| boTulInum ToxIn A | arTICle


Figure 5 Standard five injection points for treating glabellar frown lines


Figure 6 Technique of injecting the medial aspect of the orbicularis oculi and depressor supercilii (note the position of the index finger and the thumb of the nondominant hand)


What is most important is the


evaluation of the patient, and the treating physician’s understanding of why certain wrinkles are formed and which muscle(s) are creating them.


Treating glabellar lines with onabotulinumtoxinA


and producing optimal results is not a simple task. What is most important is the evaluation of the patient, and the treating physician’s understanding of why certain wrinkles are formed and which muscle(s) are creating them. once a sound assessment is made and a justifiable treatment approach is designed, then it does not matter which injection pattern one uses. Patients should be treated individually according to their idiosyncratic pattern of muscle movement. A three, five, seven or even more injection point pattern can be used if it is appropriate for that particular patient (4,15,33). However, the novice injector needs a point of reference; a standard of injection patterns to guide one during the early treatment sessions. As the neophyte injector acquires a better understanding of the functional anatomy and its responses to different patterns of injections with onabotulinumtoxinA, then a more directed and individualized approach to


Figure 7 (A) Note the parallel corrugations along the brow of this 44-year-old man frowning. (B) Note the parallel corrugations along the brow of this 61-year-old woman frowning. (C) Note the relaxation of the parallel corrugations of the brow of this same 61-year-old woman frowning


prime-journal.com | March 2011 ❚ 41


onabotulinumtoxinA injections will automatically develop(34). Do not forget to identify, photograph, and indicate to the patient prior to all onabotulinumtoxinA injections any variation in the anatomy that might be present and cause the patient’s eyebrows to be asymmetric. It appears that as much as 45 – 65% of the general female population has some form of brow asymmetry prior to ever being treated with a bonT (author’s personal observation). In order to treat the glabellar frown lines and produce


optimal, reproducible results with the least amount of complications, it is recommended that precise injections of relatively concentrated doses and low volumes be used on both sides of the midline whether or not the doses are equal. With the patient sitting up or in the semi- reclined position gently palpate the medial aspect of the eyebrows as the patient squints and frowns. After locating the belly of the corrugator supercilii with the pads of


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