Accuracy in glabellar neurotoxin injections - We've been doing it wrong for 30 years
Objectives: We have been injecting glabellar neurotoxin wrong for the last 35 years. The standardised injection patterns increase the risk of side effects and by modifying our injection protocols - both site and spread of toxin - we can get better results with lower risk of complications
Introduction: The standardised injection points for the glabellar as per the SPC for toxins are wrong. The standard injection points we’ve been teaching for over 25 years for glabellar injection are wrong. The injection sites are too high, leading to spread of the toxin into the frontalis and consequent adverse events. A tighter field of effect would allow for more accurate neurotoxin placement directly into the actual corrugator muscle itself.
Materials / method: Using a novel neurotoxin found to have a tighter field of effect, we have treated hundreds of patients using a modified injection pattern. This injection pattern actually injects directly into the muscles that are used to create the frown in the glabellar complex, whereas the injection points as per the SPC are specifically designed to stay "1cm above the orbital rim" to avoid spread into levator palpebrae superioris - a problem that some eminent injectors (Michael Kane) believe doesn’t actually happen. Follow the actual anatomy and you will get improved results
Results: This modified injection pattern has led to better results in terms of speed of onset, longevity (presumably due to increased amount of active toxin within the corrugator muscles) and a reduction in medial brow droop (caused by weakening of the medial fibres of frontalis). It has not led to an increase in lid ptosis, as would be predicted if toxin were to spread inferiorly from these novel injection points into the levator palpebrae superioris.
Conclusion: Using a neurotoxin with a tighter field of effect - either due to the characteristics of the product or by hypodilution - allows for more accurate placement of the glabellar toxin injections. This gives superior results with less risk of adverse effects
