A Combined Treatment Proposal for the Empty Deep Pyriform Space

Deepening of the nasolabial fold (NLF), drooping of the nasal tip, and facial expressions perceived as angry face, are common esthetic concerns. However, no studies have correlated this set of signs and symptoms with common anatomical causes. We review anatomical considerations of the region and propose a combined treatment modality.

We performed a retrospective analysis of cases treated with combined botulinum toxin (abobotulinumtoxinA) using an injection pattern encompassing the nasal muscles and hyaluronic acid (HA) fillers in the deep pyriform space. Photographs were taken at rest and during motion (frontal and oblique views), before and after treatment.

Results demonstrated effacement of the NLF, improved nasal tip positioning during smiling, and generally more favorable facial expressions.

Combined treatment with HA in the deep pyriform space and abobotulinumtoxinA in the nasal muscles can improve angry expression and aging stigma in patients with deep empty pyriform space, both in the static and dynamic conditions of facial mimic.

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