Atlanta, GA – November 12, 2012
Mary P. Lupo, M.D., Board Certified Dermatologist and Clinical Professor of Dermatology at Tulane University School of Medicine, presented “Practical Considerations and Complication Avoidance with Neuromodulators” at the 2012 American Society for Dermatologic Surgery Annual Meeting in Atlanta in October.
With more than 28 years of practicing in the field of dermatology, Dr. Lupo discussed different uses for neuromodulators and pointers to achieve the best results with this type of injectable. Neuromodulator dosing depends on the location of the injection and the age and gender of the patient. While the most common area that is treated with neuromodulators is the upper one third of the face, she has found that neuromodulators can enhance the results of filler on the lower two-thirds of the face.
Dr. Lupo said there are several things to take into consideration when using neuromodulators to correct frown lines, forehead furrows and crow’s feet or to lift or shape brows. First, decide on the arch or flare for the female brow, then watch for the “evil” eyebrow (the stronger one that lifts when a patient is incredulous or angry) and look for natural spocking that will be emphasized with the neuromodulator. Also, avoid injecting neuromodulators in patients with redundant upper eyelid skin and tonic brows. When treating the forehead furrow, neuromodulators should not be used in patients with low forehead heights or lax upper lids.
Neuromodulator can also soften crow’s feet, and Dr. Lupo finds the best results will be achieved in patients without solar elastosis (aged sun-damage skin) or when combined with laser resurfacing. She noted that the lower crow’s feet cannot be eliminated without risking a smile drop. Instead of a neuromodulator, fillers may be considered to diminish wrinkles in this area. When injected properly, neuromodulators can also be used to open the eyes, and for best results, this type of treatment is optimal for young or ethnic patients. Dr. Lupo often uses neuromodulators to correct eyelid drooping and brow drooping.
Treating the lower two-thirds of the face can be very beneficial to patients when done properly. When a patient wants to reduce the appearance of the lines alongside the top of the nose (also called “bunny lines), Dr. Lupo injects neuromodulators around the top of the nose to prevent the skin from scrunching. She finds that treating the massiter muscle (the muscle that runs through the rear part of the cheek from the temporal bone to the lower jaw) with neuromodulators can give the face a softer, less square- shaped look. The platysma muscle (a broad sheet of muscle fibers extending from the collarbone to the angle of the jaw) can also be injected to lift the jaw line. Some patients often find that their top gums are too prominent when smiling. Injecting the levator labii superioris alaeque nasi, or LLSAN (the muscle that dilates the nostril and elevates the upper lip), keeps the upper lip from over smiling and may also help with the horizontal upper lip line. This type of injection is not suited for a patient who has very thin lips or a long upper lip. Also, injecting the LLSAN may reduce prominent nasolabial folds.
The chin is another part of the lower face that Dr. Lupo sometimes injects with neuromodulators. The mentalis muscles are two small muscles in the center of the chin that can cause dimples in the chin or pull down the sides of the mouth. Relaxing these muscles with neuromodulators smoothes out the dimples and lifts the corners of the mouth. Dr. Lupo discussed that there are several complications that can occur when injecting into the chin, including injecting in wrong area, over or under injecting, diffusion caused by massaging and injecting different amounts resulting in asymmetry.
These are just some examples of neuromodulator considerations and complications based on Dr. Lupo’s personal experience and opinion. She recommends all board certified dermatologist receive the proper education and training before performing any procedures to avoid any complications with cosmetic or medical procedures. She highly recommends that all patients choose a physician trained in an accredited residency program who has then passed the certifying exam and who is practicing within the scope of care of that specialty.