Art Lesson Teaches Plastic Surgeons Better Botox Injection Techniques

A highly detailed body painting project helps plastic surgeons understand how underlying muscles contribute to facial lines and wrinkles as well as how to better treat them using botulinum toxin injections.

The illustrated article, which appears in Plastic and Reconstructive Surgery—Global Open, presents and describes this approach to studying the anatomy and function of the facial muscles.

“By correlating facial muscle function with the presence of hyperkinetic wrinkles, this novel teaching tool provides trainees with information of great practical importance for the preparation of highly effective treatments and low complication rates,” concludes study author Ricardo Frota Boggio, MD, PhD, of Universidade de São Paulo, Brazil. "This innovative method, in a playful and highly didactic manner, presents great potential as a teaching tool in the application of botulinum toxin A."

In Dr. Boggio's view, lack of understanding of the applied anatomy of the facial muscles and how they generate hyperkinetic wrinkles is a major shortcoming of current approaches to teaching botulin toxin injection.

The artful anatomy lesson employed a 37-year-old female model with typical hyperkinetic facial wrinkles, such as forehead lines, crow's feet around the eyes and lines around the mouth. Wrinkles in these and other areas are called by repetitive action of the facial muscles.

A professional artist painted the underlying muscles of the face and neck on one side of the model's face. The model was then photographed and videotaped as she made various facial expressions to reproduce facial lines and wrinkles.

This provided a unique opportunity to study and appreciate the how the facial muscles, individually and in interaction with each other, work to produce expressive movement of the face and to generate facial wrinkles. Looking at the opposite, unpainted side helped trainees see the corresponding appearance on clinical examination.

In addition to color photographs, the online article includes brief videos of the body painting project, showing the relationship between facial movements and facial wrinkles and demonstrating proper botulinum toxin injection technique in each treated area.