15 Neurotoxin Injection for Elevating the Oral Commissures
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Indications
Neurotoxin can be injected in the depressor anguli oris (DAO) muscles to elevate the oral commissures. This is indicated in patients with downturned corners of the mouth. Neurotoxin alone can be used in this area, but most often must be combined with filler injections to the oral commissure (see also Chapter 43).
Anatomic Considerations
The DAO muscle originates along the oblique line of the mandible and inserts into the modiolus. Contraction of the DAO muscle pulls down the corners of the mouth. Weakening this muscle will result in a compensatory upward pull of the zygomaticus muscles, which results in elevation of the oral commissures.
Injection Technique
A single injection per muscle is suggested and well tolerated. The DAO muscle should be palpated while having the patient actively frown. If the belly of the muscle cannot be palpated, a rough estimate of its location can be made by going 1 cm lateral to the oral commissure and then 1 cm inferiorly. Inject approximately 2 to 5 BU or 6 to 15 DU deeply into each muscle.
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