Botulinum Toxin Injection


General assessment

I would now like to introduce you to Reena. Reena is currently 29, and I asked her what areas of her face she was concerned with, and she mentioned that she had 3 main concerns. The first was that she would ideally like to have some treatment to the chin to make it more dominant, the second was her lips, and finally, she has an interesting issue with her nose. Let’s begin by just having a look at her face overall, we can immediately see that Reena is young and beautiful, she has a beautiful face shape – her face is overall an oval or heart shape, due to good lateral projection of her cheeks coming down into a delicate chin. We can also see that Reena has very beautiful skin, and this is even toned from the hairline to the chin. Clearly, her most beautiful feature is her eyes, they are large and dominant. Accordingly, when we treat a young, beautiful model like Reena, we have to be very careful to embellish her pre-existing features.

Nose assessment

Let’s have a look at her nose in detail, you can see that at rest, there are no obvious issues, however, if I ask her to begin speaking, if you observe closely you will notice a quite significant downturn to the tip of her nose, and when she is talking she is contracting her depressor septi nasi. In turn this is causing excessive depression of the nasal tip. When she smiles, we notice that she has a very short distance between the lip and the base of the nose due to excessive contraction of the depressor septi nasi and the central lip elevators. This is more visible from the side view, so if I get Reena to turn towards me, and again I just ask her to start speaking towards me, if you observe first of all in smile the tip of the nose comes down and she has a very short distance from nose to lip, and now when she speaks, you will see that the tip is moving quite considerably as she speaks. We call this a dancing tip, and is can be treated easily with botulinum toxin in the depressor septi nasi muscle.

Injection site markings and treatment

We are treating Reena for the excessive activity in her depressor septi nasi. I have marked out the approximate location of this muscle, which is located deep and rises from the incisive fossa on the maxilla and inserts into the nasal septum. Its action is to bring down the tip of the nose during smile or while the patient is talking, and as we can see in Reena, the activity here is excessive. Accordingly, we can reduce activity by injecting with botulinum toxin. To treat the depressor septi nasi, I begin by numbing the area with a little bit of ice as this is a painful procedure. I lift the tip of the nose and then insert my needle into the columella to at least mid depth as the muscle is relatively deep, then I will inject 4 units of botulinum toxin.

Treatment outcome at 2 weeks

We have Reena here 2 weeks after treatment to the depressor septi nasi with botulinum toxin. You will notice that pretreatment, she had very excessive movement of the tip of the nose while talking. After treatment, although there is some movement, it is significantly reduced. Reena also underwent lip treatment to help an asymmetrical smile. If you look at her on the left, you will notice that she has more elevation of the right commissure than the left and the gap between the upper lip and the nose is very minimal. On the right, after the treatment to the depressor septi nasi with botulinum toxin and her lip with Juvederm Volbella, you can see that the smile is much more symmetrical.