the art of liquid face lift (botox)
TRANSCRIPT
2.BotoxBY
PROFESSOR OSAMA B MOAWAD
The Art of Liquid Face Lift
BoNTA-ONA; Botox, Botox Cosmetic, Allergan, Vistabel, Vistabex
What to Inject?
ABO-Botulinum-Toxin –Dysport/Azzalure/Reloxin
What to Inject?
Inco-Botulinum-toxin-A Xeomin/Xeomeen/Bocouture
What to Inject?
Where to inject? Glabella (frown
Lines )
Supraciliary wrinkles
Crow’s feet
Bunny Lines
Lip and Perioral
Nasolabial fold
Dimpled chin
Forehead
Nefertiti
Neck (platysmal band)
• Myasthenia Gravis, Eaton-Lamber
sydrome
• Myopathies
• Amyoitrophic lateral sclerosis
• Skin infection and inflammation
• Market facial asymmetry, ptosis,
dermatochalasis
• Deep dermal scarring
• Simultaneous aminoglycosides
Is Botox Good For Me?
Photography is a Must!!!!
At Rest
Making Funny Faces
Photography is a Must!!!!
Couch with adjustable head
Hand mirror
Makeup removal
Alcohol-free disinfectant
Marker Pen
1 mL insulin syringe with 0.1 mL graduations
How to Inject?
How to Inject?
How Much to Inject?
How Much to Inject?
Treatment Response is
Dose related with
regard to efficacy of
treatment and duration
of effect
Forehead-Glabella-Crow’s feet
Where to Inject?
Forehead Lines (Thinker’s Lines)
Forehead Lines Injection Sites
4-8 injection sites, women 6-15U, Men more than 15U
Forehead Lines Injection
The frontal region should always be treated in association with the glabellar area for more satisfactory results
Patients with narrow eye brow should receive fewer injections and lower doses
B
A
B
A
B
A
B
A
Glabella-Vertical Lines
Contractions of the Corrugators and to a Lesser Degree the Medial Orbicularis Oculi and the Depressor Supercilii Produce Vertical Lines Between the Eyebrow
Glabella-Horizontal Lines
Contraction of the procerus produces horizontal lines
over the bridge of the nose
Always above the supraorbital ridge regardless of
Eyebrow Position
GLABELLA INJECTION SITES
Glabella Injection Sites
5-7 injection sites, more in men.
Women -10U-30U, men 20U-40U
B
A
B
A
B
A
B
A
A
B
A
B
A
B
A
B
A
B
A
B
A
B
A
AB
AB
Orbicularis fibers
Zygomaticus fibers
• Snap Test is done first• Determine the Source of wrinkles
• Assess while Patient Animate and at Rest
Crow’s Feet Injection Sites
• 2-5 Sites. Women 1oU-30U ,Men 20U-40U
• The First Injection is in the Center of Area of Maximum Wrinkles 1cm Lateral to Lateral Orbital Rim
• The Second and Third are 1-1.5cm above and below
Wrinkles Primarily Below
the Lateral Canthus
should be injected in a
Line that Angles from
Antero-inferior to
Supero-posterior
Ant Injection Should be
lateral to a Lateral to a
line drawn vertically
from the Inner Canthus
AB
AB
AB
B
A
Eye Brow Contour Gender Differences
whereas women require an arched eyebrow, men prefer a lower, horizontal brow. We inject an additional 4 to 5U into a point 1 cm above the supraorbital rim in the mid-
pupillary line in men.
Low horizontal
High arched
Chemical Eyebrow Lift
Medial Eyebrow Elevation
Botox injection is the same as for frown lines
Lateral Eye Brow Elevation
Chemical Brow Lift
Half Dose of Medial ye Brow Lift
B
A
A B
AB
AB
AB
A Snap Test is Done First
One injection Point in the Mid-pupillary Line on the Margin of the Lower Eye Lid and Second 1cm Laterally
Lower Eyelids Wrinkles and Widening Eye Aperture
1-BTX Smoothens Inferior Wrinkles 2-Widens Eye Aperture
3-Treat Dennie Morgan Folds
Widening Eye ApertureA
B
Widening Eye Aperture
A
One Injection Point in the Mid-pupillary Line on the Margin of the Lower Eye Lid
Botox & Middle Face
Bunny Lines or Nasal Wrinkles
Ask to Laugh, Sniff and to Squint Intensely
Facial muscles
work in
combination to
occasionally
produce, in some
patients, extreme
nasal wrinkling.
Nasalis,
nasoorbicular,
nasociliary, and
nasoalar wrinkles
are shown with
forced expression.
Bunny Lines or Nasal Wrinkles
BUNNY LINES OR NASAL WRINKLES
B
A
B
A
B
A
A
Nasal Flare: Injection Sites
2.BTX injections for bunny lines may help
Medical Rhinoplasty
2U-4U on the nasal spine deep injection
often with fillers at nasolabial fold
Gummy Simile
1 cm above the insertion of nostril. 1-2 U/Side
Deep injection- orthodontic treatment
LLSAN
Better in Young Patients in Combination with Fillers
Zm,Zmi
Better in Young Patients in Combination with Fillers
LLSAN,Zm,Zm
Better in Young Patients in
Combination with Fillers
Better in young patients in
combination with fillers
Botox & Lower Face
Upper Lip Wrinkles Or Smokers Lines
Rosebud Mouth
1-U at Four Points 1.5cm Away from the Corner of the
Mouth Superficial at the vermillion. Treat the lower lip
on the same session. Better in Combination with Filler
and Resurfacing
Treatment of Labial paracommissural wrinkles
2U/side injected 2cm on a horizontal line passing through the mouth corner (risorius M)
SC.Better combine with fillers
B
A
Treatment of Labial paracommissural wrinkles
Treatment of Labial paracommissural wrinkles
B
ATreatment of Labial Paracommissural wrinkles
A
Nasolabial
Marionette line
Treatment of Marionette lines
1-2U Botox in each DAO superficially better with Dermal Fillers
B
Treatment of Marionette lines
A
2U Botox is injected in the depressor anguli oris (DAO) muscles in combination
with dermal fillers
Peau D’orange Chin
2 sites on each side at 5 mm of the medial line on
the chin protuberance perpendicular deep injection with
filler at mental crease
1-Hyper trophy of Masseter Muscle
BTX injection into
Three Different Points
that are 1.5cm Away
from the Border of
Mandibular angle
One Point in the
Thickest area and
Two other Points that
are Located ant and
post at the lower half
of the masseter
1-5 sites total 18U-30U IM with 30 gauge needle
With volumizing filler at mid face
1-Hyper trophy of Masseter Muscle
Not an MSI patient
2U deep intramuscular in 2-4 sites per chord 2cm apart. No more than
50U/session
Platysmal Bands Injection Sites
Nefertiti Face Lift
2-3 BTX along and under each mandible and to Upper part of the post platysmal band for a totoal of 15-20 U each side
Platysmal Bands Injection Sites
B
A
Platysmal Bands Injection Sites
Platysmal Bands Injection Sites
B
A
Platysmal Bands Injection Sites
A
Platysmal Bands Injection Sites
B
Platysmal Bands Injection Sites
AB
MESOBOTOX/MESOLIFT
Eyebrow shape
Greater Muscle Mass
Larger Botox Doses
Half Botox Dilutions
Prevent aging
Resurfacing Procedures
Volume Restoration
Botox in Resurfacing Procedures
Facial surgery
Laser
Light
Peels
Radiofrequency
BTX-A should be injected 3 weeks before surgery. In addition, BTX-A injections may optimize and prolong the
effect of the surface procedures
Botox is injected 3 weeks before
Blepharoplasty
Botox in Resurfacing Procedures
AB
Botox injection before dermal filler will improve theresults of both and keep it longer
Botox in Volume restoration
AB
Botox injection before dermal filler willimprove the results of both and keep itlonger
Botox in Volume restoration
AB
Botox in Volume restoration
Botox injection before dermal filler will improve the
results of both and keep it longer
AB
B
The combination of botulinum toxin type A and hyaluronic acid filler can be used to
achieve a lateral brow-lift.
A
What Do I
Expect
Immediately
after
Injections?
RednessBruisingEarly and expected
side effects include
swelling, bruising,
and redness at the
injection
Ice will lessen Bruises and Swelling
1.Patients must remain in the
vertical position,
2.Patient must avoid intense
physical exercise
3.Patient must avoid
manipulating the injected area
4.Patient must use the injected
muscle for at least 4 hours after
injections.
1.The first clinical effect
appear after 24h-72hrs
2.The effect generally last
for 3-6months
3.Repeated injection
may prolong the effect
up to 7-9months
• Avoid Injections Outside the Lateral Limbus of the Iiris
Particularly the Lower Portion or Danger Zone
• BTX is Injected Medial to the Temporal Fusion
Line at the Temporal Hair Line
AB
Pitfalls of Botox
Discomfort, Swelling
Rednes, Bruising
Eyebrow and lid ptosis
Supracillary wrinkles
‘‘Mr. Spock’’
Allergic reactions
Avoiding Injection in the Lateral Eyebrow and
Lateral Forehead
Lead to Raising the Lateral Eyebrows
Proper Selection
Higher concentration
Glaberlla first
Follow Instruction
Avoid dangerous zone
Apraclonidine
Eyelid Ptosis
• injection in the
Middle of
Glabella
Away from the
pupil line
Treatment with
0.5% Iopdine or
2.5%
Neosynephrine
Perioral Complications
Small doses
Superficial
Symmetrical
Proper selection
Follow instructions
Peri-orbital Complications
• Bruises
• Diplopia
• Ectropion
• Drooping
Lower
eyelid
• Proper
Selection
• Follow
instructions
• Injections
1.5cm
lateral to
lateral
canthus
• Snap Test
The use of injectable products for cosmetic enhancement is increasing
rapidly. This is due to the wide range of effective options, decrease in
social stigma, and the excellent safety profile.
AB
The use of injectable products for cosmetic enhancement is increasing
rapidly. This is due in large part to the wide range of effective options,
decrease in social stigma, and the excellent safety profile.
AB
The use of injectable products for cosmetic enhancement is increasing
rapidly. This is due in large part to the wide range of effective options,
decrease in social stigma, and the excellent safety profile.
A