Lower Third and Neck

part of the face and alters the mandible shape. To obtain an improvement at the mandible arch, one must block the lateral platysma bands beginning with the very upper fibers that interdigitate with the facial muscular fibers. Major lifting of the face is achieved when the lower third of the masseter fibers are blocked. As a result, the upper fibers will contract, pulling up the zygomatic zone and thinning the lower part of the face.

The dose to be used for BNT-A lifting will depend on the needs of each patient. As mentioned before, the goal is to promote full blocking of the depressors and mild or no blocking of the elevators. Below you may find suggested initial doses, which however does not mean that all the listed muscles should be injected in the first treatment. Proper physical examination at rest and during animation will identify the injection sites and muscles to be treated (Fig. 6.15, Table 6.10).

The lower third is the part of the face that often shows the most undesirable aging signs, such as deep oral commissure, loss of definition of the mandible arch, and platysma bands. Blocking the mm. depressores anguli oris will lift the corner of the mouth because the opposite muscles, the elevators of the oral commissure, will enable this area to lift. The sad look around the mouth will be improved.

Injecting into the platysma may produce a better neck contour. The over-contraction of the lateral platysma bands usually pulls down the lateral

Fig. 6.15. The injection sites for BNT-A lifting. The initial doses should be low during the first treatment session. The second treatment should be viewed as an opportunity to improve the performance of the lifting effect
Table 6.10. Doses for the treatment of different muscles for a BNT-face lift

Function

Muscle

Botox

Dysport

Comments

Elevator

M. frontalis

6-10 U

15-30 U

The blocking should be only on the most superficial fibers to remove the wrinkling and NOT its lifting effect

Depressor

M. corrugator supercilii

20-30 U

30-60 U

Full blocking is desirable

Depressor

M. procerus

3-6 U

7.5-15 U

Full blocking is desirable

Depressor

M. orbicularis oculi

12-30 U

30-60 U

The lower fibers should be injected at a very superficial level

Depressor

M. depressor septi nasi

2-4 U

8-12 U

Into the nasal base, preferably in patients with short upper lip

Elevator

M. levator labii superioris alaeque nasi

2-6 U

4-8 U

Very superficially, preferably into its medial part

Elevator

M. levator labii superioris

-

-

Not usually injected for this purpose

Elevator

M. zygomaticus minor

-

-

Not usually injected for this purpose

Elevator

M. levator anguli oris (caninus)

-

-

Not usually injected for this purpose

Elevator

M. zygomaticus major

2-6 U

6-18 U

Only if cheek lines are present and very superficially (intradermal)

Depressor

M. depressor labii inferioris

-

-

SHOULD NOT BE BLOCKED

Depressor

M. depressor anguli oris

5-10 U

10-20 U

Very important for correcting 'sad mouth'

Depressor

Platysma medial bands

10-30 U

30-60 U

Superficial if no fat content and deeper with fat deposits in the neck

Depressor

Platysma lateral bands

20-40 U

30-100 U

Same as above and the most important depressors that drop the face

All dosages are given for the total area, e.g. both sides if applicable. The dosages are for some indications sometimes lower as described in Section 5 to avoid overtreatment.

All dosages are given for the total area, e.g. both sides if applicable. The dosages are for some indications sometimes lower as described in Section 5 to avoid overtreatment.

The evaluation of results should be completely different from a surgical approach. A natural, refreshed look should be the target in the upper, mid and lower third and in the neck area. This treatment is quite suitable when patients do not have a formal surgical indication and are willing to have a quick, effective and minimally invasive non-surgical procedure (Figs. 6.i6.a,b-6.2oa,b).

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Responses

  • Mikolaj
    Which area is the lower third of the neck?
    23 days ago

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