The Art of Liquid Face Lift (Botox)

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