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Figure 5. Muscles of glabellar area.
The corrugator muscle is the thickest between the medial canthal line and midpupillary line. In some patients, this area protrudes in a frown while the area above the lateral half of the eyebrow hollows. I often see patients come in for correcting this undesirable indentation above their eyebrows. Botulinum toxin injection in the corrugator muscle effectively reduces its volume, smoothing out the bump and hollowness above the eyebrows.
The procerus muscle originates from the nasal SMAS covering the nasal bone at the nasion to ascends superficially to attach at the skin between the eyebrows. It generally reaches the supraorbital rim level. Along with the corrugator, the procerus muscle contracts to create horizontal wrinkles at the nose bridge in a frown (Figure 5).
Muscles in the glabella express anger, worry or sadness. People with a permanent frown look displeased even when they are sleeping. This can make a very negative first impression on other people. Overdevelopment of these muscles can create a permanent frown and can be corrected with botulinum toxin injection.
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So, botulinum toxin injection in the overdeveloped glabella muscles help create a more relaxed countenance. Inducing temporary paralysis of these muscles can help correct the bad habit of unintentionally frowning. In such cases, repeated treatments would not be necessary.
Injection sites are the four points from the origin of the corrugator to its attachment; 1) one point at the midpoint between where the medial end of the eyebrow meets the orbital rim and origin of the corrugator muscle to originates from the middle nasion, 2) two points from the highest protruding point at the medial canthal line when frowning, to the orbital rim margin where the corrugator muscle runs between the midpupillary line, 3) and lastly, one point above the eyebrow where the skin folds in a frown (where the corrugator attaches to the skin).
The dosage and injection depth for each of these points is a follows; 1st point – intramuscular injection of Botox 1.5-2.5unit (Dysport 3.5-6 unit), 2nd and 3rd points – intramuscular injection of Botox 1.5-2 unit (Dysport 3.5-5 unit) each, and 4th point – intradermal injection of Botox 1-2 unit (Dysport 2.5-5 unit). Adjust the dose according to the degree and depth of the wrinkles (Figure 6).
-To be continued
