
10.
go back to reference Hur MS, Lee S, Jung HS, Schneider RA (2022) Anatomical connections among the depressor supercilii, levator labii superioris alaeque nasi, and inferior fibers of orbicularis oculi: Implications for variation in human facial expressions. PLoS ONE 17:e0264148CrossRefPubMedPubMedCentral Hur MS, Lee S, Jung HS, Schneider RA (2022) Anatomical connections among the depressor supercilii, levator labii superioris alaeque nasi, and inferior fibers of orbicularis oculi: Implications for variation in human facial expressions. PLoS ONE 17:e0264148CrossRefPubMedPubMedCentral
11.
go back to reference Hur MS (2017) Anatomical relationships of the procerus with the nasal ala and the nasal muscles: transverse part of the nasalis and levator labii superioris alaeque nasi. Surg Radiol Anat 39:865–869CrossRefPubMed Hur MS (2017) Anatomical relationships of the procerus with the nasal ala and the nasal muscles: transverse part of the nasalis and levator labii superioris alaeque nasi. Surg Radiol Anat 39:865–869CrossRefPubMed
12.
go back to reference Kim H-J, Seo KK, Lee H-K, Kim J (2016) Clinical anatomy of the face for filler and botulinum toxin injection. Springer, New York Kim H-J, Seo KK, Lee H-K, Kim J (2016) Clinical anatomy of the face for filler and botulinum toxin injection. Springer, New York
13.
go back to reference Griesman B (1944) Muscles and cartilages of the nose from the standpoint of a typical rhinoplasty. Arch Otolaryngol Head Neck Surg 39:334–341CrossRef Griesman B (1944) Muscles and cartilages of the nose from the standpoint of a typical rhinoplasty. Arch Otolaryngol Head Neck Surg 39:334–341CrossRef
14.
go back to reference Vitti M, Fortinguerra CR, Corrêa AC, König B, Bérzin F (1974) Electromyographic behavior of the levator labii superioris alaeque nasi. Electromyogr Clin Neurophysiol 14:37–43PubMed Vitti M, Fortinguerra CR, Corrêa AC, König B, Bérzin F (1974) Electromyographic behavior of the levator labii superioris alaeque nasi. Electromyogr Clin Neurophysiol 14:37–43PubMed
15.
go back to reference Pessa JE, Brown F (1992) Independent effect of various facial mimetic muscles on the nasolabial fold. Aesthet Plast Surg 16:167–171CrossRef Pessa JE, Brown F (1992) Independent effect of various facial mimetic muscles on the nasolabial fold. Aesthet Plast Surg 16:167–171CrossRef
17.
go back to reference Tellioğlu AT, Özakpinar HR, Cakir B, Tekdemir I (2011) Importance of the levator labii alaeque nasi muscle in dorsal septal deviations. J Craniofac Surg 22:446–449CrossRefPubMed Tellioğlu AT, Özakpinar HR, Cakir B, Tekdemir I (2011) Importance of the levator labii alaeque nasi muscle in dorsal septal deviations. J Craniofac Surg 22:446–449CrossRefPubMed
18.
go back to reference Taş S (2016) Correcting the alar base retraction in crooked nose by dissection of levator alaque nasi muscle. Ann Plast Surg 77:383–387CrossRefPubMed Taş S (2016) Correcting the alar base retraction in crooked nose by dissection of levator alaque nasi muscle. Ann Plast Surg 77:383–387CrossRefPubMed
19.
go back to reference Letourneau A, Daniel RK (1988) The superficial musculoaponeurotic system of the nose. Plast Reconstr Surg 82:48–57CrossRefPubMed Letourneau A, Daniel RK (1988) The superficial musculoaponeurotic system of the nose. Plast Reconstr Surg 82:48–57CrossRefPubMed
20.
go back to reference Toriumi DM, Mueller RA, Grosch T, Bhattacharyya TK, Larrabee WF (1996) Vascular anatomy of the nose and the external rhinoplasty approach. Arch Otolaryngol Head Neck Surg 122:24–34CrossRefPubMed Toriumi DM, Mueller RA, Grosch T, Bhattacharyya TK, Larrabee WF (1996) Vascular anatomy of the nose and the external rhinoplasty approach. Arch Otolaryngol Head Neck Surg 122:24–34CrossRefPubMed
21.
go back to reference Duruel O, Ataman-Duruel ET, Berker E, Tözüm TF (2019) Treatment of various types of gummy smile with botulinum toxin-A. J Craniofac Surg 30:876–878CrossRefPubMed Duruel O, Ataman-Duruel ET, Berker E, Tözüm TF (2019) Treatment of various types of gummy smile with botulinum toxin-A. J Craniofac Surg 30:876–878CrossRefPubMed
22.
go back to reference Polo M (2008) Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofac Orthop 133:195–203CrossRef Polo M (2008) Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofac Orthop 133:195–203CrossRef
23.
go back to reference Oliveira AT, Paes-Souza SA, Garcia MAC, Mattos CT, Nojima MDCG (2021) Therapeutic effects of botulinum toxin type A in subjects with gummy smile: a longitudinal sEMG approach. Int Orthod 19:652–658CrossRefPubMed Oliveira AT, Paes-Souza SA, Garcia MAC, Mattos CT, Nojima MDCG (2021) Therapeutic effects of botulinum toxin type A in subjects with gummy smile: a longitudinal sEMG approach. Int Orthod 19:652–658CrossRefPubMed
Metadata
Title
Advanced Injection of Botulinum Toxin in the Nasal Muscles: A Novel Dynamic Change in Facial Expression
Authors
Helena Hotz Arroyo Ramos
Virginia Amaral
Luanda Pinheiro de Oliveira Afonso
Juliana Carlos Medeiros Campagnaro
Hannah Cade Guimarães Gazzinelli
Guilherme Muzy
Ada Regina Trindade de Almeida
Publication date
08-01-2024
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 8/2024
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-023-03751-y

Other articles of this Issue 8/2024

Aesthetic Plastic Surgery 8/2024 Go to the issue