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Six Distinct Botulinum Toxin Type A Injection Techniques For The Mentalis Muscle: A Clinical And Anatomical Approach
Mauro Barone, Medicine, Plastic surgery1, Roberta D'Emilio, Medicine and surgery
2, Maria Grazia Caputo, Medicine and surgery
2, Giuseppe Rosati, Medicine and surgery
2, Paolo Persichetti, Medicine, Plastic surgery
1.
1Campus BioMedico di Roma, Roma, Italy,
2freelance, Roma, Italy.
PURPOSE:The aim of this study is to describe the anatomical variants of the mentalis muscle, its crucial role in the dynamics of the lower third of the face and the different types of BoNT-A injections.
METHODS:We conducted a clinical analysis in 500 patients treated with BoNT-A in the mentalis muscle using different injection approaches. For each patient treated we produced static and dynamic photographs in various projections and a graphic record of the injection points and the drug units used. For the anatomical part we referred to ultrasound investigations and cadaver dissections Anatomical landmarks, depth of injection, and dosing were adapted to individual patient needs. Outcomes were assessed through both aesthetic improvement and functional preservation
RESULTS: Six distinct injection variants were identified: A single deep injection at the osseous origin, Two deep injections targeting the origins of the bilateral muscle bellies, One deep central injection combined with two superficial points to modulate both origin and cutaneous insertions, Three superficial injections forming a superior apex triangular pattern, One or two deep injections at the osseous origin via intraoral access, A mixed, asymmetric approach tailored for unbalanced contractions. These techniques demonstrated modulable effects on chin dynamics and lower lip symmetry. We then developed an algorithm to schematize injection points, anatomical variants, and doses.
CONCLUSION: The mentalis muscle requires a nuanced injection strategy to optimize BoNT-A outcomes. The six identified techniques provide a framework for tailored interventions, enhancing both aesthetic and functional results.
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