Botulinum Toxin for Glabella Area and Nose

  • Bhertha TamuraEmail author
Living reference work entry

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Part of the Clinical Approaches and Procedures in Cosmetic Dermatology book series (CAPCD)


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.


Glabella Botulinum toxin A Bunny lines Nasalis Nasociliary Nasociliary, depressor cilia Nasal transversal line Levator anguli oris and alaeque nasi muscle Bunny lines 


  1. Abramo AC, do Amaral TP, Lessio BP, de Lima GA. Anatomy of forehead, glabellar, nasal and orbital muscles and their correlation with distinctive patters of skin lines on the upper third of the face: reviewing concepts. Aesthet Plast Surg. 2016;40(6):962–71.CrossRefGoogle Scholar
  2. Carruthers A, Carruthers J. Treatment of glabellar frown lines with C. botulinum-A exotoxin. J Dermatol Surg Oncol. 1992;18(1):17–21.CrossRefGoogle Scholar
  3. Carruthers A, Carruthers J. Aesthetic botulinum A toxin in the mid and lower face and neck. Dermatol Surg. 2003;29(5):468–76.PubMedGoogle Scholar
  4. Carruthers A, Carruthers J. Eyebrow height after botulinum toxin type A to the glabella. Dermatol Surg 2007;33(1 Spec no):S26-31.CrossRefGoogle Scholar
  5. Carruthers J, Fagien S, Matarasso SL, Botox Consensus Group. Consensus recommendations on the use of botulinum toxin type a in facial aesthetics. Plast Reconstr Surg. 2004;114(6 Suppl):1S–22S. ReviewCrossRefGoogle Scholar
  6. De Almeida AR, da Costa Marques ER, Banegas R, Kadunc BV. Glabellar contraction patterns: a tool to optimize botulinum toxin treatment. Dermatol Surg. 2012;38(9):1506–15. Scholar
  7. Pessa JE, Rohrich RJ. Facial topography – clinical anatomy of the face. DiLivroso Rio de Janeiro copyright 2014.Google Scholar
  8. Pessa JE, Rohrich RJ. Facial Topography: Clinical Anatomy of the face CRC Press LLC 2012.Google Scholar
  9. Tamura B. Concepção da beleza e da estética atual. Editora Santos, 1a. edição 2007; ISBN: 9788572886611.Google Scholar
  10. Tamura BM, Odo MY, Chang B, Cucé LC, Flynn TC. Treatment of nasal wrinkles with botulinum toxin. Dermatol Surg. 2006;31(3):271–5.CrossRefGoogle Scholar
  11. Tamura BM, Odo MY, Chang BC, Cucé LC, Flynn Tc. Treatment of nasal wrinkles with botulinum toxin. Dermato Surg 2005;3:257–383.Google Scholar

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Authors and Affiliations

  1. 1.Clínicas Hospital of São Paulo of the University of Sao PauloSao PauloBrazil
  2. 2.Barradas and Bourroul’s Ambulatório de Especialidades in Sao PauloSao PauloBrazil
  3. 3.Sorocaba’s Ambulatório de Especialidade in SorocabaSao PauloBrazil

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