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Aesthetics Practice Today

Facial Anatomy for Neuromodulators 101

Published December 4, 2012 11:02 AM by Kimberly Cray

Among the most important concepts to master prior to performing neuromodulator injections is to fully understand muscle anatomy in the region. Below are among the most commonly injected muscles on the head and neck for cosmetic purposes:

Frontalis: This is the muscle responsible for the horizontal forehead lines. When this muscle is injected with a neuromodulator it softens the elevation of the forehead and brows. Too powerful of injections, especially laterally in the forehead just above the brow, can cause drooping. So caution must be taken to avoid over correction.

Corrugators: These muscles work together to form the infamous "11s" or vertical lines in the glabella. Together with the procerus muscle (see below), the corrugators contribute to the hyper-functional movement between the brows forming vertical lines.

Depressor Supercilli: These muscles also play a key role in forming vertical lines in the frown or glabella area.

Orbicularis Oculi: These muscles are responsible for closing the eye and allow for squinting. This muscle forms crows feet, or the thin horizontal lines around the eyes.

Procerus: Alongside the corrugators, this muscle lies within the center of the glabella and is also a contributor to frowning, resulting in horizontal lines in the glabella.

Platysma: This is the large muscle of the neck which as we age may form very visible bands and sagging. Injection into this muscle results in a smooth and lifted neckline.

Nasalis: This muscle is responsible for forming "bunny lines" or horizontal lines in the glabella and along the sides of the nose.

Orbicularis Oris: This is the muscle around the mouth that may lead to vertical lines or "lipstick" lines with chronic use or pursing of the lips. Older patients may complain that they cannot apply lipstick without it running. Lines caused by this muscle are typically more evident in individuals who are/were chronic smokers.

Depressor Anguli Oris: Originating at the inferior border of the mandible at the vertical level of the midpupillary line, this muscle inserts onto the corner of the mouth, forming lines that may begin to angle the mouth downward. To subtly elevate the mouth the DAOs may be injected.

It is important to note that lines form perpendicular to the way the fibers of the muscle run. So as you review your anatomy book this makes it much more clear where and how the lines are formed over time. Remember, understanding facial anatomy is essential, but just as crucial is recognizing the unique anatomy in each individual. Some patients have very prominent muscles while others may not require as much in certain areas to soften. No two patients' features or musculature are identical, so certainly understand facial anatomy, but treat each patient unique to their needs.

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    Occupation: Physician Assistant/Nurse Practitioner
    Setting: Miami & Upland, Calif.
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