“NoseTox” Techniques Emphasize Muscle Dynamics and Precision Injection

Understanding nasal muscle interactions may improve aesthetic outcomes with neuromodulator treatments targeting the lower face and nose, according to Vince Bertucci, MD, FRCPC, during his session, “The Art of NoseTox,” presented at Music City SCALE 2026.

Dr Bertucci described the muscles of facial expression as functioning “like gears,” forming an interconnected system in which weakening one muscle alters the balance of opposing forces. These shifts can affect nasal movement, smiling dynamics, and perceived facial expression.

The major nasal muscle groups involved in aesthetic movement are elevator muscles, including the procerus and levator labii superioris alaeque nasi (LLSAN), and depressor and compressor muscles, which influence nostril expansion and nasal width. The LLSAN contributes to “bunny lines,” nostril elevation, and upper lip movement during smiling.

Dr Bertucci identified LLSAN as a key contributor to the “illusion of nasal tip droop when smiling,” partly due to elevation of the alar crease and posterior-superior movement of the subnasale. Strategic weakening of the nasal portion of the LLSAN may improve this effect.

Injection precision was emphasized as critical for avoiding unintended changes in facial expression. Safe treatment zones can be defined anatomically by drawing a line between the medial canthus and nasal wing, and patients should be instructed to make a “disgusted” facial expression to isolate the muscle belly before injection.

Treatment involves low-dose, intradermal injections targeting specific muscle groups. Approximately 1.5 to 2 units per side is recommended for the nasal portion of the LLSAN, while smaller doses can be used to treat the orbicularis oculi and nasal dilator muscles.

Dr Bertucci stressed that careful localization is essential to make sure the toxin affects only intended fibers. He noted that “these limits ensure the toxin acts only on the nasal part of the LLSAN,” minimizing spread to adjacent musculature.

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Reference
Bertucci V. The art of nosetox. Presented at: Music City SCALE Symposium; May 13–17, 2026; Nashville, TN.