Problem Area: Bunny Lines
Your bunny lines/nose wrinkles may not be a problem initially, but they may start to gain some strength after treating your frown lines for a while. Some people have very prominent bunny lines even with a moderate smile and others may not notice these lines until they have a large grin or smile. Your bunny lines are formed primarily from the nasalis muscle and some recruitment from the levator labii superioris alaeque nasi (LLSAN) muscles. The LLSAN muscles help lift the upper lip along with the other levator labii muscles, so we should avoid injecting this muscle to avoid a wanky smile. I find that patients like this area treated if they have a more oily complexion and their make up tends to settle in these creases, or if they treat the glabella and find that it looks unnatural to have a smooth brow and exaggerated movement through the bridge of their nose. I can't say this would work for everyone, but a patient I follow had her nasalis treated several times over and it helped atrophy or weaken and shrink the muscle to the degree that her nose had a slimmer appearance. This could be a realistic outcome for anyone that has a bulky nasalis muscle to start.
Example A: patient never treated with a neurotoxin. Strong glabellar movement and bunny lines.
Example B: patient regularly treated with neurotoxin in the glabellar area and has some recruitment of the nasalis & levator labii, creating bunny lines across the bridge of nose.
The Fix: Neurotoxin
To treat this we would use a neurotoxin to temporarily weaken the muscle contraction. Botox or Dysport are good choices for this treatment area. An average dose for females for the nasalis is 4-8 units of Botox or 10-20 units of Dysport.
The result is not seen immediately. It takes 2-3 days for the neurotoxin to uptake into the muscle. The product is completely active at 2 weeks out. On average, the result lasts for 3-4 months. I tell my patients to budget for their treatment 3-4 times a year, if they want to keep the results up. Some patients are able to stretch their appointments out and others have to come in sooner. Metabolism, skin quality and condition, under-dosing, and overall desired result can have an impact on how often you will have a treatment.
Anatomy Lesson: Nasalis
Your nasalis is a horseshoe shaped muscle that wraps over the bridge of your nose. When you contract this muscle it creates wrinkles on your skin over the lateral and dorsal aspects of the nose bridge. As illustrated in the example photos above, these lines are apparent on a patient that has never had a glabella neurotoxin treatment and also on a patient that has regular glabella treatments. I wanted to clarify this to assure you that these wrinkles are not caused by having your glabella treated. However, they can definitely become more obvious to some once other areas of the face nearby have a smoother complexion.
Treatment Pattern: Two Pokes
To successfully treat the nasalis, plan for two pokes from the injection needle. One poke on either side of the lateral aspects of the nose. Remember the levator labii superioris alaque nasi is nearby, so air on the side of caution and treat higher on the bridge. Feel for the muscle activity underneath and plan your treatment accordingly. General rule of thumb with any neurotoxin treatment...you can always add more at a two week follow up visit.
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