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”Okay, so these areas with the Ultherapy comfort treatment that I’ve developed here at The Maas Clinic, we're able to get complete blocks with 3 tiny little shots of numbing medicine and I’ve kind of highlighted the key nerves, the infraorbital we will do a little block there that gets all of the mid-face and cheek region here, the area of the mental nerve gets the entire lower lip region so we can get all around the perioral region and the key in the neck here is this Erb’s points, there's a block that I can do in the back part of the neck, this is right in the back part of the big muscle of the neck, and as we're all these little sensory nerves come out that supply the sensation to the neck and the jawline, and by blocking that point into the longer back edge which is the big muscle I said in the neck, just tiny little subcutaneous injections makes that all numb and then I’ll hit this one called the auriculotemporal just with a couple little shots and there's actually one up here called the lacrimal and getting those blocks makes the whole brow and lower face completely numb and people can have a completely comfortable treatment.
Dr. Corey Mass: The lower face and those little shots sting a little bit but then the whole thing is done, you don’t feel anything else. The biggest issue historically, although a lot of people honestly don’t even feel Ultherapy at all. You know I’ve had it and I felt it, there were couple of hot spots but it was totally tolerable. But for slender women like you, I think a lot of slender women have more discomfort so we offer a block or some numbing, it depends on your pain sensitivity or threshold. Do you generally think you have a high pain threshold, low, or in between?
Patient: I think in between
Dr. Corey Mass: In between, okay. So for really anybody, what we can do is, hit some areas that are very specific that will make the whole area numb that we're treating and I can do whole area so that your neck is entirely numb, the lower face, in your case we're doing just the upper face, so some areas where the upper face area is numb, it’s pretty simple to do that.
These relate specifically to the neuro anatomy, its right here if you want to take a look, I’ll show you this. There's two main nerves, the mental nerve which we've talked about before, comes out for the lower face, this isn't for her, but it comes out at the first molar, it’s below the teeth and its almost always at the mid-pupil area line and then if we go at the middle of the face there's the infraorbital nerve represented right here, and you can almost feel that on yourself or on anyone, there's a little frame or hole where it comes out, I can feel that hole right there.
If I block that, you can see the nerve distribution coming out here, it gets the entire area, the lower lip, middle part of the nose and the lower eyelids, you see the little branches coming up here?
For the upper lid there's two middle nerves here, the supratrochlear and supraorbital and only some of these branches when we're doing brow lifting because when we do Ultherapy brow lifting, we are trying to pick the best vector of lifting and I’ll mark this with tresses so you'll see, but I look for what's the best direction that I’d like to you know, vector for tightening the fascia that I can use and we'll do a block primarily for this lacrimal nerve which is right at the tale of the eyebrow.
So we'll do a little drop right out here to pick that up, and the only other one that has any effect this is the, its non-labeled but is the zygomaticofacial nerve and then this one coming up here comes up from the side and right along the temporal area here, that's the auriculotemporal nerve, that's actually a division of the fifth cranial nerve, the third division now.
So in the upper face there is the first division of the fifth cranial nerve, in the mid face there are the second division of the fifth cranial nerve and this is the only one that is the third division. So we've drawn these out and I’ve written this protocol very carefully for Ultherapy comfort treatments, so we don’t have to see the big issues with people when you read online about it as uncomfortable.
We don’t have to have anyone be uncomfortable, if you do a proper block, people don’t feel anything. I'm going over this with you because yesterday we were talking to a person who was having it elsewhere but really didn't get a good block. I don’t think a lot of people even offer it.
The main thing in the neck is this point called Erb’s point which is half way between the origin of the Sternocleidomastoid muscle, the big muscle in your neck. Here is this sternocleidomastoid. It’s got a clavicular an external head which is what makes the little split here, you know there's a little split where the two heads divide for this muscle, and this muscle is also where they will often put in IJ's if you have ever been in the ICU.
If you put a line in the IJ that's the spot you do it, but that muscle right at the very back edge of it in about the mid-point of the neck, you can see her Sternocleidomastoid here coming down its about half way down right in this area is a place called Erb’s point and Erb’s point is where all these sensory nerves from the neck come up see 2, 3 branches these are all sensory nerves so if we get a good block along the back edge of the Sternocleidomastoid, we get almost all the neck except some crossing over nerves here, which is why all these little dots are along here, where we would do a little drops for doing the lower face.
So if you're interested in more information on this topic or any of our other topics please don’t hesitate to write at DrMaas.com, you can send videos, you can send photographs or just written text with questions and I’m happy to answer them. We're more than happy to have you visit our website or visit our Facebook page at Facebook.com/MaasClinic
This is Dr. Corey Maas on Looking Your Best.”