Comparative analysis of botulinum toxin injection after corrective rhinoplasty for deviated nose and alar asymmetry

Abstract

Background Deviated noses and asymmetric nostrils can be corrected using corrective rhinoplasty. However, after proper correction, adjacent facial mimetic muscles can cause recurrence of asymmetry because of preoperative habits. Objectives We performed this study to investigate the effects on botulinum toxin on the prevention of recurrence of asymmetry after corrective rhinoplasty. Methods From January 2016 to December 2019, 60 patients underwent corrective rhinoplasty and 30 received botulinum toxin type A injection (Botulax; Hugel Co.) at the depressor septi nasi and levator labii superioris alaeque nasi muscles, bilaterally. Vertical and horizontal deviations were compared preoperatively and postoperatively. Results Postoperative vertical deviation was 0.20° ± 0.65° in the botulinum toxin–injected group and 1.20° ± 0.53° in the control group (P < 0.0001). Horizontal deviation was 0.80° ± 0.52° in the botulinum toxin–injected group and 2.18° ± 0.42° in the control group (P < 0.005). Differences between preoperative and postoperative vertical deviations at 6 months were 2.30° ± 0.03° in patients who received botulinum toxin injection and 1.10° ± 0.22° in controls (P < 0.005). Conclusions Botulinum toxin effectively restricted the paranasal muscles without any significant adverse events. We recommend injecting botulinum toxin after corrective rhinoplasty to prevent recurrence of deviation by facial mimetic muscles.

Myomodulation Using Botulinum Toxin in Septorhinoplasty for Crooked Noses: Introducing the Concept and Application of Nasal Muscle Imbalance Theory

“…Lee et al 9 studied the effect of injecting botulinum toxin into the bilateral DSN and LLSAN muscles immediately after surgery in 30 patients with anthropometric analysis and subjective aesthetic grading on photographs, 1 month and 6 months post-operatively. They found that patients receiving BTX had less horizontal and vertical deviation compared to the control group without significant adverse events 9 .…”

“…They found that patients receiving BTX had less horizontal and vertical deviation compared with the control group without significant adverse events. 9 On the other hand, Yu et al 35 shared their anecdotal experience in treating bunny lines and nasal radix with BTX injection into the transverse nasalis muscle 1 week before rhinoplasty to reduce nasal skin tension and to reduce incidence of implant displacement and extrusion.…”

“…The nasal muscles move nasal cartilages and play important roles in nasal patency due to their influences on the nasal valve and appearance 8 . In addition to that, nasal muscle movements were also found to play a role in causing the nasal structures to revert to pre-operative asymmetric state 9 . Botulinum toxin (BTX) has been used on facial muscles to modulate muscle activity effectively, with minimal preventable adverse effects 9,10 .…”

“…9 Botulinum toxin (BTX) has been used on facial muscles to modulate muscle activity effectively, with minimal preventable adverse effects. 9,10 The senior author (A.D.) has used BTX for more than 20 years for a variety of conditions on the face.…”

“…8 In addition to that, nasal muscle movements were also found to play a role in causing the nasal structures to revert to preoperative asymmetric state. 9 Botulinum toxin (BTX) has been used on facial muscles to modulate muscle activity effectively, with minimal preventable adverse effects. 9,10 The senior author (A.D.) has used BTX for more than 20 years for a variety of conditions on the face.…”