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Three-Dimensional Evaluation of the Depressor Anguli Oris and Depressor Labii Inferioris for Botulinum Toxin Injections

 You-Jin Choi  ;  Young-Jun We  ;  Hyung-Jin Lee  ;  Kang-Woo Lee  ;  Young-Chun Gil  ;  Kyung-Seok Hu  ;  Tanvaa Tansatit  ;  Hee-Jin Kim 
 AESTHETIC SURGERY JOURNAL, Vol.41(6) : NP456-NP461, 2021-05 
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Issue Date
Anatomic Landmarks ; Botulinum Toxins, Type A* ; Cadaver ; Dissection ; Face / diagnostic imaging ; Facial Muscles* ; Humans ; Injections
Background: Botulinum toxin type A (BoNT-A) injection administered at an inappropriate site or depth can produce an unwanted change in facial animation because the depressor anguli oris (DAO) and depressor labii inferioris (DLI) muscles are partially overlapped. Therefore, simple BoNT-A injection guidelines, based on 3-dimensional (3D) facial anatomic references and landmarks, would be very useful.

Objectives: The aim of this study was to establish novel BoNT-A injection guidelines that include the soft tissue thickness at the lower perioral region. Data were acquired with a 3D scanning system combined with dissections in order to obtain accurate injection sites and depths for the DAO and DLI.

Methods: 3D scans of the facial skin, superficial fat, and facial muscle surface were performed in 45 embalmed cadavers. The thicknesses of the skin and subcutaneous layer were calculated automatically from superimposed images at each of 5 reference points (P) in the perioral region.

Results: In every case (100%), P3 and P5 were located in the DLI and DAO areas, respectively (45/45). Therefore, we defined P3 as the "DLI point" and P5 as the "DAO point." The soft tissue thicknesses at the DLI and DAO points were 6.4 [1.7] mm and 6.7 [1.8] mm, respectively.

Conclusions: The P3 and P5 described in this study are effective guidelines that only target the DLI and DAO. Clinicians, specifically, can easily use facial landmarks, such as the cheilion and pupil, to assign the DLI and DAO points without any measurement or palpation of the modiolus.
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2. College of Dentistry (치과대학) > Dept. of Oral Biology (구강생물학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Others (기타) > 1. Journal Papers
Yonsei Authors
Gil, Young Chun(길영천)
Kim, Hee Jin(김희진) ORCID logo https://orcid.org/0000-0002-1139-6261
Lee, Kang Woo(이강우)
Lee, Hyung Jin(이형진) ORCID logo https://orcid.org/0000-0002-3082-935X
Choi, You Jin(최유진) ORCID logo https://orcid.org/0000-0003-3701-2200
Hu, Kyung Seok(허경석) ORCID logo https://orcid.org/0000-0002-9048-3805
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