articLe | BOTulInumTOxIn A | eliminating
nasoglabellar lines along with glabellar frown lines gives an individual a relaxed, youthful appearance.
Figure 1 ‘Nasal scrunch’ or ‘bunny lines’, produced by the transverse nasalis. Note the nasoglabellar lines which are accompanied by (A) nasociliary rhytides, (B) naso-orbicular and nasoalar rhytides, (C) nasociliary and nasoalar rhytides, and (D) nasoorbicular and nasoalar rhytides
In many areas of the mid face, better overall cosmetic
results can be achieved with different soft tissue fillers, or with resurfacing techniques and other types of invasive procedures, while supplementary treatments with onabotulinumtoxinA injections can be used to enhance and prolong final aesthetic outcomes (7).
Nasoglabellar lines There are many individuals who form diagonal nasoglabellar lines over the lateral walls of the nasal bridge near the root of the nose that radiate downward, toward the alae, and accentuate when they speak, smile, laugh, or frown. These wrinkles are produced by the contraction of the transverse nasalis. Their depth and pattern can be different on either side of the midline (Figure 1). They are anatomically distinct both in location and source from the horizontal lines that span transversely across the nasal radix, which are produced by the downward pull of the procerus. When this radial fanning of longitudinal wrinkles of the upper lateral aspect of the nasal bridge occurs as a compensatory manoeuvre after treatment of glabellar frown lines with
onabotulinumtoxinA, these lines are referred to as the ‘BOTOx® sign’ (Figure 2) (7). However, when these nasoglabellar lines occur naturally and without treatment, they are referred to as ‘bunny lines’ or a ‘nasal scrunch’ (Figure 3) (7,8). There are some individuals with inelastic, lax, redundant skin, who elevate skin and soft tissue of the mid face when they forcibly squint and produce deeply corrugated nasoglabellar rhytides. For these patients, whose nasoglabellar lines are not produced by the contraction of the transverse nasalis, but by the elevation and pleating of submalar and lateral nasal skin, injections of onabotulinumtoxinA are not helpful.
Functional anatomy nasoglabellar lines result from contraction of the upper or transverse portion of the nasalis, also called the compressor naris. nasoglabellar lines are produced by squinting forcibly. If these lines become prominent without any upward movement of cheek skin, then the patient will most likely produce them readily after the glabellar lines are treated with onabotulinumtoxinA. naturally occurring nasoglabellar
Figure 2 ‘BOTOX® Sign’. (A) Patient frowning and without nasoglabellar lines prior to a treatment with onabotulinumtoxinA. (B) Same patient frowning 3 weeks after onabotulinumtoxinA treatment of his glabellar frown lines. Note the presence of compensatory nasoglabellar lines, i.e. ‘BOTOX® Sign’. (C) Two weeks after a touch-up injection of onabotulinumtoxinA in the transverse nasalis and 5 weeks after the original onabotulinumtoxinA treatment. (Note the compensatory nasoglabellar lines are gone.)
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May 2011 |
prime-journal.com
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