The author discusses practical guidance for treating the lower face with botulinum toxin. Whilst Abobotulinumtoxin A and Onabotulinumtoxin A are discussed in relation to treating the lower face, Incobotulinum toxin A is not acknowledged, despite the available literature on the off-label lower facial uses. A detailed list of medical contraindications for treatment is conveyed, including caution with presenting individuals with reliance upon lower facial competence owing to certain occupations (musicians / media). The author correctly acknowledges the importance of a thorough consultation and assessment of the muscular activity of the lower face with discussion of all treatment options. Facial musculature images underpin the anatomical discussion; yet, some key lip elevator muscles are absent, most notably the levator anguli oris. A detailed description of the anatomical and technical product placement considerations when treating the musculature of the lower face is conveyed, with supporting rationale for suggested techniques. The author advocates a superficial injection technique for depressor anguli, despite the close proximity of the modiolus, and the boney insertion along the inferior border of the mandible. The rationale for treating the platysma is correctly conveyed as reducing platysmal banding as opposed to improving moderate / severe skin laxity. A description of the potential complications arising from BoNTA underpins each anatomical region discussed.  The author provides a comprehensive overview of advanced technical considerations for aesthetic nurses undertaking treatment of the lower face with BoNTA.

Advanced botulinum toxin injection techniques for lower facial correction.
Arias L.
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Anna Baker

BJN Aesthetic Nurse of the Year 2016.

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