Treatment of the upper facial musculature with botulinum toxin injections

Abstract

The understanding of key anatomical structures and their relevance to clinical practice will enhance not only treatment outcomes, but also patient safety. The aim of this article is to offer an overview of upper facial anatomy to encapsulate what every medical aesthetic practitioner needs to know to achieve a safe, successful treatment outcome following the injection of botulinum toxin. It is hoped that this paper will offer an insight into the upper facial muscles and how they respond when chemically denervated. Practitioners must demonstrate an in-depth understanding of the assessment and evaluation of the facial musculature both at rest and in dynamic motion, and also fully comprehend the process of injecting botulinum toxin in its entirety, to ensure the upper face retains a natural pattern of facial movement and expression, thus avoiding the inappropriate outcomes that are so often seen. Astute observation skills are essential to truly understand the variance seen in every individual's pattern of facial expression. The findings discussed by the author are primarily based on her clinical experience. Some information presented is subjective rather than objective and is offered as a balanced overview. The author will endeavour to share her approach, which has been honed over 8 years of experience treating upper facial muscles with botulinum toxin.