Cosmetic use of botulinum toxin in the upper face

Glabellar contraction patterns: a tool to optimize botulinum toxin treatment

BACKGROUND

Botulinum toxin is a well-established treatment for dynamic glabellar lines. A previous study evaluated the existence of glabellar contraction "patterns," according to the predominance of eyebrow approximation, depression, or elevation movements, namely "U," "V," "convergent arrows," "omega," and "inverted omega."

OBJECTIVES

To confirm contraction patterns in the adult population for a better treatment approach and to verify whether changes occur after repeated treatment.

METHODS

Pairs of photographs-at rest and under contraction-from two groups were retrospectively analyzed: 334 adult volunteers with a predominance of specific movements, being verified and 36 previously treated individuals when they returned for re-injections.

RESULTS

The five glabellar contraction patterns were confirmed. Each individual's initial pattern reappeared upon waning of the toxin effect.

CONCLUSION

Interpersonal differences in facial animation are observed. Classifying glabellar wrinkles allows accurate treatment with botulinum toxin, injecting the most commonly recruited muscles with higher doses or into more sites. Muscles not so recruited are spared or injected with lower doses for more-effective and -natural results. Although botulinum toxin blockade causes recruitment of adjacent muscles, the initial muscle contraction pattern is resumed when the effect wanes.

Lower-face and neck antiaging treatment and prevention using onabotulinumtoxin A: the 2010 multidisciplinary French consensus--part 2

BACKGROUND

Onabotulinumtoxin A has been used for many years in the aging face treatment. A survey was organized to identify current practices in France.

OBJECTIVE

To develop consensual recommendations for treating aging lower face and neck with onabotulinumtoxin A.

METHODS AND MATERIALS

Fifty-seven participants to six regional surveys reviewed practices and techniques for each individual treatment indication. From conference summaries and data from a questionnaire, consensual recommendations were developed.

RESULTS

General considerations, key treatment rules, injection specifics (dose, site, and techniques), associated procedures/treatments, and procedure follow-up were defined by indication, i.e., nasolabial angle, nasal tip repositioning, dilated nostrils, lips and perioral area, Marionette lines and depressor anguli oris, gingival smile, risorius and zygomatic perioral muscles, masseters, chin, and platysma. For the consensus participants, current onabotulinumtoxin A use is a global preventive and corrective treatment. Overall, judicious treatment of multiple sites and adjunctive modalities, such as fillers, peels, and laser, leads to satisfactory results with a youthful, harmonious, animated, and natural-looking face.

CONCLUSION

Years of experience using onabotulinumtoxin A result in sophisticated treatment approaches, more specific targeted injections, and better understanding of lower facial and neck aging, leading to satisfying therapeutic results for patients and clinicians.