Objectives: A “Domino effect” while botulinum therapy can appear when we don’t consider a synergy and antagonism of of target and intact facial muscles. It is not always a desirable aesthetic result, which looks like the domino effect, when one of the zones correction leads to an activation of other muscles with an undesirable aesthetic result. This effect can be prevented and treated.
Introduction: Toxin therapy shouldn’t be directed to separate muscles. It should be aimed at the features of the interaction of facial muscles. Unfortunately, interactions between them is not always under control of direct synergy and antagonism. These interactions are more complicated than it is usually considered.
Materials / method: A review and analysis of many own clinical cases have been conducted during a long practice. Groups muscles analysis was conducted while certain mimic tests. Kinematic chains were discovered for every individual patient’s mimic patterns, in which target and additional muscles were defined. Doses were divided among muscles depending on their activity and contribution into mimic pattern realization.
Results: We got a satisfactory aesthetic correction in all cases while individual choice of botulinum toxin doses and the target injection points. Despite the fact that this strategy differed from the standard injection points and doses, this approach is justified and allows to prevent the “Domino effect” from muscles unaccounted for the correction, which are included into the certain kinematic chain and can be activated.
Conclusion: The prevention of the “Domino effect” is more preferable than the treatment following. A construction of the whole kinematic chains is very useful in prognosis of botulinum toxin therapy results. Understanding of development of a new muscular relations let us prevent undesirable aesthetic results in the way of working with the whole kinematic chains.
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