Treatment of Nasal Wrinkles with Botulinum Toxin:

A narrative-style review of non-surgical rhinoplasty: Indications, outcomes, and limitations

The aim of this narrative-style review was to evaluate non-surgical rhinoplasty in terms of indications, outcomes, and limitations. Both 'PubMed' and 'Science Direct' were reviewed by all authors, in order to reach consensus with regard to the chosen studies. Studies published from 1980 to 2023 were searched using the key terms "non-surgical rhinoplasty", "dermal filler", "thread lifting", and "botulinum toxin", and relevant papers were selected. Non-surgical rhinoplasty refers to the use of injectable temporary fillers to augment selected areas of the nose, in order to achieve improved appearance or function in select patients. It includes the use of dermal fillers, thread lifting, and botulinum toxin injections. The perfect dermal filler would be inexpensive, safe, painless to inject, hypoallergenic, and long lasting. In addition, it should produce consistent and predictable results, feel natural under the skin, take little time to inject, be ready to use, exert no downtime on the patient, and have a low risk of complications. Regions of the nose treated with filler injections include the frontonasal angle, dorsum, nasolabial angle, and columella. Thread lifting and botulinum toxin injection are the other methods of non-surgical rhinoplasty. Dermal fillers, thread lifting, and botulinum toxin injections can be used as non-surgical rhinoplasty. Dermal fillers and botulinum neurotoxin can be used alongside each other to allow minimally invasive resculpting of the nasal region and midface, compensating for a reduction in tissue volume and the formation of rhytides.

Novel Classifications for Muscular Contraction of the Lower Face and Neck

BACKGROUND

Currently, there are no scales that address lower-face muscular contraction patterns, and there is only one that addresses platysmal bands.

OBJECTIVE

The goal of this article is to create scales to classify the strength and contraction patterns of the lower face and neck based on (1) the muscular anatomy and contraction patterns of the platysma and (2) the strength of the depressor anguli oris (DAO).

METHODS

Three hundred sixty patients participated in the study. Standardized photogarphs were taken in an effort to characterize muscle contraction patterns.

RESULTS

A novel classification measuring the strength of the DAO is presented. For the DAO, 4 different contraction patterns were observed: Type 1 (38%), Type 0 (26.3%), Type 2 (25.2%), and Type 3 (8.6%). The remainder (1.9%) used asymmetric contraction. For platysmal bands, 3 different contraction patterns were observed: complete contraction (64.53%), lateral contraction (19.83%), and central contraction pattern (11.73%). A small percentage of patients (3.91%) had an asymmetric contraction pattern.

CONCLUSION

Categorization of contraction of the DAO and platysmal bands into these proposed classifications provides objective measurements that can be helpful for designing treatment protocols and assessing response to treatment.

The Use of Neurotoxins in the Male Face

Injection of neurotoxin is the most commonly performed cosmetic procedure in the United States, and the total number of male patients seeking botulinum has steadily increased over the years. Because of their unique aesthetic goals, expectations, and anatomy, men require differing botulinum toxin doses and techniques. This article provides an evidence-based approach to botulinum toxin in men. Each area of the face is discussed separately, focusing on gender differences in anatomy, treatment goals, and injection method.

Global Aesthetics Consensus: Hyaluronic Acid Fillers and Botulinum Toxin Type A-Recommendations for Combined Treatment and Optimizing Outcomes in Diverse Patient Populations

BACKGROUND

Combination of fillers and botulinum toxin for aesthetic applications is increasingly popular. Patient demographics continue to diversify, and include an expanding population receiving maintenance treatments over decades.

METHODS

A multinational panel of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated guidelines with a worldwide perspective for hyaluronic acid fillers and botulinum toxin. This publication considers strategies for combined treatments, and how patient diversity influences treatment planning and outcomes.

RESULTS

Global Aesthetics Consensus Group recommendations reflect increased use of combined treatments in the lower and upper face, and some midface regions. A fully patient-tailored approach considers physiologic and chronologic age, ethnically associated facial morphotypes, and aesthetic ideals based on sex and culture. Lower toxin dosing, to modulate rather than paralyze muscles, is indicated where volume deficits influence muscular activity. Combination of toxin with fillers is appropriate for several indications addressed previously with toxin alone. New scientific data regarding hyaluronic acid fillers foster an evidence-based approach to selection of products and injection techniques. Focus on aesthetic units, rather than isolated rhytides, optimizes results from toxin and fillers. It also informs longitudinal treatment planning, and analysis of toxin nonresponders.

CONCLUSIONS

The emerging objective of injectable treatment is facial harmonization rather than rejuvenation. Combined treatment is now a standard of care. Its use will increase further as we refine the concept that aspects of aging are intimately related, and that successful treatment entails identifying and addressing the primary causes of each.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, V.

Global Aesthetics Consensus: Botulinum Toxin Type A--Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications

BACKGROUND

Botulinum toxin type A injection remains the leading nonsurgical cosmetic procedure worldwide, with a high rate of efficacy and patient satisfaction.

METHODS

A multinational, multidisciplinary group of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated consensus recommendations with a worldwide perspective for botulinum toxin and hyaluronic acid fillers. This publication on botulinum toxin type A considers advances in facial analysis, injection techniques, and avoidance and management of complications.

RESULTS

Use of botulinum toxin has evolved from the upper face to also encompass the lower face, neck, and midface. The Global Aesthetics Consensus Group emphasizes an integrative, diagnostic approach. Injection dosage and placement are based on analysis of target muscles in the context of adjacent ones and associated soft and hard tissues. The indication for selection of botulinum toxin as a primary intervention is that excessive muscular contraction is the primary etiology of the facial disharmony to be addressed. Global Aesthetics Consensus Group recommendations demonstrate a paradigm shift toward neuromodulation rather than paralysis, including lower dosing of the upper face, more frequent combination treatment with hyaluronic acid fillers, and intracutaneous injection where indicated to limit depth and degree of action.

CONCLUSIONS

The accumulation of clinical evidence and experience with botulinum toxin has led to refinements in treatment planning and implementation. The Global Aesthetics Consensus Group advocates an etiology-driven, patient-tailored approach, to enable achievement of optimal efficacy and safety in patient populations that are rapidly diversifying with respect to ethnicity, gender, and age.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, V.

Anatomy of the Lower Face and Botulinum Toxin Injections

The use of botulinum toxin in the lower face is more complex and less reliable than its use in the upper face. Use in the lower face is also fraught with more adverse events. The anatomy of the lower face is complex, as the muscles of this region are very close together and interface at different levels and depths to perform heterogeneous functions, such as talking, eating, drinking, and expressivity of the face. This article, based on the anatomical knowledge of each muscle of the lower face, provides recommendations and guidelines to perform botulinum toxin injection safely. The review of each muscle with its relevant anatomy and relationship of this three-dimensional anatomy with the cutaneous plane gives the exact position of injectable locations. For each muscle, the number of points related to the motor end plate location and the exact dose related to the muscular mass are indicated. Summary tables are provided.

Aesthetic use of BoNT: Options and outcomes

There are a multitude of uses for BoNT in the aesthetic realm. Efficacy has been shown in softening glabellar creases, crows feet, forehead rhytides, and in correcting facial asymmetries, including mild eyelid ptosis. Facial shape can be altered through injections of BoNT into masseter, and smiles can be altered with BoNT. Clinical examples of the above will be shown, as well as adverse outcomes with inaccurate injection techniques.

The successful use of botulinum toxin for the treatment of nasal hyperhidrosis

BACKGROUND

Patients with facial hyperhidrosis often experience occupational, social, and psychological problems. Botulinum toxin type A, which has been shown to be useful in the treatment of hyperhidrosis, can cause the paralysis of facial muscles if used in the skin overlying the facial muscles. It can, however, be used in the skin of the nose without significantly affecting the muscles of facial expression.

METHODS

Two patients with severe nasal hyperhidrosis were treated with botulinum toxin.

RESULTS

Two patients with severe nasal hyperhidrosis responded to a single session of treatment with intradermal injections of botulinum toxin.

CONCLUSIONS

This treatment method for nasal hyperhidrosis is simple, well tolerated, and effective, and significantly improves the quality of life of the affected individuals.