Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin.
OBJECTIVE
To propose a safe and reproducible injection point for botulinum toxin-A (BTX-A) as a supplementary method for the treatment of gummy smile, as determined by assessment of the morphologic characteristics of three lip elevator muscles.


METHODS
A total of 50 hemi-faces from 25 adult cadavers (male 13, female 12; ages, 47 to 88 years) were used in this study. Topographic relations and the directions of the lip elevator muscles (ie, levator labii superioris [LLS], levator labii superioris alaeque nasi [LLSAN], and zygomaticus minor [ZMi]), were investigated. Possible injection points were examined through the study of predetermined surface landmarks.


RESULTS
The insertion of the LLS was covered partially or entirely by the LLSAN and the ZMi, and the three muscles converged on the area lateral to the ala. The mean angle between the facial midline and each muscle vector was 25.8 +/- 4.8 degrees for the LLS, 55.7 +/- 6.4 degrees for the ZMi, and -20.2 +/- 3.2 degrees for the LLSAN; no significant differences were noted between male and female subjects or between left and right sides. The three vectors passed near a triangular region formed by three surface landmarks. The center of this triangle, named the "Yonsei point", was suggested as an appropriate injection point for BTX-A. The clinical effectiveness of the injection point was demonstrated in selected cases with or without orthodontic treatment.


CONCLUSIONS
Under careful case selection, BTX-A may be an effective treatment alternative for patients with excessive gingival display caused by hyperactive lip elevator muscles.
Hwang
Woo-Sang
WS
Department of Orthodontics, Yonsei University College of Dentistry, Seoul, Korea.
Hur
Mi-Sun
MS
Hu
Kyung-Seok
KS
Song
Wu-Chul
WC
Koh
Ki-Seok
KS
Baik
Hyoung-Seon
HS
Kim
Seong-Taek
ST
Kim
Hee-Jin
HJ
Lee
Kee-Joon
KJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002102:Cadaver; D005152:Facial Muscles / Q000033:anatomy & histology* / Q000187:drug effects; D005260:Female; D005882:Gingival Diseases / Q000628:therapy*; D006801:Humans; D007273:Injections, Intramuscular; D008046:Lip / Q000033:anatomy & histology* / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012904:Smiling
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A