Botox Flashcards
What muscles cause frown lines?
Glabellar complex, which is the corrugator supercii, procerus, depressor supercii
Muscles for crows feet
Lateral orbital oracular is oculi, inferior orbicularis oculi
What muscle target for eyebrow lift
Superior lateral orbital orbicularis oculi. Can also treat the glabellar complex.
What muscle is targeted for the mental crease or a chin line or chin, puckering and dimpling?
Mentalis
What muscle is targeted for the nasolabial folds and a gummy smile
Levator labii superioris alaeque nasii
What muscle is targeted for bunny lines?
Nasalis
What muscle is targeted for marionette lines?
Depressor anguli orris
Patient Botox process
Take out product and prepare ~10min prior
RENEWD
Review patient’s case
-Aesthetic history and satisfaction
-Allergies
-Social history
Exam of patient while using a mirror
Note any areas of asymmetry to pt and in paperwork
Educate on tx options, anticipated results, realistic expectations, aftercare
Warn of potential risks/complications
Document with photographs of mapping, photos of static and dynamic lines, how many units.
Aftercare for Botox
- no massage or touching the area
- no heat / exercise x2-3 days
- no lay down for 2-4 hrs
- no alcohol
- if bruising/ swelling, gentle ice x10min q1-2h
- partial results lead to full results approx 2 weeks, lasts 3-6mos depending on metabolism
Glabellar safety zone
0.5-1cm above orbital rim at the lateral limbus line, no more than 1cm above, down to approx 1cm below the glabellar prominence.
Glabellar injections, dosing
Women: 20U, men: 25U
Deep injection to procerus 3-6Units, 1-2point injection in the procerus.
Deep injection to the corrugator within safety zone, holding to prevent diffusion down to lid, angled towards procerus, approx 2-5U.
Tail ends of the corrugators can be injected more superficially since it attaches to the dermis at the outer ends. Approx 1cm lateral and superior to the main body injections. 2-3U.
I do approx 16 units for 5-6 point injection to glabellar area.
Tx for blepharoptosis
OTC eye drops: Alpha adrenergic drops like naphazoline/pheniramine, 1 drop QID to affected eye
Forehead frontalis safety zone
Staying between the lateral limbus lines, approx 2cm below the hairline, and 2cm above the supaorbital ridge.
You can also go just lateral to the safety zone lines, still approx 2cm below hairline at the point of maximal brow elevation.
Peaked brow is caused by? Corrected by?
Caused by
- a strong lateral frontalis
- injecting lateral to the limbus lines too superiorly or with a very small dose
- omitted lateral frontalis tx
Corrected by
- injecting a bit more, inferiorly and laterally in the frontalis:
- 1.25-2.5U just inferior to the lateral safety zone in line with the most peaked portion of the brow
Frontalis forehead tx
Women: 15-22.5U
Men: 20-25U
Using 4-6 points of injection depending on forehead width, inject 1-2.5U approx 1cm apart, evenly across for symmetry. (Mainly 2 or 2.5U per injection, 3 if male and strong).
Then inject 1.25-2.5U (small dose but not too small) just lateral to the safety zone line approx 2cm below the hairline at the point of maximal brow elevation.
Brow lift safety zone and tx
Women: 5-7U total
Men: 7.5-10U total
Safety zone: at least 1cm outside orbital rim, below supraorbital ridge, lateral to lateral limbus line.
Insert needle approx 1.5cm lateral to lateral limbus line in the safety zone. Angle subdermally toward the forehead. Inject 2.5U. Go 1cm medially toward the limbus line and inject 1.25U.
Compress away from eye.
Can also use 0.5-1U per injection.
Crows feet safety zone and tx
Women: 15-20U total
Men: 20-25U total
Safety zone: 1cm outside orbital rim, above the superior margin of the zygoma. The extended safety zone goes up to the lateral limbus line with same margins, only use if necessary.
Inject approx 2.5U at a time, 0.5cm apart, with 2-3 injection points. Evenly space them along the arc of the external orbital rim.
Usually the middle injection is in line with the lateral canthus.
Botox reconstitution
Inject air by vacuum until no more gets sucked in.
Dilute with 2-2.5mL, aimed at the vial wall, gently swirl. Preserved saline preferred for pain. Or numb with local lido but it has ~2hours before wears off which ppl might dislike. Or do half lido half saline.
Nasals safety zone and tx
Women and men: 2.5-5U
Safety zone diamond:
Top corner is at the least protruding part of the nose between the canthi (nasion).
The bottom corner is halfway between the nasion and nasal tip.
The side corners are the points at which the nasion ala line intersects the intercanthal line.
Inject subdermally, angling toward nasal wall with 1.25U each side, 2 injection points total.
Masseter safety zone and tx
20-50U each side, 3-4 injection points.
At least 5-7U per injection, about 0.5-1cm apart.
At least 1.5cm above the margin of the mandible. Identify borders of the masseter. Stay below the ear lobe-corner of mouth line. Inject deeply with the muscle contracted.
Be mindful of those with less skin elasticity getting jowling.
