The nasal back symmetry is particularly important for beauty, but nasal deviation and nostril asymmetry are common, often caused by asymmetric growth of nasal bone and cartilage or trauma.
However, due to the influence of past habits, after proper correction, muscle contraction in adjacent areas of the face may relapse into nasal asymmetry.
Therefore, patients will be told not to laugh or eat solid food after clinical surgery.
At present, BoNT-A has become the first choice to regulate facial muscle excitability,
In this issue, we will summarize the treatment of nasal asymmetry after nasal remodeling surgery for BoNT-A.
Retrospective study
In 2020, Lee et al. explored nasal asymmetry after BoNT-A nose reconstruction surgery.
30 patients received BoNT-A injection treatment.
Of the 60 patients, 46 had priority in surgery,
14 patients underwent nasal reconstruction again.
Preoperative study,
The patients were photographed one month and six months after the operation,
The aesthetic symmetry is evaluated.
Aesthetic evaluation,
The researchers first made a vertical line at the midpoint of the eyebrows on both sides as a vertical line,
The medial canthus midpoint and lip margin can also be determined,
Make a horizontal line at the nose tip,
Symmetry measurement is carried out together.
For postoperative evaluation,
Vertical and horizontal offset assessment,
The horizontal offset refers to the difference in the angle of the lower edge of the nasal alar on both sides (Figure 1).
Figure 1 Facial aesthetic evaluation sign
BoNT-A South Korea is used to inject Botulax,
BoNT-A South Korea is used to inject Botulax,
The concentration is 100U/2.5mL.
30 gauge needle is used for injection,
Respectively inject depressor septum muscle (4) U)
Bilateral levator labii nasalis (2 on each side) U, Figure 2),
Inject immediately after operation.
Figure 2 Schematic diagram of improving nasal symmetry by BoNT-A injection of nasal septum depressor muscle and bilateral levator nasalis superioris muscle (blue dot refers to nasal septum depressor muscle, yellow dot refers to levator nasalis superioris muscle)
The average follow-up time of the subjects was 31. The age, vertical deviation and horizontal deviation of the two groups of patients before surgery were all 5 months.
In addition, the deviation angle of BoNT-A was improved to (2). 30 °± 0.03 ° 6 months after operation, which was 10 °± 0.22 ° compared with the control group (1).
In addition, the study compared the vertical and horizontal deviation angle difference between 1 month and 6 months after surgery, and the results showed that the BoNT-A fruit was durable and would not cause recurrence of facial asymmetry (Table 2). The improvement diagram of different patients is shown in Figure 3-5.
In terms of satisfaction, 28 patients (933). 3%) of BoNT-A reported good results, and their satisfaction was higher than that of the control group (53%).
There were no adverse reactions such as ecchymosis, bleeding, infection or allergy in the study. Two patients reported general chills, which were relieved after conservative treatment. 8 patients felt uncomfortable when smiling.
Table 1 Comparison of vertical and horizontal deviation angles after BoNT-A nose reconstruction
Table 2 Vertical and horizontal deviation angles of BoNT-A injection (the deviation angles of 1 month and 6 months are similar)
Figure 3 Schematic diagram of nasal symmetry of 39 year old female patient at baseline (A) and 6 months after surgery (with BoNT-A injection)
To sum up, BoNT-A paranasal muscle intervention has no adverse reaction of Ming X. The results of this study support that BoNT-A can prevent the asymmetric reproduction of the nose caused by the contraction of surrounding muscles after nasal remodeling.
reference
Lee W, Ahn TH, Cheon GW, Lee MJ, Yang EJ. Comparative analysis of botulinum toxin injection after corrective rhinoplasty for deviated nose and alar asymmetry [published online ahead of print, 2020 Jun 18]. J Cosmet Dermatol. 2020; 10.1111/jocd.13523. doi:10.1111/jocd.13523
A The current situation of face slimming injection for the treatment of sound barrier
At present, the application of type A injection thin face (BoNT-A) otorhinolaryngology has gradually expanded, reducing the risk of laryngeal dystonia, and has become the main treatment option for spastic dysphonia (Figure 1). In addition, otolaryngologists also use it to treat diseases such as idiopathic acoustic tremor, muscle tone sound barrier, cyclopharyngeal hypertrophy, chronic cough, vocal cord granuloma, etc. In this issue, we will summarize and explore the current situation in the field of sound barrier for BoNT-A.
Figure 1 Schematic diagram of spastic dysphonia after 2 weeks of BoNT-A treatment before treatment
Related research
01
In 2020, Patrick et al. conducted a clinical study on the application of BoNT-A in American otolaryngologists. The research content mainly includes 26 items of questionnaires. The questionnaire was prepared by the American Academy of Otolaryngology Head and Neck, including multiple choice questions and free questions, and was investigated among American otolaryngologists through email.
The results showed that 246 otolaryngologists were sent out of the questionnaire, 81 of whom returned to the questionnaire (the response rate was 32). 9%). The general results showed that 68% of the participants were laryngologists, and 66% of the participants worked in teaching medical centers. In terms of treatment of BoNT-A, the distribution of injection experience of the participants is average. Most participants have been treated with BoNT-A for 0-25 years, with an average of 21 times per month and 5 times per month (Table 1).
Table 1 General characteristics of questionnaire participants
Name of the questionnaire Participants reported that the main diseases of BoNT-A are:
Adductive spastic dysphonia (ADSD, 77%)
The second is tremor (10%),
Abductive spastic dysphonia (ABSD, 6%)
Mixed spastic dysarthria (4%), etc.
Most doctors choose the injection site.
Unilateral injection (92%) was used to treat ADSD,
ABSD was treated with bilateral injection (74%).
For idiopathic voice tremor,
Most doctors choose unilateral treatment (96%).
For the initial treatment dose,
The average initial dose of ADSD was 1.6U,
However, there are more ABSDs, 4.2U.
The initial dose of other diseases is shown in Table 2.
Draw conclusions through weighted calculation
The average initial dose of throat injection of BoNT-A was 2.6U
Table 2 Application of BoNT-A in various sound barrier diseases
In the process of BoNT-A injection in clinical practice, 54% of the participants will use a bottle of BoNT-A to treat multiple patients within one day, with different doses.
26% of the participants (n=20) will use a bottle of BoNT-A separately for each patient, and the rest of the drugs will be abandoned. 60% of the therapists will use 100U injection to slim the face, and 40% will use 50% U injection to slim the face.
In addition, in terms of brand selection, 99% of participants used Botox, and only 1% of participants received Xeoming treatment (Table 3).
Among all participants, EMG commonly used technical means (88%), followed by nasal acupuncture.
In addition, 42% of the participants in the teaching medical center and the private institution BoNT-A teaching medical center use each bottle of multi dose treatment, and 89% of the private participants use each bottle of multi dose injection.
Table 3 BoNT-A sound barrier injection rules for 81 participants
The study further found that currently in the United States, due to insurance reasons, BoNT-A specifications are divided into 100U treatment specifications and 50U beauty specifications. Among them, 50U BoNT-A of beauty specification is not covered by insurance, which leads to drug waste and additional economic burden when clinical otolaryngologists use 1000U BoNT-A to inject small doses of BoNT-A to treat sound barrier.
