Anatomy of the face, face wrinkles and preferable sites of injections

1. Essential anatomy for facial injections
MOHAMED ELADL
9.05.2014

2. DrMEladl
OBJECTIVES
 Outline muscle groups of the face: muscles of mastication and muscles
of facial expression.
 Discuss the functional groups of muscles of facial expression: dilator
and sphincter mechanisms of the orifices of the face.
 Describe the attachment and function of the muscles of facial
expression.
 Summarize the attachment of levator palpebrae superioris.
 Discuss the anatomy of wrinkle lines in the face in relation to the
muscles involved, preferred sites of injections, and possible
complications
 Horizontal lines of the forehead.
 What are Mephisto sign, Lateral brow lift, Glabella lines, Crow’s feet,
Bunny lines, Marionette lines, Cobblestone appearance, Gummy smile
and Nefertiti lift.
 Describe the blood supply of the face: branches of internal and external
carotid arteries.
 Describe the motor and cutaneous innervation of the face.

3. DrMEladl
MUSCLES OF THE FACE
 Muscles of mastication
 Muscles of facial expression

4. DrMEladl
MUSCLES OF MASTICATION
 Temporalis
 Masseter
 Pterygoids Muscles

5. DrMEladl
 Functional groups surround the orifices
 Sphincters & Dilators
MUSCLES OF FACIAL EXPRESSION

6. DrMEladl
 Sphincters:
Orbicularis oculi muscle
MUSCLES AROUND THE ORBIT

7. DrMEladl
 Sphincters:
Orbicularis oculi muscle
MUSCLES AROUND THE ORBIT
Medial palpebral ligament
Lateral palpebral raphae
Lacrimal gland

8. DrMEladl
 Dilators:
Levator palbebrae Superioris
(opposes the Palbebral part of
orbicularis oculi muscle)
MUSCLES AROUND THE ORBIT

9. DrMEladl
 Dilators:
Frontalis (opposes the orbital part of orbicularis oculi muscle)
MUSCLES AROUND THE ORBIT

10. DrMEladl
HORIZONTAL WRINKLES IN FOREHEAD
 Lies at right angles to the line of pull of the underlying
muscle (Frontalis muscle)
 Dynamic wrinkles are those that appear only during active
movement of the face.
 Static wrinkles are those that are always present even
when the face is at rest.

11. DrMEladl
HORIZONTAL WRINKLES IN FOREHEAD
Injection should NOT be confined to the midpubillary lines and
should extend laterally to avoid Mephisto Sign

12. DrMEladl
 A true upper lid ptosis (drooping) can occur if the
neurotoxin is injected in or near the levator muscle.
HORIZONTAL WRINKLES IN FOREHEAD

13. DrMEladl
 Close to the eye:
Corrugator supercilii
MUSCLES AROUND THE ORBIT
Draws the eyebrows medially and
inferiorly and is responsible for the
vertical wrinkles above the nose
which is called Glabellar lines

14. DrMEladl
 Close to the eye:
Procerus Muscle
MUSCLES AROUND THE ORBIT
Depresses the medial end of the
eyebrows is responsible for the
horizontal wrinkles over the
dorsum of the nose.

15. DrMEladl
 Are vertical lines that appear
between the eyebrows.
 Appear over time from the
effects of age, sun exposure and
habitual frowning, whether while
awake or during sleep, due to
tension.
 Injection is made close to the
midline for Procerus and
corrugator Muscles
FROWN(GLABELLAR) LINES

16. DrMEladl
 Lie on the lateral side of the eye due
to contraction of the orbital part of the
orbicularis oculi with age
 They are at right angles to the line of
pull of orbicularis oculi muscle
 The injection must be not so close to
the orbit to avoid infiltration of the
lateral rectus which results in medial
squint.
CROW’S FEET LINES

17. DrMEladl
 Sphincter:
Compressor Naris
-Is the transverse part of nasalis muscle
-Form aponeurosis over the bridge of
the nose
MUSCLES OF NOSTRILS

18. DrMEladl
 Dilators:
1. Dilator Naris
(anterior part of nasalis)
Are few muscle fibers inserted into
the lateral part of the ala of the
nose and draws the alar cartilage
downward and laterally (opens the
naris)
2. Depressor Septi
From maxilla above the incisors
and inserted into the nasal septum
MUSCLES OF NOSTRILS

19. DrMEladl
 Dilators:
1. Dilator Naris
(anterior part of nasalis)
are few muscle fibers inserted into
the lateral part of the ala of the
nose and draws the alar cartilage
downward and laterally (opens the
naris)
2. Depressor Septi
3. Levator Labi superioris aleque
nasi
From frontal process of maxilla and
divides into two parts one to the
alar cartilage of the nose and the
other into the upper lip
MUSCLES OF NOSTRILS
1
2
3
These dilators are obvious in infants with respiratory distress

20. DrMEladl
 Bunny lines: Along the upper
third of the nose and nasal
bridge.
 Deepening of nasolabial folds:
which are lines or folds that run
from the nose to the corners of
the mouth.
WRINKLES RELATED TO NOSE AREA

21. DrMEladl
 Horizontal wrinkles which form
across the ridge of the nose as
people age.
 They tend to form as a result of
years of smiling, frowning, and
forming expressions with the
face.
BUNNY LINES

22. DrMEladl
 Sphincters:
 Orbicularis Oris
From medial parts of maxilla and
mandible and inserted into the mucus
membrane of the lips
The tone of the muscle closes &
protrudes the lips as in whistling &
kissing
MUSCLES AROUND THE MOUTH

23. DrMEladl
 Dilators:
1. Levator Labii
Superioris alique nasi
2. Levator Labii
Superioris
3. Levator Anguli Oris
4. Zygomaticus minor
5. Zygomaticus major
6. Rizorius
7. Depressor anguli oris
8. Depressor Labi
inferioris
9. Mentalis
B. Buccinator
M. Masseter
MUSCLES AROUND THE MOUTH
1
2
3
4 5
7
8
9
B M

24. DrMEladl
 Dilators:
 Levator Labii Superioris
Is a superficial muscle arise
above the infraorbial foramen
 Levator Anguli Oris
Is a deep muscle below the
infraorbital foramen
 The infraorbital nerve &
vessels are sandwiched
between these 2 muscles
 The levator labii superioris
is responsible for
deepening of the
nasolabial sulcus
MUSCLES AROUND THE MOUTH
LAO
X
X
X

25. DrMEladl
PLATYSMA MUSCLE

26. DrMEladl
 The most common wrinkles in
the perioral area are:
1. Nasolabial Lines and
Parentheses lines.
2. Lipstick lines
3. Marionette lines
WRINKLES IN PERIORAL AREA

27. DrMEladl
NASOLABIAL FOLDS
 Are deep creases or folds that
run from the corners of the
nose down to the corners of
the mouth.
 Usually single but can be
more than one.
 These start as smile lines but
with age the fat in the cheeks
slides down and combines
with muscle shrinkage and
loss of skin elasticity.

28. DrMEladl
 The levator labii superioris is
responsible for deepening of
the nasolabial sulcus
NASOLABIAL FOLDS
*
*

29. DrMEladl
 Some individuals develop lines
that arc around the corners of
the mouth and usually are
extension of nasolabial
folds.
 They are often shallow, fine
lines.
PARENTHESES LINES

30. DrMEladl
 Lines that etch vertically from the
upper or lower lips
 They are more prevalent on the
upper lips.
 While they are sometimes called
smoker’s lines, most individuals
develop the lines are not smokers.
 The lines are a result of loss of
volume that occurs with age.
 These lines can contribute to
lipstick bleeding, hence the name
'lipstick lines'.
LIPSTICK LINES

31. DrMEladl
 These lines that run straight
downwards from the corners of the
mouth can make you look
unhappy.
 They form as facial volume begins
to deplete and deeper creases
begin to form below the mouth.
MARIONETTE LINES

32. DrMEladl
 Formed mainly by the depressor anguli oris muscle and
by the platysma muscle
 Injection should be 1cm lateral to the angle of the mouth to
avoid asymmetry
MARIONETTE LINES
*

33. DrMEladl
FACIAL ARTERY
Supraorbital n & a
Supratrochlear n & a
Superior labial a
Inferior labial a
Facial a
Angular a

34. DrMEladl
SENSORY NERVE SUPPLY OF THE
FACE

35. DrMEladl
MOTOR NERVE SUPPLY OF THE FACE

36. DrMEladl
MOTOR NERVE SUPPLY OF THE FACE
Auriculotemporal n.
Superficial temporal a.
Temporal
Zygomatic
Buccal
Mandibular
Cervical
Facialnervebranches
Greater auricular n

37. DrMEladl

38. Thank You