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Good knowledge of functional anatomy (where are the muscles and what are their action) is essential for successful and safe injections of BTX.

The muscles of the face are skin muscles, with no bone attachment . Duchenne de Boulogne, a French neurologist en 1862 was the first to study the role of the facial muscles in the expression of emotions. His work, published in England by Charles Darwin in his book” Expression of emotions in human and animals”, is still relevant when injecting BTX into facial muscles. He defines the “orthography of facial expression in movement.” and “the reason behinds the lines, wrinkles and folds of the moving face.”

He postulated that the movement of a single muscle could create the impression that the entire expression has changed, hypothesis which is confirm every day with the use of BTX into facial muscles.

Duchenne de Boulogne

Adapted from Duchenne

Physiotherapy and dystonia

Jean-Pierre Bleton, physiotherapist in Paris has published boks on physiotherapy for spasmodic torticollis
and for writer’s cramp.

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