Treatment guidelines for botulinum toxin type A for the periocular region and a report on partial upper lip ptosis following injections to the lateral canthal rhytids

Inactivation of the orbicularis oculi muscle by chemodenervation with botul inum toxin type A (Botox, Allergan, Inc., Irvine, Calif.) as a sole procedu re or in conjunction with blepharoplasty has proved to be a reliable method to improve the appearance of the periocular area. Botox has the unique and ideal characteristic in that, with repeated use, there is potential for a prolonged clinical effect with smaller dosages. In addition, if a complicat ion does arise-while not aesthetically acceptable and potentially untoward- it is time-limited, and the anatomical area will eventually return to its p retreatment baseline status. In this study, in three cases [in more than 10 00 crow's feet treatment sessions (2000 sides)l over the course of 1 year, partial lip ptosis resulting from weakening of the zygomaticus major muscle after the injection of Botox into the periocular region are reported. This article reviews suggested treatment guidelines and anatomic considerations for the periocular region to maintain injection standardization and improv e the safety profile of Botox as the aesthetic indications for its use expa nd and the number of individuals who inject it increases.