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Chapter 5. Bunny Lines

Bunny Lines Anatomy

Several muscles contribute to bunny lines, but the nasalis is the most significant.

(Adapted with permission from Ipsen.)

Shaded in yellow in the illustration, the nasalis resembles an upside-down horseshoe, with the curve formed by transverse fibers over the nasal dorsum. Bunny line wrinkles, which appear on the lateral/dorsal aspects of the nose but which may extend out to the lower eyelid - are present in some people naturally during expression, especially in Asian and Hispanic patients, and in patients with thin skin and fair complexion. Darker complexions and oily skin are more likely to produce wrinkles limited to the nasal dorsum.

Patients should be asked to laugh, sniff, and to squint intensely as if a very bright light is before their eyes. Usually, bunny lines are not present in kinetic patients with a mild smile. They only become evident when smiling at maximum contraction. In hyperkinetic patients, bunny lines are found with a mild smile and worsen at maximum contraction.

Blue ovals (see the illustration) represent the approximate appropriate injection zone area for neurotoxin treatment of the nasalis muscle.

Bunny Lines Treatment Approach

(Adapted with permission from de Maio M, Rzany B. Botulinum Toxin in Aesthetic Medicine. Berlin, Springer-Verlag; 2007.)
Bunny lines are typically treated via 2 lateral injections.

Bunny lines may be treated alone or in conjunction with the treatment of crow's feet and glabellar lines. Bunny lines are typically treated via 2 lateral injections totaling either 10 to 30 DYSPORT Units or 5 to 10 BOTOX Units into the nasalis (blue ovals in the illustration). Sometimes an additional dorsal injection is required. Injections should be limited to the levator labii superioris alequae nasi to avoid lip ptosis.

Bunny Lines Case

This patient wanted her bunny lines softened when she smiled.

The practitioner injected patient at the 2 blue circles (photo) with injections of 10 DYSPORT Units each. The total dose was 20 DYSPORT Units.

Bunny Lines Injection Demonstration

The total dose was 20 DYSPORT Units.

Bunny Lines Results

Patient expression alternates from rest to "scrunching."

The patient shown 17 days after treatment with DYSPORT for bunny lines, with good result. More intensive treatment could have impaired patient's smile. The patient received a total of 20 DYSPORT Units, 10 units per side.

The same patient is seen in the video 17 days after DYSPORT treatment. The patient alternates expression from rest to scrunching of nose.

Bunny Lines Treatment Summary

Treatment of bunny lines increases patient satisfaction with overall concomitant treatment of the upper face, including the glabella or crow's feet. Potential adverse events of bunny lines treatment are ecchymosis, hematoma, and - rarely - diplopia and upper lip ptosis.