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The Art of Liquid Face Lift (Botox)

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We are truly in an “era of injectables,” with access to a varied armamentarium of products that yield dramatic aesthetic results with minimal recovery downtime. From its first published mention as an aesthetic treatment for glabellar lines in 1992, the use of commercially available BoNT type A (BoNTA) has captivated healthcare professionals and lay people alike. The availability of newer BoNTA formulations, with more expected in the near future, poses an exciting opportunity for aesthetic practitioners to reach an ever expanding potential patient base and provide increasingly refined treatment

Published in: Health & Medicine

The Art of Liquid Face Lift (Botox)

  1. 1. 2.Botox BY PROFESSOR OSAMA B MOAWAD The Art of Liquid Face Lift
  2. 2.  BoNTA-ONA; Botox, Botox Cosmetic, Allergan, Vistabel, Vistabex What to Inject?
  3. 3. ABO-Botulinum-Toxin – Dysport/Azzalure/Reloxin What to Inject?
  4. 4. Inco-Botulinum-toxin-A Xeomin/Xeomeen/Bocouture What to Inject?
  5. 5. 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)
  6. 6. • 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?
  7. 7. Photography is a Must!!!! At Rest
  8. 8. Making Funny Faces Photography is a Must!!!!
  9. 9. 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?
  10. 10. How to Inject?
  11. 11. How Much to Inject?
  12. 12. How Much to Inject? Treatment Response is Dose related with regard to efficacy of treatment and duration of effect
  13. 13. Forehead-Glabella-Crow’s feet Where to Inject?
  14. 14. Forehead Lines (Thinker’s Lines)
  15. 15. Forehead Lines Injection Sites 4-8 injection sites, women 6-15U, Men more than 15U
  16. 16. 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
  17. 17. B
  18. 18. A
  19. 19. B
  20. 20. A
  21. 21. B
  22. 22. A
  23. 23. B
  24. 24. A
  25. 25. 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
  26. 26. Glabella-Horizontal Lines Contraction of the procerus produces horizontal lines over the bridge of the nose
  27. 27. Always above the supraorbital ridge regardless of Eyebrow Position GLABELLA INJECTION SITES
  28. 28. Glabella Injection Sites 5-7 injection sites, more in men. Women -10U-30U, men 20U-40U
  29. 29. B
  30. 30. A
  31. 31. B
  32. 32. A
  33. 33. B
  34. 34. A
  35. 35. B
  36. 36. A
  37. 37. A
  38. 38. B
  39. 39. A
  40. 40. B
  41. 41. A
  42. 42. B
  43. 43. A
  44. 44. B
  45. 45. A
  46. 46. B
  47. 47. A
  48. 48. B
  49. 49. A
  50. 50. B
  51. 51. A
  52. 52. AB
  53. 53. AB
  54. 54. Orbicularis fibers Zygomaticus fibers • Snap Test is done first • Determine the Source of wrinkles • Assess while Patient Animate and at Rest
  55. 55. 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
  56. 56. 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
  57. 57. AB
  58. 58. AB
  59. 59. AB
  60. 60. B
  61. 61. A
  62. 62. 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
  63. 63. Chemical Eyebrow Lift Medial Eyebrow Elevation Botox injection is the same as for frown lines
  64. 64. Lateral Eye Brow Elevation Chemical Brow Lift Half Dose of Medial ye Brow Lift
  65. 65. B
  66. 66. A
  67. 67. A B
  68. 68. AB
  69. 69. AB
  70. 70. AB
  71. 71. 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
  72. 72. Lower Eyelids Wrinkles and Widening Eye Aperture 1-BTX Smoothens Inferior Wrinkles 2-Widens Eye Aperture 3-Treat Dennie Morgan Folds
  73. 73. Widening Eye Aperture A
  74. 74. B
  75. 75. Widening Eye Aperture A
  76. 76. One Injection Point in the Mid-pupillary Line on the Margin of the Lower Eye Lid
  77. 77. Botox & Middle Face
  78. 78. Bunny Lines or Nasal Wrinkles Ask to Laugh, Sniff and to Squint Intensely
  79. 79. 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
  80. 80. BUNNY LINES OR NASAL WRINKLES
  81. 81. B
  82. 82. A
  83. 83. B
  84. 84. A
  85. 85. B
  86. 86. A
  87. 87. A
  88. 88. Nasal Flare: Injection Sites 2.BTX injections for bunny lines may help
  89. 89. Medical Rhinoplasty 2U-4U on the nasal spine deep injection often with fillers at nasolabial fold
  90. 90. Gummy Simile 1 cm above the insertion of nostril. 1-2 U/Side Deep injection- orthodontic treatment
  91. 91. LLSAN Better in Young Patients in Combination with Fillers
  92. 92. Zm,Zmi Better in Young Patients in Combination with Fillers
  93. 93. LLSAN,Zm,Zm Better in Young Patients in Combination with Fillers
  94. 94. Better in young patients in combination with fillers
  95. 95. Botox & Lower Face
  96. 96. 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
  97. 97. 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
  98. 98. A Treatment of Labial paracommissural wrinkles
  99. 99. Treatment of Labial paracommissural wrinkles B
  100. 100. ATreatment of Labial Paracommissural wrinkles A
  101. 101. Nasolabial Marionette line Treatment of Marionette lines 1-2U Botox in each DAO superficially better with Dermal Fillers B
  102. 102. Treatment of Marionette lines A
  103. 103. 2U Botox is injected in the depressor anguli oris (DAO) muscles in combination with dermal fillers
  104. 104. 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
  105. 105. 1-Hyper trophy of Masseter Muscle
  106. 106. 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
  107. 107. 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
  108. 108. 2U deep intramuscular in 2-4 sites per chord 2cm apart. No more than 50U/session Platysmal Bands Injection Sites
  109. 109. 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
  110. 110. Platysmal Bands Injection Sites B
  111. 111. A Platysmal Bands Injection Sites
  112. 112. Platysmal Bands Injection Sites B
  113. 113. A Platysmal Bands Injection Sites
  114. 114. A Platysmal Bands Injection Sites B
  115. 115. Platysmal Bands Injection Sites AB
  116. 116. MESOBOTOX/MESOLIFT
  117. 117. Eyebrow shape Greater Muscle Mass Larger Botox Doses Half Botox Dilutions
  118. 118. Prevent aging Resurfacing Procedures Volume Restoration
  119. 119. 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
  120. 120. Botox is injected 3 weeks before Blepharoplasty Botox in Resurfacing Procedures AB
  121. 121. Botox injection before dermal filler will improve the results of both and keep it longer Botox in Volume restoration AB
  122. 122. Botox injection before dermal filler will improve the results of both and keep it longer Botox in Volume restoration AB
  123. 123. Botox in Volume restoration Botox injection before dermal filler will improve the results of both and keep it longer AB
  124. 124. B
  125. 125. The combination of botulinum toxin type A and hyaluronic acid filler can be used to achieve a lateral brow-lift. A
  126. 126. What Do I Expect Immediately after Injections? Redness BruisingEarly and expected side effects include swelling, bruising, and redness at the injection
  127. 127. Ice will lessen Bruises and Swelling
  128. 128. 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.
  129. 129. 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
  130. 130. • 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
  131. 131. Pitfalls of Botox Discomfort, Swelling Rednes, Bruising Eyebrow and lid ptosis Supracillary wrinkles ‘‘Mr. Spock’’ Allergic reactions
  132. 132. Avoiding Injection in the Lateral Eyebrow and Lateral Forehead Lead to Raising the Lateral Eyebrows
  133. 133. Proper Selection Higher concentration Glaberlla first Follow Instruction Avoid dangerous zone Apraclonidine
  134. 134. Eyelid Ptosis • injection in the Middle of Glabella Away from the pupil line Treatment with 0.5% Iopdine or 2.5% Neosynephrine
  135. 135. Perioral Complications Small doses Superficial Symmetrical Proper selection Follow instructions
  136. 136. Peri-orbital Complications • Bruises • Diplopia • Ectropion • Drooping Lower eyelid • Proper Selection • Follow instructions • Injections 1.5cm lateral to lateral canthus • Snap Test
  137. 137. 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
  138. 138. e use of injectable products for cosmetic enhancement is increasing idly. This is due in large part to the wide range of effective options, decrease in social stigma, and the excellent safety profile. AB
  139. 139. 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

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