By Kate Coleman-Moriarty
Written via a most sensible professional within the box, this source introduces the reader to the pharmacology of botulinum toxin and describes and the total variety of suggestions for its optimum administration-including secure dealing with, the choice and evaluate of sufferers, capability problems and pitfalls, and asthetic recommendations. It additionally offers comparative details on different modalities resembling laser and hyaluronic acid, in addition to capability hazard components, so readers can decide upon the easiest technique for every sufferer.
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Extra resources for Botulinum Toxin in Facial Rejuvenation
This means that inferoorbital contents (muscle and fat) are prone to bulging in front of the orbital rim, creating ‘bags’. 5 Short orbital rim–lash distance allows safe botulinum toxin to the preseptal orbicularis if hypertrophied. (a) is before Botox® and (b) is after Botox®. b toxin successfully to pretarsal wrinkles without protrusion of orbital fat or folds of skin (Fig. 5ab). ó Examine the height and width of the zygomatic arch. Does the orbicularis muscle sag between the cheekbone and the eye?
Contraindications and complications 45 Complaint:‘It didn’t last’ Examine the patient if possible, but this complaint is usually made at a followup visit. Check the batch used and the other patients treated with it. The patient is usually right. The most likely cause will be excessive dilution of the botulinum toxin or denaturation by agitation or the wrong room temperature. Reassure the patient. Resist any temptation to re-inject within 12 weeks in order to avoid the risk of stimulating antibody formation (see below).
Examine the contour of the socket. Is it shallow, allowing anterior displacement of orbital fat and bags? Does the inferior orbital rim protrude? Is it recessed behind the level of the anterior surface of the cornea? This may also be assessed by the ‘pencil test’. Ask the patient to hold a pencil vertically against the anterior cheekbone. If this passes in front of the cornea (Fig. 4a), then the patient has good lower lid skeletal support. If the pencil only reaches the lash margin (Fig. 4b), then the patient is at risk of developing sagging of the lower lid and widening of the palpebral aperture if botulinum toxin is injected for pretarsal orbicularis wrinkles.