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Anatomy & botulinum toxin injections, a practical guide by experts for specialists desiring to enhance their knowledge and expertise for aesthetic practices
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Dr Patrick Trevidic presents the new edition and extensive update of our best-selling title: Anatomy & Botulinum toxin injections.
We are proud after seven years, and an extensive update to release the new edition of our best selling title on Anatomy & Botulinum toxin injections. Key features: for each muscle, starting with profile, origin, connections, followed by action and innervation, and concluding with topographic illustrations, this user friendly format builds on your understanding of injectable facial anatomy. Side-by-side images with explanatory text and anatomical drawings with concise labelling and expanded descriptive captions makes this book an ideal study companion that highlights and explain key concepts.
For this very special second edition we are honoured and proud to introduce an entire chapter devoted to the botulinum toxin molecular aspects, formulations, and pharmacodynamics, plus potential future developments. Professor Bernard Poulain, Research Director at the National Centre for Scientific Research at the Institute of Cellular and Integrative Neurobiology summarises what is currently known about the botulinum toxin that will help practitioners to use it with the most practical and safest methods. At the end of this extensive chapter, Annexe 1 and Annexe 2 will help you apply the highly scientific content into real-life practice.
Special attention is paid to 3D muscles such as the corrugator supercilii, procerus, levator labii superioris alaeque nasi, depressor anguli oris, mentalis with an in depth origin and a superficial skin insertion. This will help you insert the inferior and superior injections points in the most appropriate plane. The importance of understanding regional muscular balance cannot be overemphasized. New and future injectors will appreciate descriptions of the upper face internal and external muscular balances in the textbook and 3D animations in the DVD that clearly demonstrate the antagonist and synergist muscle activities. It is important to correlate the number of injected units to the volume of the treated muscle to obtain an optimal aesthetic result. For example, do you know that volume of the platysma is 5 times bigger than that of the corrugator?
In this edition, you will find information on three new muscles that are equally important to understand and consider when deciding on a treatment strategy. For example, the botulinum toxin treatment of the nasalis muscle decreases the dilated aspect of the nostril, whereas treating the depressor septi nasi enhances the nasal tip projection and improves the relationship between the nasal tip and the upper lip. The anatomical keys relating to the masseter muscle will help you when treating our Asian patients who frequently seek an aesthetic alteration of hypertrophic masseter to reduce a prominent mandibular angle.
As patients do not come in our offices with an anatomical map on full view, our main goal is to make our anatomical descriptions useful in a real-life practice. For this reason, we have introduced an “Exquisite Trio”, incorporating the anatomical view on a cadaver, paired with a drawing of the muscle, and finally the clinical case. This triple demonstration will facilitate a clinical approach when analysing our patients.
Patrick Trevidic, MD
In order to get the best results possible while minimizing any undesirable after effects, the physician must have a keen knowledge not only of anatomy, but also the dynamic of all muscles in play.
Our expansive experience in cadaver dissection allowed us to create a book in which a surgical approach to the anatomy of facial muscles is combined with an analytical evaluation of the effects on expression wrinkles, produced as a result of muscle contraction. In order for the reader to get the most out of this book, we chose an atlas-like format, one which gave us the possibility to insert full page image accompanied by concise, easy to follow descriptions of the relevant muscles.
Our aim is to take the readers on a journey, starting from an anatomical base, then on to an aesthetic analysis of the targeted areas, and finally reaching the injection sites on their appropriate techniques.
The contents are clear, comprehensive and easy to use. Each chapter is dedicated to detailing one given muscle: the full muscle profile, progressive dissections showing the targeted muscle, connections with the more important anatomical structure of the region, the correlation with its external clinical elements on the skin which allow us to better find the origin and injection points, the innervation, and the motor endplates localization, and finally the injection techniques and doses. The enclosed DVD allows the reader to see the reconstruction of the head and its facial muscles in 3D and the full dissection on cadavers of the targeted muscles with the injection points clearly indicated. My hope is that experienced surgeons and young colleagues alike will appreciate and value this book. I also hope that like me they will find that serious, detailed studies about facial anatomy as well as understanding of facial muscles dynamics will aid in improving their techniques.
Fabio M Ingallina, MD
This book chapter reviews the state of art on botulinum toxin mechanisms.
Thirty years ago, Alan Scott pioneered a new field of medicine: the use of Botulinum toxin in therapy. For over 30 years, an incredible number of new indications have been assessed, then approved or rejected. The use of botulinum toxin for aesthetic purpose, pioneered by Carruthers and Carruthers in 1992, has been another breakthrough in botulino-therapy. Let us come back to the seminal work of Alan Scott: genious intuition and solid knowledge of state of art basic science. Indeed, without knowing that botulinum toxin do not cross the blood brain barrier and acts in the periphery, that botulinum toxin causes muscle paralysis and secretory gland drying by preventing acetylcholine release, in a very long lasting manner, he would had not envisioned a possible use of botulinum toxin in therapy.
During the last three decades, our basic knowledge on botulinum toxin has been greatly improved. Most importantly, the molecular and cellular mechanisms involved in botulinum toxin action have been entirely deciphered. Indeed, it has been established that (i) neurotoxin separate from complexing proteins at physiological pH in less than one minute, (ii) only the neurotoxin (150 kDa) is neuroactive and the complexing proteins do not participate in the therapeutic effects, (iii) specific receptors for botulinum neurotoxins have been identified onto nerve endings explaining why botulinum neurotoxin is so effective on certain nerve terminals, (iv) it is internalized in nerve endings and intracellular targets of the various botulinum toxin types have been identified. This book chapter reviews the state of art on botulinum toxin mechanisms.
Since thirty years, a lot of issues have been resolved, at least in part. This is the case of (i) the factors that participates to myorelaxation: blockage of acetylcholine and muscle fibres atrophy; (ii) what determines the life-span of botulinum neurotoxin in the extracellular space and inside nerve endings, (iii) why its action can prolong for months, (iv) what influences its diffusion/dissemination when in muscles or glands (i.e. what determines the field of effect) and the circulating fluids (source of undesired effects). Knowing all these basic science aspects is essential for any-body who wants using botulinum neurotoxin in a rational manner, in the daily practice or with in mind developing new indications. Therefore, a large part of this book chapter is aimed at reviewing what may favour higher, longer, and safer efficacy.
During the past three decades, new commercial botulinum toxin products differing by their formulation, system of units, presence of excipients as Human Serum Albulmin, have appeared on the market. This book chapter and Annexe II is also aimed at helping you to decode the information mentioned in the manufacturers’ data sheets and packaging (type of botulinum toxin; manufacturer name: OnabotulinumtoxinA, IncobotulinumtoxinA, AbobotulinumtoxinA; RimabotulinumtoxinB; what stands behind the mention of amount by weight of toxin or neurotoxin, what is behind the mention of units on packaging; why units are manufacturer specific and not interconvertible; how the different relative human serum albumin content in the commercial products can impact on the quantity of botulinum neurotoxin that can be taken from vials in the clinic…
To summarize, this chapter 1 and ensuing Annexes summarise what is currently known about botulinum toxin with the hope of helping practitioners to use it in the most rational way possible, and to anticipate future development. It is also aimed at answering some of the most frequent questions that may rise in the context of daily clinic practice.
Research Professor Bernard Poulain, Institute of Cellular and integrative Neuroscience, CNRS
Each section of this chapter is dedicated to detailing one given facial muscle.
In this dense chapter of our best seller, Anatomy & Botulinum toxin injections, each muscle has a dedicated section. It is divided in 3 parts: the first one, Muscle profile, and the second, Injection technique and the last one : Key elements.
The Muscle profile section begins with the definition, and is followed with the origin, insertion, connections, innervation, action, and wrinkles of each muscle. The text is accompanied by clear anatomical view and schema.
It is then followed by the injection technique section where you will find injection point number, sites, plane, effect.
The text is accompanied by clear anatomical view locating injection points, clinical cases.
In the key elements section, all important information are available at a glance on just one page on a very clear lay-out.
In this edition about facial muscles, special attention is paid to 3 D muscles.
It also features 3 new muscles: nasalis, depressor septi nasi and masseter muscles.
In this chapter, you will find the following muscles: Frontalis – Corrugator supercilii – Procerus – Depressor Supercilii – Orbicularis Oculi – Nasalis – Levator labii superioris alaeque nasi – Depressor septi nasi – Orbicularis oris – Depressor anguli oris – Mentalis – Masseter- Platysma
This chapter is filled with useful tips for botulinum toxin injections from our Experts.
This chapter is very practical and useful for botulinum toxin injections.
It begins with useful tips on syringes and needles.
The right equipment is very important as it can save wasting botulinum toxin. Using the right needle makes the injection less painful for the patient. Selecting the right needle for your injections decreases the risk of touching a vessel or a nerve. There are many more essential information on syringes and needles in this part.
There is also a little trick to switch from one product to another. Posology and frequency have a section of their own.
Medical records are very important too to be able to repeat the treatment on your patient’s next visit.
Post-injection care and control appointment conclude this do’s and don’ts chapter.