17 Neurotoxin Injection for Smoker’s Lines
Difficulty: ●●
Patient Satisfaction: ●●
Risk: ●●
Indications
Perioral wrinkles extend radially from the lips due to the repeated puckering motion from speaking or smoking. In women, lipstick may “bleed” into these lines. In nonsmokers, these lines can be produced in patients who purse their lips while talking.
Anatomic Considerations
The orbicularis oris muscle is the sphincter that surrounds the mouth. Repeated contraction of this muscle may result in circumoral rhytids.
Injection Technique
BoNTA is injected at the vermillion border, usually 1 to 2 units per quadrant. Not more than four injections are performed on each lip, and not more than two per side. (Because of the increased zone of effect for Dysport, the authors prefer Botox in this area.) The wrinkles themselves do not necessarily need to be injected, as the mild paresis of the muscle will improve the entire region injected.
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