Indexed on: 03 Nov '04Published on: 03 Nov '04Published in: Annales de Chirurgie Plastique Esthétique
As usual, the face at rest is analysed before btx injection. But the interest of the analysis of the face dynamically, in a functional way, with the help of the palpation, is demonstrated. A key point is to decide to favor the high position of the highbrow more than to totally fade the frontal wrinkles. To perform this, a new functional segmentation of the frontalis muscle is described. The role of the procerus muscle as antagonist of the frontalis muscle, inferior medial part, is explained. To elevate the medium third of the eyebrow, the lateral part of the corrugator muscle is injected with a specific technique. This technique decreases the risk of weakening the overlying frontalis muscle and the underlying levator palpebrae muscle. To achieve a higher elevation of the eyebrow tail, and to totally fade the upper and medium crow's foot, different points of injection on the lateral orbital rim are described, without the risk of migration to the oculo motor muscles. Fading the tear trough with the injection of the superior malar part of the orbicularis oculi muscle is explained. Thanks to the use of the functional analysis of the face and to the comprehension of the fabulous possibilities of the botulinum toxin A, it is now justified to switch from a "ready to wear" way of injection to a "haute couture" way, that is to say adapted to each patient.