Anatomy

Table 5.7. Characteristics of the m. levator labii superioris and the m. levator labii superioris alaeque nasi

Muscle

Action

Synergists

Antagonists

M. levator labii superioris Elevates and everts the upper lip.

Creates and moves the middle portion of the nasolabial fold.

M. levator labii superioris Medial part: dilates the alaeque nasi nostril

Lateral part: raises and everts the upper lip Creates the most upper portion of the nasolabial fold.

Lateral part of m. levator labii superioris alaeque nasi, m. levator anguli oris and mm. zygomati-cus major and minor

Medial part: m. dilator nasi

Lateral part: m. levator labii superioris, m. zygomaticus major and minor and m. levator anguli oris

M. depressor anguli oris and m. orbicularis oris

M. depressor anguli oris and m. orbicularis oris

In static analysis, there should be a prominent nasolabial fold. The surrounding structures such as cheeks, lips and chin should also be evaluated. If the prominent nasolabial fold is surrounded by atrophic tissues and the upper lateral part of the nasal flare is flat, it is likely that the best treatment should be the injection of fillers. In contrast, if the surrounding tissues are prominent and there is a bulging area at the upper lateral part of the nasal flare, the injection of botulinum toxin should be considered.

In the dynamic analysis, patients should be asked to smile at maximum contraction. The most upper part of the nasolabial fold should be even more pronounced. Palpation at this level confirms the contraction of the levator labii su-perioris alaeque nasi where it divides its fibers to the nasal flare and upper lip.

The ideal patients to start with the injection of BNT-A are those with a short distance between the vermillion border and the nasal base (short upper lip). When smiling, these patients should present excessive gum exposure. Patients with a long upper lip (vermillion border to nasal base) should be carefully treated, because one of the undesirable results of the injection at the nasola-bial fold level is the upper lip lengthening.

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