Objectives: To describe the anatomy of the continuous fibromuscular layer of the lower face, discuss the development of age-related indications and propose neuromodulator-based interventions for this area. We provide evidence-based recommendations on optimal applications of neuromodulators to rebalance the musculoaponeurotic layer for natural results. We demonstrate how careful and deliberate placement of botulinum toxin can create an expressive, well-balanced face that reflects health, vitality and happiness.
Introduction: Surgeons and physicians using neuromodulators to rebalance the facial musculature need to develop an in-depth and holistic understanding of the five tissue layers of the face and how they interact to produce facial expressions. An understanding of the dynamic anatomy of the continuous superficial fibromuscular layer of the face is essential, and how the mimetic muscles exert directional influence through it. Knowledge of how to use neuromodulators to rebalance the musculoaponeurotic layer will facilitate more natural outcomes as demonstrated here in the lower face.
Materials / method: IncobotulinumtoxinA (incoA) was used to reduce directional pull by the mentalis and depressor anguli oris (DAO), while platysmal tension in the lower face was reduced with 2U aliquots of incoA along the mandibular ramus. A second row of toxins was also injected below the mandibular border to further relax upper neck platysmal tension and define the jawline. The directional pull of the DAO on the superficial muscular aponeurotic system (SMAS) and oral commissure was targeted by 2.5U of incoA into the muscle from the middle of the marionette line, as shown in two of our female patients.
Results: The lower face was rebalanced by correcting the platysmal tensioning across the jawline in combination with the mimetic, directional depressor muscles. This resolved the dour facial expression associated with a higher resting tone in this region.
Conclusion: We showed how the mimetic muscles are interconnected and exert a directional pull on the SMAS. The ability to tension or relax the muscular parts of the SMAS further affects resting facial and emotional expressions. Using neuromodulators, these ‘tensioning zones’ and ‘directional mimetic muscles’ can be modulated to effect facial expressions. Rebalancing the muscular tension in the face in combination with skin quality-focused modalities to address wrinkling leads to more natural outcomes.
Declaraciones
¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No
¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No
¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No
¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No
Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.