RESUMO
BACKGROUND: Nasal wrinkles on the dorsum of the nose can frequently be treated with botulinum toxin type A by injecting a few units into the nasalis muscle. Between 2 and 5 U of botulinum toxin have commonly been used. However, clinicians have observed that some nasal wrinkles persist following nasalis treatment. OBJECTIVE: To detail remaining nasal and perinasal rhytids and further injection sites, which can lead to improvement. METHODS: Two hundred fifty patients with nasal rhytids were treated between 1997 and 2004. Three units of botulinum toxin type A were injected bilaterally into the nasalis muscle. Patients were seen at 1 month for follow-up, and the remaining rhytids were documented. RESULTS: Forty percent of patients had satisfactory treatment of nasal wrinkles with the initial bilateral 3 U injections. Sixty percent of subjects had remaining nasal rhytids following the nasalis muscle injections. Thirty percent o f subjects hadpersistent wrinkles at the root of the nose (nasal orbicular wrinkles), and 30% had wrinkles at the nasal root and between the eyes (nasociliary wrinkles). The injection of botulinum toxin into additional locations according to the anatomic differences of each person showed excellent resolution of the rhytids without complications. CONCLUSION: Understanding nasal wrinkle patterns allows for complete wrinkle treatment of the nose beyond simple bilateral treatment of the nasalis. New points of botulinum toxin application improve not only wrinkles at the root of the nose but also wrinkles in the nasoalar area.