The Aesthetic Guide is part of the Informa Markets Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

Botulinum toxin treatments useful in correcting lower-third of face

Article-Botulinum toxin treatments useful in correcting lower-third of face

Key iconKey Points

  • Aesthetically treating perioral musculature is a common indication for botulinum toxin
  • Botulinum toxin can be effective nonsurgical approach to treat masseter hypertrophy
  • Facial asymmetry, Bell's palsy may be treated with botulinum toxin

Today, botulinum toxin is most commonly used in the upper-third of the face for aesthetic rejuvenation. This neurotoxin also proves, however, to have much utility in the mid- to lower-third of the face, serving as a very useful monotherapy for a gamut of cosmetic and medical indications.

Dr. Cohen
THE NOSE When speaking or smiling, the depressor septi nasi muscle running from the upper lip to the nose may be pulled down, resulting in aesthetic concern in some patients. Here, a small dose of botulinum toxin ranging from two to four units can offer a cosmetic correction by slightly lifting the tip of the nose.

"During a rhinoplasty procedure, surgeons will often sever this muscle to help lift the nose up. Using Botox (onabotulinumtoxinA, Allergan), we can weaken the muscle and achieve a noninvasive, nonsurgical aesthetic correction," says Nowell Solish M.D., a cosmetic dermatologist in Toronto.

While the depressor septi nasi drops the tip of the nose when contracted, the nasalis muscle is the most important muscle for promoting bunny lines, whether naturally present or appearing after Botox treatment of the glabella and crow's feet areas.

Botox often can be used to correct this aesthetic concern in patients, but caution is warranted and careful injection technique is crucial, as the adjacent levator labii superioris muscle extending from the side of the nose to the zygomatic bone could also be accidentally injected.

"If your needle tip is not medial enough, you could miss the nasalis muscle and accidentally inject the levator labii superioris alaeque nasi (LLSAN) muscle just lateral. Injection of the LLSAN muscle is a legitimate target if you want to treat and correct a gummy smile, but not appropriate if the goal is to inject the nasalis muscle to treat bunny lines alone," says Joel Lee Cohen, M.D., director of AboutSkin Dermatology and DermSurgery P.C., Denver.

Dr. Solish
MOUTH MATTERS Aesthetically treating the perioral musculature is a common indication for botulinum toxin. Here, small doses of the toxin can be injected in the orbicularis muscle around the mouth in order to improve wrinkling when speaking or chewing.

According to Dr. Solish, botulinum toxin may often do a better job in preventing these lines than they do treating them. Therefore, treatments could be started at an earlier age, before these lines arise. Botulinum toxin treatments can also work well in this area in conjunction with filler, as the filler could last longer due to the decrease in puckering that patients will do.

Though higher doses of botulinum toxin in this area may achieve a longer duration of effect, it also may result in mouth dysfunction. Therefore, more frequent botulinum toxin treatments using lower doses is likely the safest and more effective approach for this indication.

"If you are just treating vertical muscle columns without etched-in muscle lines, I would use lower doses and have patients come in more frequently for treatments," Dr. Cohen says. "However, if you are treating patients who have muscle columns that are starting to have etched-in lines or more significant etched-in lines, I will often pretreat with botulinum toxin and follow up about two weeks later with an ablative fractionated laser, resurfacing or even deep TCA peel to smoothen out the area."

Hide comments


  • Allowed HTML tags: <em> <strong> <blockquote> <br> <p>

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.