Anatomy toxin injections
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This document provides an overview of the anatomy related to botulinum toxin injections. It discusses the muscles of the forehead, brow, eyes, lips and neck in detail. For each muscle, it describes the origin, insertion, innervation, blood supply, function and related anatomy. It also discusses injection patterns and dosages for treatments like brow lifts, lip treatments, masseter reduction and neck tightening. Potential complications of neck injections are also outlined. The goal is to understand the anatomy to maximize efficacy and safety of botulinum toxin procedures.
Anatomy toxin injections
- 1. ANATOMY RELATED TO BOTULINUM TOXIN A INJECTIONS LEE WALKER BDS MFDS RCPSG MJDF RCS ENG
- 2. OBJECTIVES • To have a practical, interactive session • To take away something useful that can be applied to your daily practice • To understand the anatomy related to botulinum toxin administration • To learn strategies to maximize efficacy and minimise the risk of complications
- 3. OBJECTIVES
- 5. FRONTALIS
- 6. FRONTALIS • ELEVATES BROW AND LOWERS ANTERIOR HAIRLINE • BILATERAL /SYMMETRICAL • AMUSCULAR SUPERIORLY • ROUGHLY RECTANGULAR IN SHAPE • MUSCLE FIBRES VERTICALLY ORIENTATED • THIN MUSCLE 1 – 1.5 MM • LIES AT A UNIFORM DEPTH BENEATH SKIN 3-5 MM
- 7. FRONTALIS • SENSORY INNERVATION VIA SUPRAORBITAL AND SUPRATROCHLEAR NERVES (RUN DEEP TO FRONTALIS) • SUPRAORBITAL HAS SUPERFICIAL BRANCH RUNS ALONG ORBITAL RIM TO LATERAL SCALP • MOTOR INNERVATION VIA TEMPORAL BRANCH OF FACIAL NERVE (FRONTAL NERVE)
- 8. FRONTALIS • THE OBICULARIS RETAINING LIGAMENT (ORL) DEEP BOUNDARY BETWEEN FOREHEAD AND UPPER EYELID • ANY TREATMENT WHICH TRANSMITS THROUGH ORL ENTERS THE SOFT TISSUES OF THE UPPER EYELID • ORL 2-3 MM ABOVE SUPRAORBITAL RIM • SUPRAORBITAL NERVE TRAVERSES THE ORL THROUGH A FACIAL TUNNEL (SUPRAORBITAL CREASE) • IMPORTANCE - AVOIDANCE OF EYELID PTOSIS
- 9. FRONTALIS
- 10. FRONTALIS
- 11. FRONTALIS
- 12. FRONTALIS
- 13. FRONTALIS
- 14. FRONTALIS
- 15. FRONTALIS
- 16. FRONTALIS
- 17. FRONTALIS
- 18. FRONTALIS
- 19. FRONTALIS
- 20. OBICULARIS OCULI
- 21. OBICULARIS OCULI
- 22. OBICULARIS OCULI • 3 PARTS – ORBITAL/PRESEPTAL/PRETARSAL • BROAD/THIN CIRCUMFERENTIAL MUSCLE • SPHINCTER • SUPERFICIAL • UPPER BORDER BLEND WITH CORRUGATOR/FRONTALIS • NERVE SUPPLY – TEMPORAL/ ZYGOMATIC • BLOOD SUPPLY VIA OPTHALMIC/ZYGOMATICORBITAL/ANGULAR
- 23. OBICULARIS OCULI • LOWER BORDER CLOSELY ASSOCIATED WITH ZYGOMATICUS MUSCLES • CAN WORK INDEPENDENTLY (REDUCE GLARE) • DEPRESSES LATERAL BROW • MOVES EYEBROW MEDIALLY AND SLIGHTLY DOWN WARDS
- 24. OBICULARIS OCULI
- 25. OBICULARIS OCULI
- 27. OBICULARIS OCULI
- 28. OBICULARIS OCULI
- 29. OBICULARIS OCULI
- 30. OBICULARIS OCULI
- 31. OBICULARIS OCULI
- 32. OBICULARIS OCULI
- 33. OBICULARIS OCULI
- 34. CORRUGATOR • LIES DEEP TO OTHER MUSCLES • 5-8 MM UNDER SKIN • NARROW MUSCLE • NO BONY ATTACHMENTS LATERALLY • THICKEST (2-3MM) 199MM FROM NASION • MININMAL MUSCLE MASS LATERALLY
- 35. CORRUGATOR
- 36. CORRUGATOR
- 37. CORRUGATOR
- 38. CORRUGATOR
- 40. CORRUGATOR
- 41. CORRUGATOR
- 42. CORRUGATOR
- 45. CORRUGATORS
- 47. CORRUGATOR
- 48. GLABELLA ‘U’ PATTERN (Trindade 2012)
- 53. MEDICIS GLABELLA ASSESSMENT SCALE MUSCLE MASS MORE IMPORTANT THAN FROWN SEVERITY • Wrinkle depth and depression (How deep are the wrinkles and brow depression at full contraction?) • Inter-brow space (How much does it change from relaxation to full contraction?) • Glabella muscle size and shape (Are the glabella muscles bulging at the point of maximum frown?) • Shape and position of the brow (are the glabella muscles depressed or distorted at the point of maximum frown?)
- 54. WRINKLE DEPTH
- 56. MUSCLE SIZE AND SHAPE
- 57. BROW POSITION
- 58. PROCERUS
- 59. PROCERUS • DEPRESSES MEDIAL HEAD OF BROW • RESPONSIBLE FOR HORIZONTAL LINES IN GLABELLA • SUPPLIED BY TEMPORAL/ZYGOMATIC AND BUCCAL BRANCHES (ANGULAR NERVE) • DEEP NASAL PORTION AND SUPERFICIAL IN FRONTALIS AREA • BLOOD SUPPLY VIA SUPRAORBITAL ARTERY
- 60. PROCERUS • DEEP INSERTION TO BONE (NASION) • SUPERFICIAL ATTACHMENT MERGING WITH FRONTALIS • LONGER IN WOMEN 19MM – 16MM IN MEN • THIN, PYRAMIDAL MUSCLE
- 61. PROCERUS
- 62. PROCERUS
- 63. PROCERUS
- 64. PROCERUS
- 65. PROCERUS
- 69. DEPRESSOR SUPERCILI • ORIGIN – BONY ATTATCHMENT NEAR MEDIAL CANTHUS • COURSES DIRECTLY UPWARDS, PARALLEL WITH PROCERUS TO ATTACH INTO SKIN OF FOREHEAD 14- 15MM
- 72. OBICULARIS ORIS • BROAD, ELLIPTICAL MUSCLE • INTERNAL (PARS LABIALIS) EXTERNAL (MARGINALIS) • INSERTION DEFINES THE WET/DRY BORDER OF LIP • NERVE SUPPLY BUCCAL BRANCH (SUPERIOR/INFERIOR) • BLOOD SUPPLY VIA SUPERIOR/INFERIOR LABIAL ARTERY
- 73. OBICULARIS ORIS
- 74. OBICULARIS ORIS
- 75. OBICULARIS ORIS
- 76. OBICULARIS ORIS
- 77. OBICULARIS ORIS
- 78. DEPRESSOR ANGULI ORIS • TRIANGULAR SHAPED MUSCLE • LIES BEHIND MARIONETTE LINES • FROM CORNER OF MOUTH TO MANDIBLE BORDER • DEPRESSES CORNER OF MOUTH • NERVE SUPPLY MANDIBULAR BRANCH • BLOOD SUPPLY VIA INFERIOR LABIAL ARTERY
- 86. MENTALIS • PAIRED CENTRAL MUSCLE FROM DEEP ON ANTERIOR MANDIBLE • PROTRUDES LOWER LIP AND DIMPLES CHIN • NERVE SUPPLY VIA MANDIBULAR BRANCH • BLOOD SUPPLY VIA INFERIOR LABIAL/ MENTAL ARTERY
- 87. MENTALIS
- 88. MENTALIS
- 89. MENTALIS
- 90. MUSCLES INVOLVED IN ‘GUMMY SMILE’
- 94. INTRADERMAL TOXIN • LARGE PORES • OILY SKIN • SWEATING • ACTS ON CHOLINERGIC RECEPTOR OF PILOSEBACEOUS UNIT • CAN WEAKEN MUSCULAR ACTIVITY • RESPONSIBLE FOR ‘SHINY’ APPEARANCE • WEARS OFF QUICKER IF USING FOR ‘BABY BOTOX’
- 96. MASSETER ANATOMY
- 97. FACE SCULPTING USING TOXIN • 8 UNITS PER SITE WITH 12.7MM NEEDLE • 3 DIFFERENT HEADS – DEPTH ACCORDING • REPEAT AT 6 WEEKS
- 98. FACIAL SCULPTING • RISK OF LOSS OF FULL SMILE DUE TO DIFFUSION INTO RISORIUS • ASYMMETRY OF SMILE • WEAKNESS AND ACHING ON CHEWING- OCCURS FOR FIRST 8-12 WEEKS • ‘JOWLING’ DUE TO EXCESS SKIN DROOPING OVER ATROPHIED MUSCLE – RESOLVES QUICKLY • BRUISING COMMON
- 100. DECOLLATAGE • SUPERFICIAL INTRADERMAL INJECTION • OVER DILUTE – NEED LARGER DIFFUSION DUE TO GREATER SURFACE AREA • WEARS OFF QUICKER THAN FACE • TAKES LONGER TO ACHIEVE RESULTS • EXCESSIVE DOSAGE CAN LEAD TO WEAKENING OF INTERCOSTAL MUSCLES ON DEEP INSPIRATION
- 101. NEFERTITI LIFT • Hyperkinetic platysma and inelastic & saggy skin cause blunting of the jaw line • Nefertiti lift redefines the elegant/sharp lines of jaw and neck for a tighter more youthful, contoured look
- 102. NEFERTITI LIFT • Inject toxin inferior to the mandibular border posterior to the DAO & anterior to the SCM down a band or along the mid portion of the neck • INJECTION SITES 30 – 60 units per side -2CM APART
- 104. NECK TOXIN COMPLICATIONS • Asymmetric smile • Disruption of lip competence • Incontinence of food and liquids • Dysarthria • (pronunciation) • Dysphonia • (pitch of voice) • Dysphagia • (cannot swallow