Closeup of beautiful mouth and lips with botox and syringe
So in the latest issue of Plastic and Reconstructive Surgery Journal, they had an article on using BOTOX® injections for the muscles that pull down the outer part of the lower lip. This muscle can “cause an individual to appear sad or angry and contributes to the development of the labiomental folds.”
In other words, do you have a downturn to your mouth? Are you forming marionette lines?
So this article, “A Retrospective and Anatomical Study Describing the Injection of Botulinum Neurotoxins in the Depressor Anguli Oris,” reviews the anatomy and where to do the injection. Here is where I will make a plea to you
It matters who is doing your Botox injection. Anatomy, depth, and amount injected make a difference.
In this study they did a restrospective chart review of 275 patients and they did a bunch of cadaver dissections to look at the position, size, and depth of this muscle.
They conclude with this advice:
- three small injections
- the first injection is 2mm inferior to the oral commissure, and the next two followed out along what we frequently call the marionette lines. The middle area is the best area to hit.
- Don’t go too close to the lip, otherwise you can hit other muscles which could affect speaking and eating.
- you do NOT want to go medial to this- those are the muscles of the lip, and if you hit those, when you smile your lip won’t come down.
- The dose varied patient to patient, but usually was small- only 3-4 units/side.
- Do NOT go too deep. The muscle you want is superficial. If you go deep you will get the lip depressor.
My thoughts?
This is not a common area for me to inject. I liked their review of anatomy. When doing less traditional areas, your injector’s understanding of the anatomy- muscle size, muscle width, muscle depth- is super important. And many of these muscles just need a teeny tiny bit. Too much can overwhelm the balance or cause the Botox solution to spread locally to muscles we didn’t want to block.