Auada Souto Mariam Patrícia, Souto Luís Ricardo Martinhão
Dermatology & Plastic Surgery, Marília Day Clinic, Marília, Brasil.
J Cosmet Dermatol. 2021 May;20(5):1381-1384. doi: 10.1111/jocd.13869. Epub 2020 Dec 11.
In the lower third of the face, botulinum toxin A is used to obtain a more harmonious contour. The anatomical complexity of the face requires a more precise application of botulinum toxin.
Describe the treatment of an unexpected effect after botulinum toxin A application in the lower third of the face.
PATIENT/METHODS: A 51-year-old female patient presented to our clinic for application of botulin toxin aiming to improve facial wrinkles and contour. 50 U of botulinum toxin type A were applied to the upper third and 20 U to the lower third of the face. The patient returned after 10 days with a smile asymmetry and an excessive and unconscious lowering on the right side of the lower lip while laughing. So, 3 U of botulinum toxin were applied to the center of the depressor labii inferioris muscle on the right side.
The patient returned with a satisfactory correction of the smile asymmetry.
Although treatments with botulinum toxin A are considered safe, unexpected results can occur. In our case, it probably occurred due to medial injection or diffusion of botulinum toxin A into depressor anguli oris muscle on the left side that may lead to paralysis of the left depressor labii inferioris muscle and downward hyperfunction of the unaffected right lower lip. The correction was made with a new injection of botulinum toxin A in the depressor labii inferioris hyperactive muscle at the right side.
在面部下三分之一区域，A型肉毒毒素被用于获得更和谐的轮廓。面部的解剖结构复杂性要求更精确地应用肉毒毒素。
描述面部下三分之一区域应用A型肉毒毒素后出现意外效果的治疗情况。
患者/方法：一名51岁女性患者到我们诊所接受肉毒毒素注射，旨在改善面部皱纹和轮廓。在上三分之一面部注射50单位A型肉毒毒素，在下三分之一面部注射20单位。10天后患者复诊，出现微笑不对称，大笑时右侧下唇过度且无意识地下垂。于是，在右侧降下唇肌中部注射3单位肉毒毒素。
患者复诊时微笑不对称得到满意矫正。
尽管A型肉毒毒素治疗被认为是安全的，但仍可能出现意外结果。在我们的病例中，可能是由于A型肉毒毒素向左侧口角降肌的内侧注射或扩散，导致左侧降下唇肌麻痹，未受影响的右侧下唇功能亢进。通过在右侧降下唇肌功能亢进的肌肉中再次注射A型肉毒毒素进行了矫正。
