Botulinum toxin–induced blepharoptosis: Anatomy, etiology, prevention, and therapeutic options

Nestor, Mark S.; Han, Haowei; Gade, Anita; Fischer, Daniel L.; Saban, Yves; Polselli, Roberto

doi:10.1111/jocd.14361

Cited by 40 publications

(31 citation statements)

References 68 publications

(144 reference statements)

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“…Therefore, it is important to identify and differentiate wrinkles in the nasal region. In addition, BoNT in the nasal region can cause major problems, such as diplopia resulting from the unintended blocking of the rectus inferior or medialis [ 4 , 5 , 32 , 33 ]. Although the incidence of BoNT causing diplopia is uncommon, it can be critical to some individuals [ 3 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although sensitivity to BoNT differs among individuals, there is no effective treatment for ptosis, which persists for several months [ 31 , 32 ]. Accurate BoNT injection points from an anatomical point of view have been suggested in various studies concerning BoNT injection in specific muscles [ 16 , 17 , 18 , 19 , 20 , 21 , 33 , 34 , 35 , 36 , 37 ]. According to the meta-analysis conducted by Camargo et al, most studies had duration of treatment of 5 months [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

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Novel Anatomical Guidelines on Botulinum Neurotoxin Injection for Wrinkles in the Nose Region

Lee

et al. 2022

Toxins

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Botulinum neurotoxin injection surrounding the nose area is frequently used in aesthetic settings. However, there is a shortage of thorough anatomical understanding that makes it difficult to treat wrinkles in the nose area. In this study, the anatomical aspects concerning the injection of botulinum neurotoxin into the nasalis, procerus, and levator labii superioris alaeque muscles are assessed. In addition, the present knowledge on localizing the botulinum neurotoxin injection point from a newer anatomy study is assessed. It was observed that, for the line-associated muscles in the nose region, the injection point may be more precisely defined. The optimal injection sites are the nasalis, procerus, and levator labii superioris alaeque muscles, and the injection technique is advised. We advise the best possible injection sites in association with anatomical standards for commonly injected muscles to increase efficiency in the nose region by removing the wrinkles. Similarly, these suggestions support a more precise procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Novel Anatomical Guidelines on Botulinum Neurotoxin Injection for Wrinkles in the Nose Region

Lee

et al. 2022

Toxins

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“…Injecting BoNT into the superolateral portion of the eye regions may cause side effects of ptosis, which have been reported [ 18 , 19 ]. Eyelid ptosis can occur when a large dose of the injection is given, or when the injection site is close to the orbital rim.…”

Section: Discussionmentioning

confidence: 99%

“…Eyelid ptosis occurs in the paralysis of levator palpebrae superioris muscle [ 20 ]. Although sensitivity to BoNT differs among individuals, there is no effective treatment for ptosis, which persists for several months [ 18 , 19 ]. Xerohphthalmia may occur because BoNT affects the palpebral portion of the orbicularis oculi muscle.…”

Section: Discussionmentioning

confidence: 99%

Novel Anatomical Proposal for Botulinum Neurotoxin Injection Targeting Lateral Canthal Rhytids

Lee

Kim

et al. 2022

Toxins

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Botulinum neurotoxin injections near the lateral canthal rhytids are commonly used in cosmetic settings; however, there is a lack of thorough anatomical knowledge, and an effective way to treat them with accumulating knowledge is needed. The anatomical characteristics concerning the injection of botulinum neurotoxin into the orbicularis oculi muscle were evaluated in this review. Current knowledge on the identification of botulinum neurotoxin injection points from recent anatomical research was assessed. The lateral canthal lines are involved with the orbicularis oculi muscle and nearby anatomical structures, and the injection points can be more precisely defined. The best possible injection sites were provided, and the injection procedure was described. This review proposes evidence for injection sites associated with the surface anatomy of the orbicularis oculi muscles to enhance the effectiveness of easing lateral canthal rhytids.

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“…1 Botulinum toxin type A (BoNT-A), the most potent serotype, 2 is a blocker of acetylcholine release from presynaptic terminals 3 widely used for treating blepharospasm, hemifacial spasm, strabismus, and other neurological conditions. 4,5 It has also been proposed for the management of neuropathic pain due to its antinociceptive effect not related to muscle activity, 3 but the cosmetic use of BoNT-A has made it actually popular. 5 Aesthetic applications of BoNT-A may lead to some complications, including unwanted muscle paralysis.…”

Section: Introductionmentioning

confidence: 99%

Muscle Function Recovery Following Botulinum Toxin Type A Facial Injections: A Case Managed With Photobiomodulation Therapy

et al. 2022

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Introduction: Aesthetic applications of botulinum toxin type A (BoNT-A) may lead to some complications, including unwanted muscle paralysis. Moreover, BoNT-A effects may last several months, and there is no medical intervention so far to accelerate muscle function recovery. Case Report: A female patient with a movement disorder of the mimic muscles resulting from BoNT-A injections received daily sessions of photobiomodulation therapy (PBMT). A fast improvement in both facial asymmetry and muscle function was noted within a few weeks. After nine weeks, almost complete recovery was achieved. Conclusion: According to the current case, PMBT seems to be an effective intervention to accelerate muscle function recovery following BoNT-A use.

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Botulinum toxin–induced blepharoptosis: Anatomy, etiology, prevention, and therapeutic options

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 40 publications

References 68 publications

Novel Anatomical Guidelines on Botulinum Neurotoxin Injection for Wrinkles in the Nose Region

Novel Anatomical Guidelines on Botulinum Neurotoxin Injection for Wrinkles in the Nose Region

Novel Anatomical Proposal for Botulinum Neurotoxin Injection Targeting Lateral Canthal Rhytids

Muscle Function Recovery Following Botulinum Toxin Type A Facial Injections: A Case Managed With Photobiomodulation Therapy

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