Các Kỹ Thuật Tiêm Thẩm Mỹ (Cosmetic Injection Techniques)

186
SECTlON IV • Filler Injection Techniques
e
f
Fig. 59.1a-f (Continued) (e) Herpetic outbreak after filler injections to nasolabial folds. (f) Tyndall
effect seen on the lower eyelids.

CHAPTER 59 • Management of Aller Injection Complications
187
• Additional Reading
Cox SE, Adigun CG. Complications of inject-
able fillers and neurotoxins. Dermatol
Ther 2011 ;24:524-536 PubMed
Dayan SH, Arkins 1P. Brindise R. Soft tissue
fillers and biofilms. Facial Plast Surg 2011 ;
27:23-28 PubMed
Dayan SH, Arkins 1P, Mathison CC. Manage-
ment of impending necrosis associated
with soft tissue filler injections. 1 Drugs
Dermatol2011;10:1007-1012 PubMed
Niamtu 1 lll. Complications in fillers and
Botox. Oral Maxillofac Surg Clin North Am
2009;21 :13-21, v PubMed
Rzany B, Becker-Wegerich P, Bachmann F,
Erdmann R, Wollina U. Hyaluronidase in
the correction of hyaluronic acid-based
fillers: a review and a recommendation
for use. 1 Cosmet Dermatol 2009;8:317-
323 PubMed

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Appendices

190
A
--···--
Neurotoxin/Filler Injection
Techniques Arranged by Order
of Difficulty and Level of
Experience Required

APPENDIX A • Injection Techniques Arranged by Order of Difficulty
191
Level
BoNTA
Rllers
Beginner
Glabella
Nasolabial folds
Craw's feet
Lips
Nasal tip lift
Marionette lines
Dimpled chin
Earlobe rejuvenation
Bunny lines
Menta I crease
Intermediate
Forehead
Oral commissure
Oral commissure/DAO
Prejowl sulcus
Lateral browlift
Forehead wrinkles
Chemical browlift
Chin augmentation
Lip lift
Temporal fossa
Smoker's lines
Acne scars
Necklace lines
Lateral malar prominence
Hypertrophic orbicularis oculi
Submandibular and buccal hollow
Hyperhidrosis axilla
Advanced
Nefertiti neck lift
Vertical lip lines
Platysma I banding
Refractory glabellar lines
Nasal flare
Medial midface
Gummy smile
Lateral browlift
Masseter hypertrophy
Dorsum of hands
Hyperhidrosis hands
Liquid facelift
Hyperhidrosis feet
Sculptra
Migraine
Expert
Frey syndrome
Tear trough
Submandibular gland hypertrophy
Rhinoplasty
Parotid gland hypertrophy
Nasal valve stenting
Medial orbital hollow
PMMA

B
-------···-------
Sample Informed Consent Form for
Neurotoxin Injections
I authorize Dr.
to perform injection of BotoxjDysportfXeomin on me.
Indications for procedure: Facial wrinkles
Risks of procedure: Bleeding, bruising, pain, infections, asymmetry, not fully im-
proved wrinkles, temporary drooping of the eyelid, need for additional treatment,
may also need filler for improved correction. In addition, there have been reports of
distant spread of botulinum toxin that has resulted in secondary problematic weak-
ness. These observations have been reported only in children being treated for spas-
ticity and have never been reported with the cosmetic use of these products.
Alternative treatments: No treatment, filler injection, chemical peels, laser re-
surfacing, etc.
Photographs: I give my consent for photographs to be taken before and after the
procedure for documentation.
I will allow these photographs to be shown to other patients. My name and other
personal information will not be disclosed. YES NO
I will allow these photographs to be placed on the Internet. My name and other
personal information will not be disclosed. YES NO
I understand that the results of these injections are not immediate and it may
take 7 to 10 days for the full effect of the injection to be seen.
I am aware that the practice of medicine and surgery is not an exact science, and
I acknowledge that no guarantees have been given to me concerning the results of
this procedure.
Patient ________________ Date ______ _
Physician _______________________ _
Witness ________________________ _
192

c
-------···-------
Sample Informed Consent Form for
Filler Injections
I authorize Dr. _____ to perform injection of ________ _
on me.
Indications for procedure: Facial wrinkles, facial aging
Risks of procedure: Bleeding, bruising, pain, infection or inflammation, asym-
metry, not fully improved wrinkles, lumps, nodules, vascular injury or ocdusion,
scarring, need for additional treatments, delayed hypersensitivity, allergic reaction.
(Additional risk for PMMA: This is a permanent product and cannot be removed.)
Alternative treatments: No treatment, use of a different filler product
Photographs: I give my consent for photographs to be taken before and after the
procedure for documentation.
I will allow these photographs to be shown to other patients. My name and other
personal information will not be disdosed. YES NO
I will allow these photographs to be placed on the Internet. My name and other
personal information will not be disdosed. YES NO
Anesthesia: I consent to the administration of anesthetics considered necessary
or advisable. I understand that all forms of anesthesia involve risk and the possibil-
ity of complications, injury, and allergic reaction.
I am aware that the practice of medicine and surgery is not an exact science, and
I acknowledge that no guarantees have been given to me concerning the results of
this procedure.
Patient ________________ Date ______ _
Physician _______________________ _
Witness ________________________ _
193

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Index
Note: Page references followed by a fort indicate figures or tables, respectively.
A
AbobotulinumtoxinA (BoNTA-ABO). See Dysport
Acetylcholine, 74, 76, 80,82
Acne scars, filler injection treatment for, 170-172,
172/
Acyclovir creams, 182
a-Adrenergic agonists, as eyelid ptosis treatment,
88-89
Aging, facial
as midface hollowing cause, 149
as oral commissure angle changes cause, 118
as parotid gland hypertrophy cause, 69
as submandibular gland ptosis or hypertrophy
cause, 72
American Academy of Facial Plastic and Recon-
structive Surgery, 8
American Society for Aesthetic Plastic Surgery, 8
American Society for Dermatologic Surgery, 8
American Society of Ophthalmic Plastic and
Reconstructive Surgery, 8
American Society of Plastic Surgeons, 8
Anesthesia techniques, 96-99
Angular artery
in medial midface hollowing treatment, 149,
150/
in nasolabial fold injections, 104
in sunken cheeks treatment, 158/
Anterograde injections, of fillers, 100, 102/
for lip augmentation, 115, 116/
Antiviral therapy, 115, 182
Apradonidine, 89
Armpits, profuse sweating of, 76-79, 77/. 78/
Arrhythmias, local anesthetic injection-related,
98
Artefill. See Polymethylmethacrylate injections
Asian patients, hypertrophic masseter musde
enlargement in, 66
B
Belotero, 93, 129
Benzocaine, lidocaine, and tetracaine (BLT), 97
Biofilms, 183
Bite disorders, post-botulinum toxin injection, 67
Blanching, vascular compromise-related, 183, 184/
Blepharoplasty patients, mild fat herniation in,
128
BLT (benzocaine, lidocaine, and tetracaine), 97
BoNTA-INC. See lncobotulinumtoxinA
BoNTB. See Myobloc
Bot ox
for lip lift, 45-46, 46/
for lower eyelid roll (fullness), 33
overview of, 2, 4t
preparation (reconstitution) of, 5
for smoker's lines, 48
Botulinum toxin A formulations
comparison of, 4t
overview of, 2-4
preparation (reconstitution) of, 5
Botulinum toxin A injections
adjunctive use of, with lip filler injections, 115
for bunny lines, 34-37
for dimpled chin, 54-56
for forehead wrinkles, 16-21, 125
for glabellar frown lines, 1 0-15, 122-124
for "gummy" smile, 50-53
for gustatory sweating (Frey) syndrome, 74-75
for lateral brow lift, 17, 26-28
for lip lift, 45-46
for lower eyelid roll, 32-33, 33/
for masseter musde hypertrophy, 66-68
for migraine headaches, 84-87,85/. 86/
for nasal flare, 40-41
for nasal tip lift, 38-39
for necklace lines, 60-62
195

196
Index
Botulinum toxin A injections (continued)
for Nefertiti neck lift, 62-65
for oral commissure elevation, 42-44
for parotid gland hypertrophy, 69-71
for platysma! banding, 57-59,60
for profuse sweating
of feet, 82-83,83/
ofhands,80-81,81f
of underarms, 76-79
for smile lines and craw's feet, 22-25, 181
for smoker's lines, 4 7-49
for submandibular gland hypertrophy, 72-73
Botulinum toxin injections
action mechanism of, 2
duration of clinical effect of, 88
level of difficulty of, 190-191
for"liquid"facelift,180-181,181/
overview of, 2-4, 4t
preparation of, 5
Bovine collagen
allergy to, 94
disadvantages of, 92
Food and Drug Administration approval for, 95t
polymethylmethacrylate microsphere suspen-
sions in. See Polymethylmethacrylate (PMMA)
Brow
ptosis of
botulinum toxin injection-related, 88, 125
chemical brow lift for, 29-31, 31/
compensation for, 17
filler injection treatment for, 134-136, 136/
in forehead wrinkle treatment, 17
resting position of, 17
Brow injections, lateral, for migraine headache
treatment, 84
Brow lift
chemical, 29-31,31/
lateral, 17, 26-28,28/
filler injections for, 134-136, 136/
Brow position, in men and women, 16
Bruising. post-botulinum toxin injection, 11, 17,
22-23
bunny lines treatment-related, 35
lateral brow lift-related, 26-27,30
lower eyelid roll treatment-related, 33
parotid gland hypertrophy treatment-related, 70
submandibular gland ptosis treatment-related, 73
Bruising. post-filler injection
aging hand rejuvenation-related, 174
chin augmentation-related, 161
facial volumizing (Sculptra)-related, 177
jawline rejuvenation-related, 167
lateral brow lift-related, 135
lateral malar prominence augmentation-related,
153
lip augmentation-related, 115
marionette line treatment-related, 112
medial midface hollowing treatment-related,
149,150
mental crease augmentation-related, 165
nasolabial fold injections-related, 105
oral commissure elevation-related, 119
sunken upper eyelid treatment-related, 132
tear trough deformity treatment-related, 128
vertical lip line treatment-related, 121
Bruxism,66
BTXA, overview of, 3, 4t
Buccal region, as filler injection site, 156-157, 158/
Bulimia, as parotid gland hypertrophy cause, 69
Bunny lines, 34-37
botulinum toxin A treatment for, 34-37,36/
definition of, 34
Bupivacaine, as arrhythmia cause, 98
c
Calcium hydroxylapatite ( CaHA), 92, 93
Calcium hydroxylapatite injections
for acne scars, 171
for aging hand rejuvenation, 173-174
Food and Drug Administration approval for, 95t
injection technique, 93
for jawline rejuvenation, 167
for lateral malar prominence augmentation,
153
for medial midface hollowing, 149, 150-151
for nasal valve stenting, 147
for nasolabial folds, 1 05, 106
for nonsurgical rhinoplasty, 141
precautions regarding, 93
for sunken temples, 138
Canadian Society for Aesthetic Plastic Surgery, 8
Cheekbone augmentation, filler injections for,
152-155, 154{
Cheeks
"apple," 104
sunken, filler injections for, 156-159, 158/
Chemical peel, of perioral lines, 121
Chewing disorders, post-botulinum toxin injection-
related, 67
Chin
alloplastic implants for, 160,161
augmentation with filler injections, 160-163,
162/
cleft, 162/
dimpled ("peau d'orange"), 54-56, 56/. 165
Chin crease. See Mental crease
Collagen injections. See also Bovine collagen;
Human collagen; Porcine collagen
for acne scar treatment, 171
Columella, horizontal crease below, 52/
Complications
of botulinum toxin injections, 88-89, 89/
of filler injections, 182-187
Corrugator muscles, hyperactivity of, 29
Corrugator superdlii muscle
anatomy and function of, 11, 12/
contraction of, 10
origin site of, 10

Corrugator supen::ilii muscle injections
forglabellarfrownlines, 10-15,13-15/
for lateral brow lifts, 29, 31/
positioning patterns of, 10
Cross-hatching injection technique, 101,102/
for facta! volumizing (Sculptra), 179/
for nasolabial folds, 105
for polymethylmethacrylate filler use, 1 08
for vertical lip lines treatment, 120, 121/
Craw's feet, botulinum toxin A treatment for,
22-25,181
D
injection technique in, 23-25, 24/
precautions regarding, 22
Dental blocks
contraindication to, 152
for lip filler injections, 114
for mental crease filler injections, 164
technique of, 97, 98
Depot injection technique
for chin augmentation, 160
for fadal volumizing (Sculptra), 177, 179/
for forehead wrinkles, 125, 126/
for mental crease augmentation, 164
for oral commissure elevation, 119/
with polymethylmethacrylate fillers, 108
for sunken temples, 137-138
Depressor anguli oris muscle, in marionette line
treatment, 111
Depressor anguli oris muscle injections, 119
for oral commissure elevation, 42-44
Depressor labii inferioris muscle, in "Nefertiti
neck lift" procedure, 63, 65/
Depressor septi nasi muscle injections, 38-39,
39/
Dermabrasion, for perioral lines, 121
Dilator nasalis muscle injections, for nasal flare
correction, 40-41,41/
Drooling, post-botulinum toxin injection, 55
Drool lines. See Marionette lines
Dry eye, 33, 89
Dysphagia, 58, 63
Dysphonia, 58
Dysport
E
for glabellar frown lines, 11
overview of, 2, 4t
preparation (reconstitution) of, 5
for smile line and craw's feet, 23
Earlobe rejuvenation, 168-169, 169/
Ela-Max, 97
"Elvis snarl and muscle," 50
Embolism, 122, 145, 1 78
EMLA (eutectic mixture of local anesthetics), 97
Epinephrine, 97
sensitivity to, 98
Erythema, filler injection-related, 183
Index
197
Eyelids
F
lower
fat herniation of, 33
preexisting laxity of, 32
roll (fullness) of, 32-33,33/
Tyndall effect on, 186/
upper
botulinum toxin-related ptosis of, 11, 17,
88-89,89/
orbicularis oculi muscle injection-related lag
of, 23
sunken, 131-133, 133/
Face lift, "liquid," 180-181, 181/
Face lift surgery, lower, 58
Facial artery, 72, 18'\/'
Facial mimetic muscles, 75
Facial nerve, 69, 72
Facial vein, 72
Facial volumizing (Sculptra), 176-179, 179/
Fainting, epinephrine-related, 98
Fanning injection technique, 100-101,102/
for chin augmentation, 160-161
for facial volumizing (Sculptra), 177, 179/
for marionette lines, 112/
for medial midface hollowing, 149
for nasolabial folds, 105
for oral commissure elevation, 119/
for sunken cheeks, 156-157,158/
Fat augmentation
of the aging face, 176
of the lateral malar prominence, 152
Feet, profuse sweating of, 82-83, 83/
Ferning injection technique, 101,102/
Fever blisters, 115
Filler injections, facial, 91-95,100-102
for acne scars, 170-172, 172/
for aging hands rejuvenation, 173-175, 175/
for cheekbone or malar prominence augmen-
tation, 152-155, 15'\/'
for chin augmentation, 160-163,162/
complications of, 182-187
for earlobe rejuvenation, 168-169,169/
for facial volumizing (Sculptra), 176-179, 179/
Food and Drug Administration-approved, 95t
for forehead wrinkles, 125-127, 126/
for glabellar frown lines, 122-124, 12'\/'
indications for, 104
injection techniques for, 92
for jawline rejuvenation, 166-167, 167/
for lateral brow lifts, 134-136, 136/
level of difficulty of, 190-191
for lip augmentation, 46, 114-117, 116/
for "liquid" facelift, 180-181, 181/
formarionettelines,94, 108,110/.111-113,112/
for medial midface hollowing, 149-151, 150/
in the mental crease, 164-165, 165/
for nasal valve stenting, 146-148,147/

198
Index
Filler injections, facial (continued)
for nasolabial folds, 104-107, 106/
for nonsurgical rhinoplasty, 140-145, 142-144/
"off-label," 92
for oral commissure elevation, 118-119, 119/
overview of, 92-95
precautions regarding, 93
for smoker's lines, 49
for sunken cheeks, 156-159, 158/
for sunken temples, 137-139, 139/
for sunken upper eyelids, 131-133, 133/
for tear trough deformity, 128-130, 130/
techniques, 92, 103-107
for vertical lip lines, 120-121, 121/
Fluoroquinolones, 183
5-Fluorouracil, 183
Flute playing, 45-46, 47
Food and Drug Administration approval, of
injectable materials, 8, 10, 85, 92
Forehead,volumelossin,29
Forehead injections, for migraine headache
treatment, 84
Forehead wrinkles. See also Glabellar frown lines
botulinum toxin injection treatment for, 16-20
combined with filler injections, 126
injection techniques, 16-20, 18-20/
precautions regarding, 17
filler injections for, 125-127, 126/
combined with botulinum toxin injections,
126
Frey syndrome, 74-75,75/
Frontalis muscle
anatomy and function of, 16, 1 7
in brow ptosis, 17
in glabellar frown line treatment, 13/. 1'\.f. 15/
resting tonic contractions of, 17
Frontalis muscle injections
G
for forehead wrinkles,16,17-18,18-20/
injection technique, 16
for lateral brow lifts, 27, 28/. 29, 30,31/
Galea aponeuritica, 16
Gate theory, of pain, 98
Glabellar injections
forfrownlines,l0-15,18,122-124,123,124/
anatomic considerations in, 10, 12/
combined with filer injections, 122, 123
injection techniques, 11-15,13-15/
persistent frown lines after, 123
precautions regarding, 11
for lateral brow lifts, 29-30
for migraine headache treatment, 84
as upper eyelid ptosis cause, 89/
Glabellar rhytids, horizontal, bunny lines related, 34
Granulomas, filler injections-related, 183
Grid pattern injection technique, 101,102/
for facial volumizing (Sculptra), 177, 179/
"Gummy smile" treatment, 50-53, 51/. 52/
H
HA. See Hyaluronic acid
Hand muscles, post-botulinum injection weakness
of,81
Hands
aging, filler injection-based rejuvenation of,
173-175,175/
profuse sweating of, 80-81, 81/
Headaches, post-injection, 11, 88
Hematomas
post-botulinum toxin injection, 70, 72, 73
post-filler injection, 174, 178
Hemorrhage, submandibular gland ptosis
treatment-related, 72
Herpetic outbreak, filler injection-related, 182, 186/
HIV patients, parotid gland hypertrophy in, 69
Human collagen, as facial filler, 95t
Hyaluronic acid
composition of, 92
Food and Drug Administration approval for, 92,
95t
types of, 92
Hyaluronic acid injections, 92-93
for acne scartreatment, 170-171
for aging hand rejuvenation, 173-174
as delayed hypersensitivity cause, 185/
for earlobe rejuvenation, 168, 169/
for glabellar frown lines, 122-124, 124/
for jawline rejuvenation, 166-167, 167/
for lateral malar prominence augmentation, 153
for medial midface hollowing, 149, 150-151
for mental crease augmentation, 164-165
for nasal valve stenting, 147
for nasolabial folds, 1 05, 106
for nonsurgical rhinoplasty, 141-145, 142-144/
for oral commissure elevation, 42, 43, 118-119
precautions regarding, 93
premixed with lidocaine, 92
for sunken temples, 137-138
for sunken uppereyelids,131-133,133/
forteartrough deformity, 128-130, 130/
Tyndall effect of, 93,105,112,119, 129, 130/.
164-165,171,182
for vertical lip lines, 120-121, 121/
Hyaluronidase injections, as '!Yndall effect treat-
ment, 129, 182
Hypersensitivity delayed, filler injection-related,
183, 185/
Ice, for anesthesia, 96
lncobotulinumtoxinA, overview of, 2, 4r
Informed consent
for botulinum toxin injections, 191
for filler injections, 193
Infraorbital nerve, 149, 150/. 154/
Infraorbital nerve blocks, 96, 128, 152
Infraorbital rim. See Orbital rim, infraorbital
Injectable materials, safety considerations for, 8

Injectors, training of, 8
forpoly-L-lacticacid us,176-177,178
Instrumentation, for botulinum toxin A injections,
6, 7/
Insulin syringes, for botulinum toxin A injections,
6, 7/
International Federation of Facial Plastic Surgery
Societies, 8
International Society of Aesthetic Plastic Surgery, 8
Interosseous muscles, in hand filler injections, 173
Intravascular injections. See also Vascular injuries
with poly-L-lactic acid, 178
in submandibular gland ptosis treatment, 72, 73
in sunken upper eyelid treatment, 131, 132
Iopidine, 0.5%, 89
J
jawline rejuvenation, with filler injections,
166-167, 167/
jowls
facelift treatment for, 166
formation of, 156, 166
juvederm, 115, 171
K
Kenalog, 183
L
Laser resurfacing, of perioral lines, 121
Levator labii superioris alaeque nasi muscle
anatomy and function of, 50
in "bunny lines" treatment, 35, 36/
in nasal flare correction, 41/
Levator labii superioris alaeque nasi muscle
injections, for "gummy smile," 50-52,
51/. 52/
Levator labii superioris muscle, in "bunny lines"
treatment, 36/
Levator palpebrae superioris muscle
in glabellar frown line treatment, 11,13-15/
in lateral brow lifts, 27, 28/.30,31/
Lidocaine, 96
as EMLA component, 97
as epinephrine alternative, 98
fatal overdoses of, 98
in filler injections, 94, 95~ 114-115, 177
in regional nerve blocks, 97
topical intraoral, 98
Lids. See Eyelids
Lightheadedness, epinephrine-related, 98
Linear threading injection technique
for facial volumizing (Sculptra), 177
for mental crease filling, 164
for nasolabial folds, 105
for vertical lip lines, 120
Lip(s)
anesthetization of, 97
augmentation with fillers, 114-117, 116/. 181
drooping, 55, 63
Index
199
pursing of, 48, 120
in smoker's lines treatment, 48-49, 49/
vertical lines of,120-121, 121/
Lip lifts, 45-46, 46/
Lipoatrophy, of the aging face, 176
Luer locks, 6
M
Macrolide antibiotics, 183
Malar implants, permanent, 152
"Malar mound." See Malar prominence
augmentation
Malar prominence augmentation, filler injections
for, 152-155, 154/
Male patients
botulinum toxin A dosages for, 16
brow position in, 16
Mandible. See also jawline rejuvenation; jowls
in masseter muscle hypertrophy treatment, 68/
Mandible injections, in Nefertiti neck lift procedure,
63,65/
Mandibular border, width narrowing procedure for,
66-68,68/
Mandibular notch, in parotid gland hypertrophy
treatment, 69
Marionette lines
definition of, 111
fillerinjectionsfor,94,108,110/. 111-113,
112/
Masseter muscle
in gustatory sweating (Frey) syndrome, 75
hypertrophy of, 66-68, 68/
Melolabial groove. See Marionette lines
Mental crease
in dimpled chin treatment, 55, 56/
filler injections for, 164-165,165/
Mental foramen
in chin augmentation, 161, 162/
in jawline rejuvenation, 167
Mentalis muscle injections, for dimpled chin,
54-56, 56/. 165
Mentalis muscles, anatomy and function of, 164
Mental nerve
in chin augmentation, 161
in jawline rejuvenation, 167/
Mental nerve blocks, 96
"Mephisto" (devilish) sign, 17,20/
Metacarpal bones, in hand filler injections, 173
Midface, medial hollowing of, filler injections for,
149-151,150/
Migraine headache treatment, 84-87,85/. 88
trigger points in, 84-85, 86/
Mini-mucosal nerve blocks, 96
Mouth. See also Lip(s); Oral commissures
asymmetric, 48, 49
injections around
precautions regarding, 45-46
for smoker's lines correction, 48-49, 49/
"Mr. Spack" sign, 17, 20/

200
Index
Miiller's muscle stimulation, as eyelid ptosis
treatment, 88-89
Myobloc, overview of, 3, 4t
N
Naphazoline, combined with pheniramine, 89
Naphcon A, 89
Nasal flare, 40-41,41/
Nasalis muscle, in nasal flare treatment, 41/
Nasalis muscle injections, for bunny lines
treatment, 34-37,36/
Nasal tip, drooping
filler injections for, 141, 144/
tip lift for, 38-39,39/
Nasal valve stenting, filler injections for, 146-148,
147/
Nasolabial angle, 38
"Nasolabial fold-free" face, 104
Nasolabial folds
in facial volumizing (Sculptra), 177, 179/
filler injections for, 94, 104-107, 106/, 108-110,
109/, 186/
in Nefetiti neck lift, 63
in sunken cheeks treatment, 156, 158/
Necklace lines treatment, 60-61,61/
Neck lift
Nefertiti, 62-65, 64/. 65/
ptotic submandibular glands appearance
following, 72
surgical, 58
Necrosis, nonsurgical rhinoplasty-related, 145
Needle injections, as pain cause, 96
Needles, for injectable filler use, 92
Nefertiti, Queen, 62, 64/
Nefertiti neck lift procedure, 62-65, 64/. 65/
Nerve blocks
dental. See Dental nerve blocks
regional. See Regional nerve blocks
Neuronox, overview of, 3, 4t
Neurotoxins. See Botulinum toxins
Nodules, filler injections-related, 177-178, 183
Nonsteroidal anti-inflammatory drugs, as biofilm
cause, 183
Nose, twisted/crooked, 141,143-144/
Nostrils, flaring of, 40-41,41/
"No Waste" syringes, 6, 7/
0
Occipitofrontalis muscle injections, for migraine
headache treatment, 86/
OnabotulinumtoxinA (BoNTA). See Botox
Ophthalmic artery, embolization of, 122
Oral commissures
in lip augmentation, 115
in marionette line treatment, 112/
in smoker's lines treatment, 49
Oral commissures elevation, 42-45, 118-119, 119/
Orbicularis oculi muscle
anatomy and function of, 22, 26, 32
contraindication as poly-L-Iactic acid injection
site, 178
hypertrophy of, 32-33,33/
differentiated from lower eyelid fat herniation,
33
lateral, hyperactiviry of, 26-28, 28/. 29
orbital, 32
in tear trough deformity treatment, 128, 130/
Orbicularis oculi muscle injections
for hypertrophic orbicularis oculi muscle, 32-33,
33/
for lateral brow lifts, 26-28,28/. 29-31,31/. 135
for smile lines and crow's feet treatment, 22-25,
24-25/
Orbicularis oris muscle
anatomy and function of, 45, 48
contraction of, as circumoral rhytid cause, 120
contraindication as poly-L-Iactic acid injection
site, 178
in dimpled chin treatment, 55, 56/
Orbicularis oris muscle injections, for lip lift,
45-46,46/
Orbital rim
p
infraorbital rim
in lateral malar prominence augmentation, 154/
in teartrough deformity treatment, 128-129,
130/
lateral
in facial volumizing (Sculptra), 177
in lateral browlift, 136/
in orbicularis oculi muscle injections, 23, 24/. 25/
superior, as filler injection site, 131-132, 133/
Palpebral aperture, widening of, 32, 33/
Parotidectomy, superficial, as gustatory sweating
cause, 74
Parotid gland, hypertrophy of, 69-71, 71/
"Peau d'orange" chin, 54-56, 56/, 165
Periocular area, venous structure of, 22-23
Perioral region
smoker's lines of, 48-49, 49/
vertical lines of, 120-121,121/
Pharyngeal muscles, relationship to submandibular
glands, 72
Pheniramine, combined with naphazoline, 89
Philtra! columns, filler augmentation of, 46/, 114,
115, 116/
Physician Coalition for Injectable Safety (PCIS), 8
Platysma! bands
botulinum toxin treatment for, 57-59, 59/
definition of, 57
in Nefertiti neck lift procedure, 62-63, 65/
Platysma muscles, anatomy and function of, 57,
62,69
PLLA. See Poly-L-Iactic acid
PMMA. See Polymethylmethacrylate
Poly-L-Iactic acid, composition of, 94
Poly-L-Iactic acid injections, 92, 94

for aging hands rejuvenation, 17 4
for earlobe rejuvenation, 168
for facial volumizing (Srulptra), 176-179, 179/
Food and Drug Administration approval for, 92,
95t
injection techniques, 94, 176-177
precautions regarding, 94, 177-178
preparation (reconstitution) of, 176-177
for sunken cheeks, 157
for sunken temples, 138
Polymethylmethacrylate, 92
composition of, 93
properties of, 93
uses of, 94
Polymethylmethacrylate injections
for acne scars, 171
Food and Drug Administration approval for, 92,
95t
for jawline rejuvenation, 167
for marionette lines, 108, 11 0/
fornasolabialfolds,105,106,108-110,109/
precautions regarding, 94
Porcine collagen, as facial filler, 95t
Posterior tibial nerve blocks, 82
Povidone iodine (Betadine), 74-75
Prejowl sulrus, augmentation of, 166-167, 167/
Prilocaine, as EMLA component, 97
Procerus muscle
contraction of, 10
in glabellar frown line treatment, 13-15/
hyperactivity of, 29
origin site of, 10
Procerus muscle injections, for lateral brow lifts,
29,31/
Pterygoid muscles, lateral, in parotid gland
hypertrophy treatment, 69
Ptosis
brow
botulinum toxin injection-related, 88, 125
chemical brow lift for, 29-31,31/
compensation for, 17
filler injection treatment for, 134-136, 136/
in forehead wrinkle treatment, 17
eyelid
botulinum toxin injection-related, 88-89, 89/
corrugator supercilii muscle infection-related,
11
forehead wrinkle treatment-related, 17
nasal, 38-39
of submandibular glands, 72-73, 73/
Purpura, facial artery occlusion-related, 18"\f
Purtox, overview of, 3, 4t
R
Regional nerve blocks. See also names of specific
nerves
for botulinum toxin injections, 80, 82
for filler injections, 92, 94, 96, 97
Restylane, 141, 171
Index
201
Retrograde injection technique, 1 00, 102/. 108
for lip augmentation, 116/
for nonsurgical rhinoplasty, 145
Rhinoplasty, nonsurgical filler injection technique
of, 140-145
for dorsal hump straightening, 141, 142/
for drooping nasal tip correction, 141, 144/
injection technique, 140-141, 142-144/
for saddle nose deformity correction, 141,
142-143/
for twisted/crooked nose correction, 141,
143-144/
as vascular injury cause, 185/
RimabotulinumtoxinB (Myobloc), 3, 4t
Risorius muscle, in masseter muscle hypertrophy
treatment, 68/
s
Saddle-nose deformity, 141,142-143/
Saline, for botulinum toxin A preparation
(reconstitution), 5
Saliva secretion, 74
Sculptra (facial volumizing), 176-179, 179/
Sentinel vein, 134, 136/
Serial puncture injection technique, 100, 102/
for forehead wrinkle treatment, 126/
for nasolabial folds, 105
Smile. See also "Gummy smile" treatment
after oral commissure elevation, 118-119
asymmetric, 23, 45, 49
Nefertiti neck lift-related, 63
Smile lines, botulinum toxin A treatment for,
22-25
Smoker's lines, 47-49
Smoking, as perioral wrinkle cause, 120
Snap test, 33
Speech disorders, botulinum injection-related, 67
Starch-iodine test, 74-75,75/. 76,77/.78/
Steroids, as biofilm cause, 183
Submalar region, as filler injection site, 156-157,
158/
Submandibular gland injections, combined with
platysma! band injections, 58
Submandibular glands, ptosis or hypertrophy of,
72-73,73/
Superficial musculaaponeurotic system (SMAS), 57,
60,69,180
Supraorbital artery
in glabellar filler injections, 122, 12"\f
in upper eyelid filler injections, 131, 133/
Supraorbital blood vessels, 122
Supraorbital nerve, in upper eyelid filler injections,
131,133/
Supraorbital rim, in frontalis muscle injections, 18/
Supratrochlear artery
in glabellar filler injections, 122, 12"\f
in upper eyelid filler injections, 131, 133/
Supratrochlear nerve, in upper eyelid filler
injections, 131, 133/

202
Index
Sural nerve blocks, 82
SWallowing dysfunction, post-botulinum injection,
57,60,61,67,70,72
Sweating, profuse
of the feet, 82-83,83/
gustatory (Frey syndrome), 74-75,75/
of the hands, 80-81, 8lf
of the underarms, 76-79,77/.78/
Syringes, for botulinum toxin A injections, 6, 7/
T
Tachycardia, epinephrine-related, 98
Tear trough, in facial volumizing (Sculptra),
177
Tear trough deformity, filler injections for,
128-130, 130/
Temple
anatomic boundaries of, 137
sunken, filler injections for, 137-139, 139/
Temporal fossa, hollowing of, filler injections for,
137-139, 139/
Temporalis muscle, in masseter muscle
hypertrophy treatment, 67
Temporalis muscle injections
for migraine headache treatment, 84, 86/
for sunken temples, 137, 139/
Tetracaine, 97
Threading injection technique
for chin augmentation, 160-161
for jawline rejuvenation, 166-167
Tongue movement disorders, submandibular gland
ptosis treatment-related, 72
Topical anesthesia/anesthetics, for filler injections,
92, 93, 94, 96, 97
Trapezius muscle injections, for migraine headache
treatment, 84-85, 86/
Trigeminal nerve, anatomy and function of,
96,99/
Tyndall effect, 93,105,112,119, 129,130/. 164-165
definition of, 93
treatment for, 182
u
Underarms, profuse sweating of, 76-79, 77/. 78/
v
Valtrex, 182
Vascular injuries, filler injection-related, 93, 94,
109, 126, 151,183,184-185/
Vermilion border injections, 48
for lip augmentation, 114, 115, 116/
for lip lift, 45
for smoker's lines, 47
for vertical lip lines treatment, 120-121,121/
Vitrase, 182
w
Whistling, 45-46, 48
Wind instrument musicians, 45-46, 48, 51
X
Xeomin, 2, 4t, 5
Xerostomia, as parotid gland hypertrophy cause, 69
Xylocaine, 132,146
z
Zygomatic arch
in lateral malar prominence augmentation, 154(
in sunken cheeks treatment, 156, 157, 158/
in sunken temple treatment, 139/
Zygomaticomalar region, 152, 154/
Zygomaticus major muscle, in orbicularis oculi
muscle injections, 23, 2'\f, 25/
Zygomaticus muscle
in masseter muscle hypertrophy treatment, 68/
in oral commissure elevation, 42