Retrograde vs spot botulinium toxin facial injection

Area of Science:

• Aesthetic medicine
• Neurology
• Anatomy

Background:

• Facial musculature exhibits significant anatomical variation in neuromuscular end plate distribution.
• Understanding this variation is crucial for effective botulinum toxin (BoNT) injection techniques.

Purpose of the Study:

• To evaluate the efficacy of retrograde botulinum toxin injection via targeted neuromuscular end plate zones.
• To assess the impact of facial muscle anatomical variation on injection outcomes.

Main Methods:

• A retrograde injection technique was applied to 10 patients, using the contralateral side as a control.
• Botulinum toxin (6 Allergan units per zone) was administered perpendicularly to targeted end zones (frontalis, corrugator supercilii, orbicularis oculi).

Main Results:

• A more prominent effect was observed on day 8 in the orbicularis oculi and corrugator supercilii muscles in 90% of patients.
• 90% of patients required additional botulinum toxin units for glabellar lines and crow's feet on the control side.
• One patient (10%) needed reinjection for glabellar lines on the control side.

Conclusions:

• Facial muscle neuromuscular plate distribution varies, necessitating tailored injection strategies.
• Retrograde botulinum toxin injections are optimal for muscles with scattered neuromuscular plates.
• This technique minimizes injection sites, pain, dosage, cost, and off-target product spread.