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page 157 use j2ee bar code 39 generator togenerate ansi/aim code 39 with java barcode 158 O FFICE -B ASED C OSMETIC P ROCEDURES T ECHNIQUES FIGURE 35.1: Code 3/9 for Java Glabella (red dots), forehead (blue dots), brow lift (green dots), crow s feet (yellow dots)..

FIGURE 35.2: Bunny lines (red dots), depressor anguli oris (purple dots), chin (blue dots), platysma (orange dots)..

thickness an servlet Code 39 d pattern of muscle bers as well as differences in the sex and race of the patient. The basic facial musculature can be seen in Figures 35.1 and 35.

2. Men, in general, require higher doses per treatment area. Thin muscles, such as the platysma, require much lower doses than larger muscles, such as the corrugators.

Patients should be evaluated for brow and lid ptosis at baseline. Asians and elderly patients may present with brow or lid ptosis at baseline, and the treatment patterns and doses of BTXA utilized should minimize the chance of exacerbating such underlying conditions. A lower eyelid snap test should be performed to reveal any underlying weakness of eyelid closure and, if present, treatment periorbitally should only proceed with caution, keeping this baseline state in mind.

BOTOX Cosmetic is FDA approved for use in the glabellar area; however, it has now been used in multiple areas, as mentioned earlier. We have included gures to show some of the common and effective uses for BTX-A. In treating the glabella, BTX-A is utilized to weaken muscles such as the bilateral corrugators, depressor supercilii, and the central procerus, which is responsible, in large part, for the glabellar lines (Figure 35.

1, red dots). Often two injections are given per corrugator (which will also treat the modestly important depressor supercilii), with one or two injections in the procerus. It has also been suggested.

that BTX-A t reatment of the glabella region results in a slight brow lift by weakening the central frontalis effect of brow elevation and thus proportionately increasing the frontalis effect of lateral brow elevation. A more advanced technique is also shown, in which BTX-A is used to weaken the lateral lid depressor muscles, thereby achieving a lateral brow lift (Figure 35.1, green dots).

Also shown in Figure 35.1 is treatment of the forehead (blue dots). To avoid lowering the brow, the forehead, being the primary brow elevator, is most commonly treated in conjunction with the glabellar area, which is composed of primary brow depressors.

When treating the forehead for the rst time, many physicians will reserve treatment of the forehead area for a two-week follow-up visit after glabellar treatment and utilize a relatively low dose to reduce the possibility of lowering the brow too much. Men particularly have lower set brows, and aggressive treatment of the forehead should be done with caution as lowering of the brow can be an unwanted result. In Figure 35.

1, treatment of crow s feet is shown (yellow dots), which results in partial paralysis of the lateral orbicularis oculi. In Figure 35.2, treatment of the nasalis, to decrease the presence of bunny lines (red dots); the depressor anguli oris, to release the downward pull on the corners of the mouth (purple dots); the chin, to reduce dimpling (green dots); the.

35 . Cosmetic BOTOX: How We Do It 159 masseter, to Code 3 of 9 for Java reduce masseter hypertrophy and help restore mandibular angles (blue dots); and the platysma (orange dots), to reduce neck rhytids, are shown. In summary, although the FDA-approved use of BOTOX Cosmetic is 20 units for the treatment of glabellar lines, there are many new and interesting uses of BTX-A for the treatment of many different facial lines. These uses have been described by astute clinicians, and such advanced techniques allow for facial contouring and the treatment of a variety of rhytids.

A proper understanding of anatomy, the individual patient s baseline state, and careful consideration of treatment goals are critical for optimal outcomes..
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