Contraction of bilateral angle depressor muscles will lead to decreased angle of mouth. The increase of DAO muscle excitability may lead to abnormal decline of oral angle. In addition, the decline of oral corners will also lead to wrinkles around the mouth, affecting the appearance. Some people will smile, and the DAO shrinks, leading to an ambiguous expression during the smile process, which causes certain social distress. As a local nerve blocking drug, type A injection can improve the abnormal angular ptosis caused by the increased excitability of DAO and can modify the smile.
DAO is a pair of triangular muscles that originate from the continuous mandibular external oblique line of the platysma cervicalis muscle and end at the corner of the mouth skin (laughing muscle and orbicularis oris muscle). It is mainly dominated by the facial nerve, and the blood supply is from the facial artery. The DAO pulls the corners of his mouth downward and inward, showing sadness, fatigue or anger (Figure 1).
Figure 1 Anatomy of DAO
For the definition of a beautiful smile, foreign scholars believe that when the radian of the upper teeth is parallel to the radian of the lower lip, the smile is more beautiful. This radian should be a convex shape (that is, the midpoint of the tooth is located at a lower place, and gradually rises from the midpoint to the outside). On the contrary, the difference between the tooth radian and the lower lip radian will reduce the beauty (Figure 2). In addition, Sarver people think that the upper jaw plane of individuals with short vertical distance is relatively flat, and it is difficult to form such a smile. Attention should be paid to this point before type A injection face slimming treatment.
Figure 2 A maxillary tooth arc is consistent with the lower lip, B tooth arc is inconsistent with the lower lip
The modification of corner droop can be achieved by type injection, face slimming injection and DAO muscle injection. When injecting DAO, when the syringe needs to identify the muscle more accurately, in order to identify its DAO for the muscle, the therapist usually requires the patient to actively pull down the corner of the mouth. At this time, the therapist can touch the muscle below the mouth crack. At the same time, try to avoid injecting the thin face into the adjacent orbicularis oris, buccinator and chin muscles. In the process of injection, it is usually necessary to master the injection amount of 2-5UA to inject thin face, the injection depth is medium, and the injection points are usually distributed along muscle fibers, with 2 points on each side (Figure 3). The dosage needs to be controlled during the injection process. Excessive injection may lead to excessive injection. Excessive paralysis of DAO may lead to chewing problems.
Figure 3 Schematic diagram of A thin face injection type DAO for treatment of angular ptosis
However, the medial side of the DAO often overlaps with the lower lip muscle, and the lateral side is close to the laughing muscle, zygomaticus major muscle, and platysma. Choi et al. discussed the distribution of facial muscles around the mouth. DAOA type injection face slimming is used to treat angular ptosis and reduce the risk. The study included 42 adult cadavers from South Korea and Thailand, including the relationship between the inner edge and the concave point in the DAO anatomical records of cadavers (including the angular axis, the inner and outer edges of the DAO, and DAO Figure 4).
Figure 4 Evaluate the more accurate anatomic position of the angle depressor muscle
(LH horizontal line of mouth angle axis, LV vertical line of mouth angle axis, P1-DAO mandibular edge is more than the inner point, P2-DAO mandibular edge is more than the outer point, P3-DAO inner edge is concave)
The results show that the sector distribution of DAO is less than 45 °, and the internal distribution is less than 30 °. Since DAO is located at the inner edge, it is difficult to predict between the lower lip muscles of the inner edge DAO. For type A injection of thin face injection, this area should be selected (Figure 5).
Fig. 5 Schematic diagram of the anatomical position and injection site of the angle depressor muscle. The outer edge of the DAO and the perpendicular line of the mouth angle axis are 45 °, and the inner edge are 30 °. This area is DAO; The shadow is 7-8 ° inward, which is the overlapping area of DAO and lower lip muscle.
Qian et al. also studied the type A injection face slimming treatment for Chinese congenital angular ptosis. A total of 36 patients were included in the 1-3 injection points of the lower lip muscle motor area on each side for treatment. The total dose of single-sided injection of 2-4U at each point for face thinning shall not exceed 8U. This is assessed by the angular variation of the mouth droop (Figure 6). Remember that the declination angle of oral angle improved significantly in January after injection (Fig. 7). The fruit can last for 6-9 months with rare side effects.
Figure 6 The red corner in the left figure is the drooping angle of the mouth corner, and the right figure is the schematic diagram of the injection point. The injection point is 8-10mm outside the mouth corner and 8-15mm below the mouth corner
A Non androgenic alopecia areata New injection face slimming treatment
Alopecia Areata (AA) is a common skin disease, which often shows non scar hair loss such as scalp, eyebrows or whiskers.
At present, alopecia areata may be related to autoimmune abnormalities, but its pathophysiological mechanism may be more complex. Previous studies have reported that substance P may play an important role in the neural regulation of hair growth. Rossi et al reported that the contents of CGRP and SP in scalp biopsy of AA patients decreased, which may be related to the decrease of blood flow in basal microvessels.
Assessment of alopecia areata
The assessment of alopecia areata mainly depends on clinical observation and photos. The therapist took photos on both sides, top and back of the patient respectively, and estimated the proportion of hair loss according to the proportion of scalp in different parts. The proportions of different scalps are shown in Figure 1. Poor treatment or no treatment means 1-29% hair regeneration, 30-59% moderate treatment, 60% obvious treatment - * * hair regeneration.
Figure 1 Scalp scale at different angles
Alopecia areata injection face slimming treatment
In 2006, others in Cutler reported the first case of headache alopecia treated by injection of thin face. The case is a 34 year old female with headache baldness in 30 months. He suffered from severe headaches, painful touch and a burning scalp. At the same time, he suffers from hair loss similar to AA in the affected areas. The patient received triamcinolone acetonide (4,6mg) injection for scalp injury, combined with 40mg intramuscular injection, and the fruit was not good. They received buspirone (55 mg), propranolol (180 mg) and tizanidine (16 mg), etc. The fruits were not good, and the pain caused by oral opioids was not completely relieved.
Therefore, therapists use type A injection to thin face and inject corrugator, interbrow, frontalis, temporalis, splenius capitis, occipital and trapezius muscles (1000 U in total). The patient began to improve 10 days after injection and lasted for 6 weeks. Three months later, the patient received the second treatment, and the pain was completely relieved for 60 days while the hair grew again significantly (Figure 2).
Figure 2 The left picture shows the patient's hair is thin and alopecia is serious before injection; The right picture shows that the hair grows obviously 4 weeks after the injection of thin face
In 2013, other people in Irimia confirmed the role of facial injection in headache alopecia. It is reported that a 33 year old woman suffered from regional headache with a diameter of 12-3cm in the right occipital region, which worsened after activities. VAS with daily pain scored 6 points (out of 10 points). Patients used NSAIDs, gabapentin, etc.
The patient then loses hair in the painful area. There was no abnormality in blood routine examination, cerebrospinal fluid examination, cranial MRI and vascular MRI. Biopsy of hair loss site showed epithelial atrophy and hyperkeratosis. Local blood vessels are normal without immune infiltration. Immunohistochemistry showed that the nerve fibers in the subepithelial plexus were decreased, which was consistent with the diagnosis of alopecia areata.
Subsequently, the patient received type A injection of facial injection of frontal muscle, temporal muscle, trapezius muscle and occipital muscle U around the pain. Three months later, the headache intensity of the patient decreased significantly, and alopecia disappeared completely. The second time, the patient was randomly treated with 100U injection of face slimming. The headache of the patient was significantly relieved, only 1-2 days/month.
However, some studies have shown that AA has limitations in the treatment of injection of thin face. In 2010, Cho et al. treated 7 AA patients with type A injection slimming test. The patients were followed up at baseline and 2, 4, 6, 8 and 12 months after injection. The face slimming injection was carried out within 0, 2 and 4 months. The patient received 10 times of U/point A-type injection of face slimming skin. The left side was injected into the circle area, and the right side was injected with normal saline (Figure AB below). The results showed that one of the seven patients was out of the study due to spontaneous hair growth. The other 6 bits, 5 bits none and 1 bit heavier (figure).
Figure 3 Comparison of injection of slimming face on the left side and injection of normal saline on the right side
Figure 4 The patient's 7AA became worse after injection
At present, there are relatively few studies on the treatment of AA with A non androgenic injection face slimming, mainly case reports. More large randomized double-blind studies are needed in the future to further demonstrate the treatment of non androgenic AA by injection of thin face.
