Botulinum Toxin for Glabella Area and Nose

Glabella has its great importance as the first cosmetic area to be treated with botulinum toxin A (BTXA) in aesthetic field. Carruthers and Carruthers (J Dermatol Surg Oncol 18 (1):17-21, 1992; Dermatol Surg 33(1 Spec No):S26-S31, 2007) had established a landmark when they realized that a therapeutic treatment for strabismus leads to the relaxation of the glabella area muscles resulting in a relaxed and nice looking patient mimic. The evolution of the aesthetic indications of botulinum toxin allowed us to treat the frontal and the crow's feet lines as well, but residual nasal lines called "bunny lines" occur in some patients after treatment. More than these lines, some patients had not only the "bunny lines" but also lines at the nasociliary area, and Tamura (2005) had published a new approach besides the treatment of the nasalis muscle: the nasociliary area muscles. When we choose a BTXA with a predictable halo of action, each patient has its individual facial mimic, which depends on the muscle characteristics, such as position, strength, length, and size. In order to make the injection technique easier and improve the outcomes, some authors have suggested glabella (De Almeida et al. Dermatol Surg 38 (9):1506-1515, 2012) and nasal area (Tamura 2005) classification. We have compiled literature and our own experience in this chapter.