NEWPORT BEACH, CALIF. Peri-oral injections of Botox may be a remedy when patients have lines radiating from the lips, a hollow appearance around the mouth, or an elongated upper lip often associated with aging, Joel Cohen, M.D., said at the annual meeting of the Pacific Dermatologic Association.
Injecting a total of 610 U of botulinum toxin type A into the orbicularis oris muscle can soften the lines and give the patient a more animated expression. The treatment also augments the upper lip in some patients, giving them a fuller lip without having to use fillers, said Dr. Cohen, a clinical assistant professor of dermatology at the University of Colorado, Denver.
Identify the injection sites by having the patient purse her lips. Inject the Botox superficially, into the peaks of the musculature. Treat the lower lip as well as the upper lip, "or it will look funny, and may accentuate any hyperfunctional musculature of the lower lip," he said.
Proper placement of the injections is important. Go too lateral, and you may weaken the lip elevators, which could result in a drooping lip and a risk of drooling. Injecting too medially or right at the midline could flatten the Cupid's bow.
Even under the best of circumstances, Botox treatments around the mouth may impair the patient's ability to purse her lips, whistle, drink from a straw, or pronounce the letters P and B. For those reasons, Dr. Cohen does not recommend this procedure to actors, singers, broadcast journalists, woodwind musicians, or scuba divers.
Moving farther down the face, Dr. Cohen said he has achieved good results injecting Botox into people with a dimpled, "golf-ball chin" that becomes especially prominent when they talk or chew. Feel along the chin for the bony margin, and inject 35 U into the belly of the mentalis muscle. With use of such small quantities, the treatment can be considered a "lunchtime" procedure.
Dr. Cohen offered a few pearls for maximizing cosmetic results and patient comfort during a lower-face procedure:
▸ Everyone has some naturally occurring lip asymmetry. Document this in photographs before the procedure, in case there's any question about it later. Some patients may benefit from a touch-up procedure a few weeks after the initial one.
▸ Makeup can obscure facial landmarks or small potential pitfalls such as vascular structures. Have the patient wipe it off before you administer the injections.
▸ Diluting the Botox makes the injections easier to perform, with no difference in cosmetic results as long as you're using an appropriate total dose. Dr. Cohen uses preserved saline, which decreases the pain.
▸ A 31-gauge syringe with a short hub also makes the procedure less painful.