FACIAL AESTHETICS in Dental Office
Dr . ALAA ELGENDY
FACIAL COSMETOLOGIST
Member of American Academy of Facial
Aesthetics
Alaa ElGendy
Graduated from Faculty Of Dentistry Cairo University
American Board Of Aesthetic Medicine ( ABAM )
Member of American Academy of Facial Aesthetics ( AAFE )
What do you expect from
this Course??
Botulinum toxin
Clostridium Botulinum bacillus produces the most potent
neurotoxins.
There are seven distinct antigenic toxins. BTX A, B, C (Cα & Cβ), D,
E, F & G produced by different strains of clostridium botulinum
BTX-A is the most potent.
BTX-A, B & F are the only serotypes available for clinical use
MECHANISM OF ACTION
Botulinum toxin binds to the presynaptic terminal of
the neuromuscular junction (NMJ) & prevents the
release of Acetylcholine(neurotransmitter) at the
(NMJ), thus preventing muscle contraction
( blocking the nerve impulses)
BTX-A works by relaxing the underlying musculature that causes
dynamic facial rhytides.
Non-dynamic rhytides may improve but rarely disappear completely.
This reaction is reversible.
Muscle atrophy (denervation atrophy) is also reversible. Localized
muscle atrophy is seen within two weeks of toxin injection, continuous for
about 4 weeks and then clinical recovery of function requires 3-6 months,
at which time the muscles returns to 70-80% of its original bulk.
Botox
Dynamic lines
Epidermis
Subcutaneous tissue
Muscle fibres
Region of
contraction
Epidermis
/BONT (A) Subcutaneous tissue
Muscle fibres
Relaxed
muscle
Cosmetic and
Dermatological Uses of BTX
Basic applications Advanced and
• Horizontal forehead lines other applications
• Glabellar frown lines
•Nasal scrunch and flare
• Crow’s feet • Upper lip wrinkles
• Marionette (sad) lines
• Bruxism
• Gummy smile
• Neck lines and platysmal
bands
• Facial asymmetry
• Hyperhidrosis
USES OF BOTOX
Horizontal
forehead lines
Drooping eyelids
Glabellar frown lines
Bunny lines
Crow’s feet
Nasolabial folds
Perioral wrinkles
Mental creases Jowls
Marionette lines
Platysmal bands
Dimpled chin
Necklace lines
Each vial of Botox contains 100MU of
clostridium botulinum toxin type A, in a
sterile, vacuum dried form.
Vials are stored in the freezer before
reconstitution.
The recommended diluent is non-preserved
normal saline.
Product then should be stored in the
refregirator at 2-8C
Dilution of BTX-A
The dilution of BTX-A may vary:
Saline diluent 1ml saline 0.1ml saline
vol.
1ml 100 u 10 u
1.5ml 66.7 u 6.7 u
2ml 50 u 5u
2.5ml 40 u 4u
3ml 33.3 u 3.3 u
Several drugs (relative)
aminoglycosides
calcium channel blockers
Cyclosporin
D-penicillamine
BTX is contraindicated in disorders of neuromuscular
transmission as myasthenia gravis.
Unrealistic goals (psychological instability).
Allergy to any of its components (botulinum toxin, human
albumin, saline).
Pregnancy and nursing.
Procedures
Patient assessment and education:
Understanding the procedure and safety concerns
What to expect after treatment
Potential side effects (bruising)
Typical time course of the clinical effects
The need of retreatment after 3-6 months
Photo before (at rest and at maximum frown) and
after 2 weeks
Also note any atypical features.
Patient semi sitting in all procedures
Post-Operative Instructions
Patient is advised to remain upright for 4 hours.
To exercise muscles for the first 2 hours.
Avoid rubbing or massaging for 4 hours.
Gummy Smile
Gingival excessive exposure during smile is also referred to
as “gummy smile”, being diagnosed in cases where, during
smile, gingival display measures more than 3 mm from its
margin up to the upper lip line.
- Patients with gummy smile may have
the following :
lack of confidence
restrained (posed ) smile
smile with their hand
in front of their mouth
Botox Management of a Gummy Smile:
- Labial hyperactivity is characterized by marked contraction of the upper lip
elevator muscles
- Administration of botulinum toxin (type A) which gives a vertical relaxation
of the upper lip but maintains the ability to smile (Polo, 2005)
- The injection site is determined lateral to each nostril, where 2 BU
is injected
- Relaxation will gradually relapse, and retreatment will be necessary
after approximately 3-6 month.
Location of
“Yonsei point”
Dimpled chin (peau d’orange/mentalis
puckering) and mental crease
Mentalis
Injection techniques – dimpled chin &
mental creases
Target muscles Number of injection points. Total starting dose
(usual range)
Mentalis 1 to 2, start with one midline Women: 2–6U
or two symmetrical on each Men: 2–8U
side of chin (two symmetrical
for mental creases)
Marionette lines/mouth frown/down-turn
corners of the mouth (oral commissures)
Depressor
anguli oris
Injection techniques – marionette lines
Target muscles Number of injection points. Total starting dose
(usual range)
Depressor anguli oris 1–2 each side 3–5 units evenly divided
between sites
General Adverse Effects
Sequelae that can occur at any site due to
percutaneous injection of botox include pain, edema,
erythema, ecchymosis, headache.
Discomfort can be decreased by use of topical
anesthetics such as EMLA cream before injection, and
the use of smaller-gauge needles.
Adverse Effects
Ecchymosis can be minimized by avoiding aspirin,
aspirin-containing products, and NSAIDs for 7 to 10
days before injection.
Bruising occurs most frequently in older patients taking
aspirin and in middle-aged persons taking vitamin E.
Limiting the number of injections and applying post-
injection digital pressure without manipulation will also
assist in reducing bruising.
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ANY Questions… ?
Thank you
