ARTICLE | THE MALE FACE | FACIAL ANATOMY AND THE USE OF BOTULINUM TOXIN Procerus


Depressor supercilii Orbicularis oculi


Levator labii superioris alaeque nasi


Compressor naris Dilator naris


Zygomaticus minor


Zygomaticus major


Depressor septi nasi


Risorius


Orbicularis oris Modiolus Platysma


Depressor anguli oris


Figure 2.3 Glabellar complex; paired corrugator supercilii and the midline procerus. gland development is clearly demonstrated by the


male beard and androgenic alopecia, and a tendency for sebaceous gland hypertrophy. Testosterone also has a deep influence on facial masculinity, a characteristic of sexual dimorphism. The abundance of hair follicles and sebaceous glands is responsible for a faster skin recovery after ablative procedures3


Frontalis Procerus


Depressor supercilii


Orbicularis oculi palpebral portion


Facial attractiveness


Orbicularis oculi–orbital portion


Facial attractiveness is an important factor in social interaction, often


preseptal pr tarsal


intelligent, and socially desirable. The rating of attractiveness may be influenced by the gender of the rater and his/her age4


Levator labii superioris alaeque nasi


personality as a result of outer traits, including facial attractiveness, is known as the halo effect5


Compressor naris Dilator naris


Comparing antique with contemporary faces, the


Zygomaticus minor


Zygomaticus major


optimal contemporary male face will have a higher lower facial height (48%) against the total average facial height6


.


Depressor septi nasi


Risorius


Orbicularis oris Modiolus Platysma


Depressor anguli oris


Orbicularis oculi. This muscle encircles the eye and functions as a sphincter. Note the fibers of this muscle are vertically oriented at the medial and lateral most aspects y function as depressors of the eyebrow.


18 ❚


Figure 1 40-year-old before (A) and after (B) treatment to the glabellar and frontal wrinkles with botulinum toxin A injection (Dysport)


June 2012 | prime-journal.com . . The stereotypical deduction of being perceived as successful,


Levator labii superioris alaeque nasi


Levator labii superioris


Levator anguli oris


Buccinator Masseter


Depressor labii inferioris


Mentalis .


The muscles of the face. (From: Benedetto AV. Botulinum Toxins in Clinical Aesthetic Practice. 2nd edn. London: Informa Healthcare Books, 2011)


Corrugator supercilii


Levator labii superioris alaeque nasi


Levator labii superioris


Levator anguli oris


Buccinator Masseter


Depressor labii inferioris


Mentalis Corrugator supercilii


Frontalis Procerus


17


Increased perceived male facial attractiveness is found in dolichocephalic (i.e. Ô long-headedÕ) males with a narrower and lower jaw (not square), and a wider and fuller lower-lip7


. Masculinity and attractiveness are two significant


components of male facial aesthetics. Features of high masculinity are cheekboneÐ jaw prominence. The perception of dominance, social boldness, and physical strength has been related to these anatomic features8, 9


.


According to some studies, extremes of masculinity may reduce attractiveness10, 11


.


The upper face The major targets of the upper face are horizontal and glabellar folds caused by the hyperkinetic muscles. The injection of botulinum toxin A is a safe and easy way to reduce mimic facial wrinkles. On the European and South American markets, onabotulinum toxin A (Botox/ Vistabel; Allergan), abobotulinumtoxin A (Dysport,/ Azzalure; Ipsen) and incobotulinum toxin A (Xeomin,/ Bocouture; Merz Aesthetics) are available. The products Botox/Vistabel and Xeomin/Bocouture are dose-equivalent. One unit of Dysport/Azzalure translates into 2–3 units of Botox12


. As a result of a greater muscle mass, males often need


higher doses of botulinum toxin treatment compared with females. A strong procerus muscle will result in a deep horizontal fold of the bridge of the nose. A dose-response study performed for male glabella lines clearly demonstrated that doses of 20 units onabotulinum toxin A were inadequate13


dosage for this area in males was 60 units13 Corrugator supercilii


. The average . The


corrugator supercilii muscle tends to insert more laterally in males. This should be evaluated before treatment so that treatment to the lateral fibres is not omitted when injecting botulinum toxin A. The natural position of the male brows is horizontal and arching is usually unwanted since it feminises appearance (Figure 1)14


. To achieve optimal results, deep glabellar folds should


be targeted using a combined approach (i.e. botulinum toxin and a dermal filler). This will not only provide a better appearance, but a significantly longer-lasting effect. In a study with adult females, the combination achieved a 32-week effect compared with 18 weeks


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