Facelifts' via botulinum toxin

International report - Botulinum toxin has been used as a non-invasive facelifting procedure for some time now, establishing itself as a useful and safe tool for facial rejuvenation in patients worldwide.

Brazilian plastic surgeon Mauricio de Maio, M.D., discusses the journey of the aging face from young to old, the kinetic changes that the structures of the face undergo as the patient ages, and exactly how to employ botulinum toxin to restore youth in an aging face.

The aging process produces a variety of changes in the skin, muscles and bones. It is the volumetric loss of fatty tissue in the face that produces the saggy appearance, which is worsened by the gravitational forces that tend to pull the facial tissues down. The levator muscles weaken with time and, as a result, the vectors of forces that were maintaining the facial structures in an upward position simply invert. When blocking the correct muscular group, the physician can invert the vectors again, now in an upward position, and a facelift can be achieved.

Upper third

The surgeon says the frontalis muscle plays the most important role in eyebrow lifting.

Its medial fibers are naturally much stronger than the lateral fibers, and that is one of the most important reasons why the lateral part of the eyebrow falls down and droops with time. According to Dr. de Maio, aging signs in the upper third of the face are mainly those related to the low position of the eyebrows associated with the presence of horizontal lines in the forehead and vertical lines in the glabella.

Dr. de Maio lifts the eyebrow by blocking the superior medial fibers of the frontalis as well as the eyebrow depressor muscles, namely the corrugator supercilli, procerus and the lateral fibers of the orbicularis oculi. He says blocking the procerus is of crucial importance when trying to lift the medial portion of the eyebrows, and that only the medial fibers of the frontalis should be blocked to enable the lifting of the lateral portion of the eyebrow.

Middle third

Dr. de Maio says, "When attempting to lift the mid third of the face, it must be verified if the presence of deep nasolabial folds is due to the hypertonicity of the levator labii superioris alaeque nasi and the levator labii superioris; otherwise, injecting Botox (Allergan) into these muscles will promote no effect at all.

"The blocking of these muscles will soften the nasolabial groove. The correct indication associated with precise doses may also produce an interesting lift of the lateral malar zone. Blocking the medial levators of the mouth will synergistically make the lateral levators contract, lifting the lateral part of the middle third of the face."

According to the surgeon, the drooping of the tip of the nose is another aging sign that Botox injections can address. If the tip of the nose falls during a smile, blocking the depressor septi nasi produces a delicate elevation of the nose and a younger appearance.

Dr. de Maio tells Dermatology Times that major positive aesthetic effects can be achieved in upper lip wrinkles, especially visible during pursing. He treats deep wrinkles with a combination of other methods such as peels and fillers.

"When I use Botox here, I prefer to inject medially into the upper lip, close to the philtrum and into the skin and the vermilion border (mucosa transition line), using the smallest dose as possible," he explains.

Lower third

According to the plastic surgeon, the lower third is the part of the face that often shows the most undesirable aging signs such as deep oral commissures, loss of the definition of the mandible arch and platysmal bands.

Blocking the depressor anguli oris will lift the corner of the mouth, enabling the opposite muscles, the levators of the oral commissure, to lift this area, and the "sad look" around the mouth will improve.

To attain a better neck contour, the surgeon injects into the platysma. The overcontraction of the lateral platysmal bands usually pulls down the lateral part of the face and alters the mandible shape.