Facial injectables and surgery, anatomy first

The muscles of the face, the nerves that supply them and the joint that moves the jaw are all head and neck anatomy. That region is where an ENT and head and neck surgeon works, in diagnosis and in the operating theatre. Injections in the face are planned from the same anatomical map.

This matters most when the reason for treatment is medical. A headache pattern, a clenching habit and a heavy upper eyelid each have a structure behind them. The treatment has to match that cause, not the symptom.

Dr. Missaghian has worked with botulinum toxin and hyaluronic-acid fillers for over 25 years. The approach is unchanged: examine first, treat the area that explains the problem, then review before anything is added.

Botulinum toxin is widely associated with cosmetic injections. It also has a medical use. In chronic migraine it is an established treatment. Where the pattern is tension-type headache, the evidence for injection is weak and other treatment is usually the better route. Clenching and grinding of the teeth are assessed in the same consultation, and any treatment for them is discussed individually rather than assumed.

In these cases the injection is placed to reduce the activity of muscles that are working too hard. For bruxism, that is usually the chewing muscle at the angle of the jaw. For chronic migraine, the injection follows an established pattern of sites in the muscles of the head and neck rather than the lines on the skin.

Diagnosis comes first. Not every headache belongs to this treatment, and some need a different investigation altogether. That assessment happens before anything is injected.

Pain in the head is not always generated in the head. The upper cervical spine, the chewing muscles and the temporomandibular joint share nerve supply and share load. A problem in one can be felt in another.

The cervical spine and the jaw are assessed by hand as part of the same consultation. Where the neck is contributing, manual treatment or medication-based therapy may form part of the plan, alongside an injection or instead of one.

Vertigo and dizziness are approached the same way, because the neck and the inner ear can both be involved. If the ear is the source, the hearing tests available in the clinic are used to look further.

Some concerns in this area are structural rather than muscular. Upper eyelid skin can gather until it rests on the lashes or narrows the upper field of vision. Blepharoplasty, a correction of the eyelid, is considered when the examination shows that the skin or the tissue beneath it is the reason.

Laser-assisted treatment of facial skin is used for defined changes in the skin surface, once the skin has been examined and the diagnosis is clear. Autologous hair transplantation, using your own hair, is carried out with a specialised team.

Surgery is discussed when it is the right option, not as a starting point. If a simpler measure addresses the cause, that is what you will be offered first.