Combined treatment with botulinum toxin and hyaluronic acid to correct unsightly lateral-chin depression*

With aging, anatomical changes are observed in the face. In the lower third, these changes are expressed as ptosis of the angle of the mouth, lip enhancement groove mentalis; decrease in concavity between the jaw and neck and very noticeable platysmal banding. The repeated contraction of muscles of the lateral-chin together with the band platysmal side form what are called a marionette groove. Treating the whole lateral-chin area can result in a more harmonious aspect of the face when compared with treatment of a marionette groove in isolation. In this paper we describe combined treatment of the lateral chin area using botulinum toxin and fillers.

Aging; Botulinum toxins; Hyaluronic acid

Authorship

André Vieira Braz

Dermatologist - Professor - Professor of Cosmiatry in the Dermatology Division, Policlínica Geral do Rio de Janeiro (PGRJ), Rio de Janeiro, RJ, BrazilPoliclínica Geral do Rio de Janeiro (PGRJ)BrazilRio de Janeiro, RJ, BrazilDermatologist - Professor - Professor of Cosmiatry in the Dermatology Division, Policlínica Geral do Rio de Janeiro (PGRJ), Rio de Janeiro, RJ, Brazil

Dailana Louvain

Dermatology Specialist – dermatologist in private clinic – Dermoclin, São José dos Campos, SP, BrazilDermatology Specialist – dermatologist in private clinic – DermoclinBrazilSão José dos Campos, SP, BrazilDermatology Specialist – dermatologist in private clinic – Dermoclin, São José dos Campos, SP, Brazil

Luana Vieira Mukamal

Doctor/Dermatologist in private clinic-, Vitória, ES, BrazilDoctor/Dermatologist in private clinic-BrazilVitória, ES, BrazilDoctor/Dermatologist in private clinic-, Vitória, ES, Brazil

Mailing address: André Vieira Braz Rua Visconde de Piraja 330 /1001, 1002 e 1003. Ipanema 22410-000 Rio de Janeiro, (RJ) Brazil E-mail: avbraz@globo.com

Conflict of interests: none.

SCIMAGO INSTITUTIONS RANKINGS

Doctor/Dermatologist in private clinic-, Vitória, ES, BrazilDoctor/Dermatologist in private clinic-BrazilVitória, ES, BrazilDoctor/Dermatologist in private clinic-, Vitória, ES, Brazil

Figures

Figures (2)

Thumbnail

FIGURE 1
A. Note the area marked in green for the application of botulinum toxin into the muscles: mentalis, depressor of the angle of the mouth and lateral platysmal bands. B. This picture shows the application of 3 units of toxin botulinum in a belly of the mentalis muscle. C. Here we highlight the application of 2 units of botulinum toxin in the upper point of the lateral platysmal band. D. Note the creation of a button anesthetic with 2% lidocaine for undertaking the puncture and the insertion of a 22G microcannula. E. 21G needle inserted up to the reticular layer of the dermis (the puncture enables insertion of the 22F microcannula) F. Once the the inlet port is opened the 22G microcannula is inserted up to the supraperiosteal plane oulined in green. Retroinjection of the product is carried out in the area cited

Thumbnail

FIGURE 2
A. We can observe ptosis of the labial commisure, resulting in a triangular depressed area at the corner of the mouth; accentuated mentolabial sulcus, forming marionette lines; decreased concavity between the jaw and neck. B. When marking the area to be filled we demarcated the chin region with a semi circle in white and a further semi circle in the area for the inferior displacement of Bichat fat. A line on the edge of the jaw brings together the two lines above, and 2 cm above these we draw another parallel line, delimiting a quadrangular area in green. C. The result in this patient after the area discussed above was filled. Significant improvement of mandibular contour and labial chin groove, as well as lifting of the labial commissure. D. On the right-side hemifacial combined treatment was performed with botulinum toxin and hyaluronic acid. Significant aesthetic improvement resulted when compared with the untreated left-side hemifacial. E. Detailed image before the combined treatment of botulinum toxin and hyaluronic acid. F. Picture showing situation following the combined treatment using botulinum toxin and hyaluronic acid. Significant aesthetic improvement in the mandibular contour resulting from treatment of the mentolabial sulcus and the marionette line

FIGURE 1 A. Note the area marked in green for the application of botulinum toxin into the muscles: mentalis, depressor of the angle of the mouth and lateral platysmal bands. B. This picture shows the application of 3 units of toxin botulinum in a belly of the mentalis muscle. C. Here we highlight the application of 2 units of botulinum toxin in the upper point of the lateral platysmal band. D. Note the creation of a button anesthetic with 2% lidocaine for undertaking the puncture and the insertion of a 22G microcannula. E. 21G needle inserted up to the reticular layer of the dermis (the puncture enables insertion of the 22F microcannula) F. Once the the inlet port is opened the 22G microcannula is inserted up to the supraperiosteal plane oulined in green. Retroinjection of the product is carried out in the area cited

FIGURE 2 A. We can observe ptosis of the labial commisure, resulting in a triangular depressed area at the corner of the mouth; accentuated mentolabial sulcus, forming marionette lines; decreased concavity between the jaw and neck. B. When marking the area to be filled we demarcated the chin region with a semi circle in white and a further semi circle in the area for the inferior displacement of Bichat fat. A line on the edge of the jaw brings together the two lines above, and 2 cm above these we draw another parallel line, delimiting a quadrangular area in green. C. The result in this patient after the area discussed above was filled. Significant improvement of mandibular contour and labial chin groove, as well as lifting of the labial commissure. D. On the right-side hemifacial combined treatment was performed with botulinum toxin and hyaluronic acid. Significant aesthetic improvement resulted when compared with the untreated left-side hemifacial. E. Detailed image before the combined treatment of botulinum toxin and hyaluronic acid. F. Picture showing situation following the combined treatment using botulinum toxin and hyaluronic acid. Significant aesthetic improvement in the mandibular contour resulting from treatment of the mentolabial sulcus and the marionette line

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Combined treatment with botulinum toxin and hyaluronic acid to correct unsightly lateral-chin depression*

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Mensagem

[1] Mailing address: André Vieira Braz Rua Visconde de Piraja 330 /1001, 1002 e 1003. Ipanema 22410-000 Rio de Janeiro, (RJ) Brazil E-mail: avbraz@globo.com