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Chapter 14: Botox (Botulinum A-toxin) -  

Injection technique for blepharospasm and facial spasm

Lecture 9 of 9  NEXT»

Benign essential blepharospasm is treated with five 2.5 unit doses of Botox injected subcutaneously at the medial and lateral aspect of each lid and at the lateral canthus (Figure 3). Care should be exercised to avoid injecting the mid portion of the upper lid so as to avoid paralyzing the levator palpebri and causing ptosis. In cases where the spasm spreads to other facial muscles and even to the neck, similar 2.5 unit injections are given subcutaneously at the site of the spasm. I have give up to 50 units at one treatment. Injection should not be made inferior to the nasolabial fold! Injections here cause lip droop that in turns leads to very annoying lip biting by the patient.

figure 3a

figure 3b

Figure 3
The site of subcutaneous injection for blepharospasm.
A typical appearance before injection.
A typical appearance a few days after injection.
An example of sites around the face that would be injected in a typical case of hemifacial spasm.



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