Essential anatomy for facial injections

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Anatomy of the face, face wrinkles and preferable sites of injections

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  • Botox will temporarily stop the underlying frontalis muscle from pulling on the skin and creating the furrows and wrinkles.
    Dynamic Wrinkles and are best treated with Botox
    http://www.medicalling.com/botox-or-browlift-for-forehead-wrinkles-top-5-wrinkles-treatment/
  • Injection of BTX to lateral frontalis, will re-balance the eyebrow position. Unintended spread of the toxin to the adjacent muscles can create their weakness and affect temporarily facial expressions or functions. Bad injection technique or muscle manipulation immediately after the treatment can cause toxin spread. For example, eyelid drooping is caused when toxin is injected to treat the glabellar complex (Figure 2), eyebrow ptosis can be induced by forehead wrinkles injection (Figure 3),

    http://www.iacdworld.org/skin/btx.htm
  • Medial end of superciliary arch passes upward and laterally to the skin superior to the middle of the supraorbital margin
    Lies deep to the orbicularis oculi
    Draws the eyebrows medially and inferiorly and is responsible for the vertical wrinkles above the nose which is called Glabellar lines
  • Superficial muscle
    Vertical muscle fibers
    Inserted into the skin of the forehead between the eyebrows
    Depresses the medial end of the eyebrows and Horizontally wrinkle the skin over the dorsum of the nose
  • The glabella, In Humans is the skin between the the eyebows and the nose
    The skin of the glabella can be used to measure skin turgor in patients suspected of being dehydrated by pinching it between the fingers and lifting it gently away from the underlying skull.
    The skin of dehydrated patients tends to remain extended ("tented") rather than promptly regaining its normal shape.
  • Superficial muscle
    Vertical muscle fibers
    Inserted into the skin of the forehead between the eyebrows
    Depresses the medial end of the eyebrows and Horizontally wrincle the skin over the dorsum of the nose
  • Levator Labi superioris aleque nasi: Longest name. from frontal process of maxilla and divides into two parts one to the alar cartilage of the nose and the other into the upper lip
    These dilators are obvious in infants with repiratory distress
  • Dilator naris Depressor septi: from maxilla above the incisors and inserted into the nasal septum
    Levator Labi superioris aleque nasi: Longest name. from frontal process of maxilla and divides into two parts one to the alar cartilage of the nose and the other into the upper lip
    These dilators are obvious in infants with repiratory distress
  • Essential anatomy for facial injections

    1. 1. Essential anatomy for facial injections MOHAMED ELADL 9.05.2014
    2. 2. DrMEladl OBJECTIVES  Outline muscle groups of the face: muscles of mastication and muscles of facial expression.  Discuss the functional groups of muscles of facial expression: dilator and sphincter mechanisms of the orifices of the face.  Describe the attachment and function of the muscles of facial expression.  Summarize the attachment of levator palpebrae superioris.  Discuss the anatomy of wrinkle lines in the face in relation to the muscles involved, preferred sites of injections, and possible complications  Horizontal lines of the forehead.  What are Mephisto sign, Lateral brow lift, Glabella lines, Crow’s feet, Bunny lines, Marionette lines, Cobblestone appearance, Gummy smile and Nefertiti lift.  Describe the blood supply of the face: branches of internal and external carotid arteries.  Describe the motor and cutaneous innervation of the face.
    3. 3. DrMEladl MUSCLES OF THE FACE  Muscles of mastication  Muscles of facial expression
    4. 4. DrMEladl MUSCLES OF MASTICATION  Temporalis  Masseter  Pterygoids Muscles
    5. 5. DrMEladl  Functional groups surround the orifices  Sphincters & Dilators MUSCLES OF FACIAL EXPRESSION
    6. 6. DrMEladl  Sphincters: Orbicularis oculi muscle MUSCLES AROUND THE ORBIT
    7. 7. DrMEladl  Sphincters: Orbicularis oculi muscle MUSCLES AROUND THE ORBIT Medial palpebral ligament Lateral palpebral raphae Lacrimal gland
    8. 8. DrMEladl  Dilators: Levator palbebrae Superioris (opposes the Palbebral part of orbicularis oculi muscle) MUSCLES AROUND THE ORBIT
    9. 9. DrMEladl  Dilators: Frontalis (opposes the orbital part of orbicularis oculi muscle) MUSCLES AROUND THE ORBIT
    10. 10. DrMEladl HORIZONTAL WRINKLES IN FOREHEAD  Lies at right angles to the line of pull of the underlying muscle (Frontalis muscle)  Dynamic wrinkles are those that appear only during active movement of the face.  Static wrinkles are those that are always present even when the face is at rest.
    11. 11. DrMEladl HORIZONTAL WRINKLES IN FOREHEAD Injection should NOT be confined to the midpubillary lines and should extend laterally to avoid Mephisto Sign
    12. 12. DrMEladl  A true upper lid ptosis (drooping) can occur if the neurotoxin is injected in or near the levator muscle. HORIZONTAL WRINKLES IN FOREHEAD
    13. 13. DrMEladl  Close to the eye: Corrugator supercilii MUSCLES AROUND THE ORBIT Draws the eyebrows medially and inferiorly and is responsible for the vertical wrinkles above the nose which is called Glabellar lines
    14. 14. DrMEladl  Close to the eye: Procerus Muscle MUSCLES AROUND THE ORBIT Depresses the medial end of the eyebrows is responsible for the horizontal wrinkles over the dorsum of the nose.
    15. 15. DrMEladl  Are vertical lines that appear between the eyebrows.  Appear over time from the effects of age, sun exposure and habitual frowning, whether while awake or during sleep, due to tension.  Injection is made close to the midline for Procerus and corrugator Muscles FROWN(GLABELLAR) LINES
    16. 16. DrMEladl  Lie on the lateral side of the eye due to contraction of the orbital part of the orbicularis oculi with age  They are at right angles to the line of pull of orbicularis oculi muscle  The injection must be not so close to the orbit to avoid infiltration of the lateral rectus which results in medial squint. CROW’S FEET LINES
    17. 17. DrMEladl  Sphincter: Compressor Naris -Is the transverse part of nasalis muscle -Form aponeurosis over the bridge of the nose MUSCLES OF NOSTRILS
    18. 18. DrMEladl  Dilators: 1. Dilator Naris (anterior part of nasalis) Are few muscle fibers inserted into the lateral part of the ala of the nose and draws the alar cartilage downward and laterally (opens the naris) 2. Depressor Septi From maxilla above the incisors and inserted into the nasal septum MUSCLES OF NOSTRILS
    19. 19. DrMEladl  Dilators: 1. Dilator Naris (anterior part of nasalis) are few muscle fibers inserted into the lateral part of the ala of the nose and draws the alar cartilage downward and laterally (opens the naris) 2. Depressor Septi 3. Levator Labi superioris aleque nasi From frontal process of maxilla and divides into two parts one to the alar cartilage of the nose and the other into the upper lip MUSCLES OF NOSTRILS 1 2 3 These dilators are obvious in infants with respiratory distress
    20. 20. DrMEladl  Bunny lines: Along the upper third of the nose and nasal bridge.  Deepening of nasolabial folds: which are lines or folds that run from the nose to the corners of the mouth. WRINKLES RELATED TO NOSE AREA
    21. 21. DrMEladl  Horizontal wrinkles which form across the ridge of the nose as people age.  They tend to form as a result of years of smiling, frowning, and forming expressions with the face. BUNNY LINES
    22. 22. DrMEladl  Sphincters:  Orbicularis Oris From medial parts of maxilla and mandible and inserted into the mucus membrane of the lips The tone of the muscle closes & protrudes the lips as in whistling & kissing MUSCLES AROUND THE MOUTH
    23. 23. DrMEladl  Dilators: 1. Levator Labii Superioris alique nasi 2. Levator Labii Superioris 3. Levator Anguli Oris 4. Zygomaticus minor 5. Zygomaticus major 6. Rizorius 7. Depressor anguli oris 8. Depressor Labi inferioris 9. Mentalis B. Buccinator M. Masseter MUSCLES AROUND THE MOUTH 1 2 3 4 5 7 8 9 B M
    24. 24. DrMEladl  Dilators:  Levator Labii Superioris Is a superficial muscle arise above the infraorbial foramen  Levator Anguli Oris Is a deep muscle below the infraorbital foramen  The infraorbital nerve & vessels are sandwiched between these 2 muscles  The levator labii superioris is responsible for deepening of the nasolabial sulcus MUSCLES AROUND THE MOUTH LAO X X X
    25. 25. DrMEladl PLATYSMA MUSCLE
    26. 26. DrMEladl  The most common wrinkles in the perioral area are: 1. Nasolabial Lines and Parentheses lines. 2. Lipstick lines 3. Marionette lines WRINKLES IN PERIORAL AREA
    27. 27. DrMEladl NASOLABIAL FOLDS  Are deep creases or folds that run from the corners of the nose down to the corners of the mouth.  Usually single but can be more than one.  These start as smile lines but with age the fat in the cheeks slides down and combines with muscle shrinkage and loss of skin elasticity.
    28. 28. DrMEladl  The levator labii superioris is responsible for deepening of the nasolabial sulcus NASOLABIAL FOLDS * *
    29. 29. DrMEladl  Some individuals develop lines that arc around the corners of the mouth and usually are extension of nasolabial folds.  They are often shallow, fine lines. PARENTHESES LINES
    30. 30. DrMEladl  Lines that etch vertically from the upper or lower lips  They are more prevalent on the upper lips.  While they are sometimes called smoker’s lines, most individuals develop the lines are not smokers.  The lines are a result of loss of volume that occurs with age.  These lines can contribute to lipstick bleeding, hence the name 'lipstick lines'. LIPSTICK LINES
    31. 31. DrMEladl  These lines that run straight downwards from the corners of the mouth can make you look unhappy.  They form as facial volume begins to deplete and deeper creases begin to form below the mouth. MARIONETTE LINES
    32. 32. DrMEladl  Formed mainly by the depressor anguli oris muscle and by the platysma muscle  Injection should be 1cm lateral to the angle of the mouth to avoid asymmetry MARIONETTE LINES *
    33. 33. DrMEladl FACIAL ARTERY Supraorbital n & a Supratrochlear n & a Superior labial a Inferior labial a Facial a Angular a
    34. 34. DrMEladl SENSORY NERVE SUPPLY OF THE FACE
    35. 35. DrMEladl MOTOR NERVE SUPPLY OF THE FACE
    36. 36. DrMEladl MOTOR NERVE SUPPLY OF THE FACE Auriculotemporal n. Superficial temporal a. Temporal Zygomatic Buccal Mandibular Cervical Facialnervebranches Greater auricular n
    37. 37. DrMEladl
    38. 38. Thank You

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