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 Dr. Cohen |
"During a rhinoplasty procedure, surgeons will often sever this muscle to help lift the nose up. Using Botox (onabotulinumtoxinA, Allergan), we can weaken the muscle and achieve a noninvasive, nonsurgical aesthetic correction," says Nowell Solish M.D., a cosmetic dermatologist in Toronto.
While the depressor septi nasi drops the tip of the nose when contracted, the nasalis muscle is the most important muscle for promoting bunny lines, whether naturally present or appearing after Botox treatment of the glabella and crow's feet areas.Botox often can be used to correct this aesthetic concern in patients, but caution is warranted and careful injection technique is crucial, as the adjacent levator labii superioris muscle extending from the side of the nose to the zygomatic bone could also be accidentally injected.
"If your needle tip is not medial enough, you could miss the nasalis muscle and accidentally inject the levator labii superioris alaeque nasi (LLSAN) muscle just lateral. Injection of the LLSAN muscle is a legitimate target if you want to treat and correct a gummy smile, but not appropriate if the goal is to inject the nasalis muscle to treat bunny lines alone," says Joel Lee Cohen, M.D., director of AboutSkin Dermatology and DermSurgery P.C., Denver.
 Dr. Solish |
According to Dr. Solish, botulinum toxin may often do a better job in preventing these lines than they do treating them. Therefore, treatments could be started at an earlier age, before these lines arise. Botulinum toxin treatments can also work well in this area in conjunction with filler, as the filler could last longer due to the decrease in puckering that patients will do.
Though higher doses of botulinum toxin in this area may achieve a longer duration of effect, it also may result in mouth dysfunction. Therefore, more frequent botulinum toxin treatments using lower doses is likely the safest and more effective approach for this indication.
"If you are just treating vertical muscle columns without etched-in muscle lines, I would use lower doses and have patients come in more frequently for treatments," Dr. Cohen says. "However, if you are treating patients who have muscle columns that are starting to have etched-in lines or more significant etched-in lines, I will often pretreat with botulinum toxin and follow up about two weeks later with an ablative fractionated laser, resurfacing or even deep TCA peel to smoothen out the area."
