OnabotulinumtoxinA from lines to facial reshaping: A new Italian consensus report

What comes first: teeth or face? Recommendations for an interdisciplinary collaboration between facial esthetic surgery and dentistry

OBJECTIVE

The aim of the present study was to provide recommendations in order to facilitate communication between dental professionals and surgeons who are collaborating in the field of dentofacial esthetics.

CLINICAL CONSIDERATIONS

Smile esthetics are beyond the scope, both of the surgeons who are collaborating with facial esthetics and of the dentists, as a wide range of treatment options from both sides is available. It can be difficult for the surgeon or the dentist that first comes in contact with the patient to conduct an individualized global treatment plan, in order to find out how the various phases of the treatment can be sequenced, as a workflow for an efficient interaction between facial surgery and dentistry still does not exist in the scientific literature.

CONCLUSIONS

Facial cosmetic procedures and dental treatment have to be planned as individual elements of the whole dentofacial esthetic rehabilitation. The treatment has to be initiated with the design of the smile and the intraoral mock-up, followed by the required surgical interventions, and to be finished with the delivery of the definitive dental restoration.

CLINICAL SIGNIFICANCE

Dentofacial esthetics require comprehensive communication between surgeons and dentists. Following the proposed recommendations, an individualized interdisciplinary treatment plan can be conducted, defining the role of each specialty.

Profiloplasty and facial contouring with injectables: A holistic, practical, and user-friendly approach

BACKGROUND

Expansion of the aesthetic treatment armamentarium with novel injectable products has greatly improved our ability to reshape and enhance the facial profile. However, full-face "profiloplasty" with injectables remain a nascent concept and is insufficiently considered in daily practice. While techniques have been widely published for treating the individual facial areas that constitute an attractive profile-including the forehead, nose, lips, jawline, and chin-the literature remains fragmented on more universal methods for profile improvement.

AIMS

To collate disparate knowledge on profile optimization with injectables, and define a holistic, practical, and user-friendly approach to profiloplasty and facial contouring.

METHODS

Consideration is given to key anatomical aspects and the changes that occur with age; patient assessment parameters for planning profiloplasty; and the technical specifications, product selection, and essential safety considerations for minimizing the risk of complications and optimizing the effectiveness of treatment.

RESULTS

Relevant case studies are presented.

CONCLUSIONS

Holistic approaches of this type are essential if we are to maximize the potential of full-face treatment with injectables-both now and in the future.

Treating Glabellar Lines With Botulinum Toxin: Does Your Patient Need to Frown Steadily?

BACKGROUND

The variable relationship between the orbicularis supercilii and frontalis muscles may cause side effects with botulin toxin; steadily frowning is the usual recommendation. Eliminating the need to frown until all injections are over might enhance efficacy and lessen the neurotoxicity risks related to muscle exhaustion.

OBJECTIVES

The goal of this study was to investigate whether the digital caliper-assessed distances between the medial and lateral corrugator injection sites and the midline differed significantly in patients persistently frowning from patients resting.

METHODS

Seventy-six individuals with glabellar wrinkles treated with botulinum toxin in the authors' private practices for glabellar lines voluntarily contributed their retrospective data about the positions of injection sites. The investigators had freely chosen to inject the medial and lateral sections of the corrugator supercilii during persistent maximum frown or at rest.

RESULTS

The mean differences in distances between the medial and lateral injection points and the estimated midline were clinically trivial (1.0 ± 1.28 and 1.5 ± 2.53 mm, respectively), although the distances between the relaxed and contracted medial and lateral injection sites exceeded 1.8 and 2.5 mm in 33.9% and 46.4% of patients, respectively. Distance differences, not significant before 40 years old, were statistically significant only for the lateral injections in older patients (on average, 1.9 ± 3.01 mm).

CONCLUSIONS

The average distances from the medial and lateral injection points and the midline appear minimally different in patients who frown until all injections are over and, conversely, patients who rest. Persistently frowning might be advisable only in patients older than 40. Facial asymmetries may be a confounding factor.

LEVEL OF EVIDENCE: 4

Neurotoxin in the Lower Third of the Face

Botulinum toxin A (BT) is the most required treatment in face rejuvenation. However, applications of BT on the lower third are off-label and specific tips for the treatment of this area should be taken into account to achieve best results. In the current study, literature concerning BT treatment of lower face has been revised and summarized according to anatomy and indications, tips, and complications. BT treatment of the lower face has been reported to be effective and safe when performed with adequate knowledge of anatomy and techniques.

Cosmetic Treatment Using Botulinum Toxin in the Oral and Maxillofacial Area: A Narrative Review of Esthetic Techniques

Botulinum toxin (BoNT) is an anaerobic rod-shaped-neurotoxin produced by Clostridium botulinum, that has both therapeutic and lethal applications. BoNT injection is the most popular cosmetic procedure worldwide with various applications. Patients with dynamic wrinkles in areas such as the glabella, forehead, peri-orbital lines, nasal rhytides, and perioral rhytides are indicated. Excessive contraction of muscles or hyperactivity of specific muscles such as bulky masseters, cobble stone chins, gummy smiles, asymmetric smiles, and depressed mouth corners can achieve esthetic results by targeting the precise muscles. Patients with hypertrophic submandibular glands and parotid glands can also benefit esthetically. There are several FDA-approved BoNTs (obabotuli-numtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, letibotulinumtoxinA, prabotulinumtox-inA, daxibotulinumtoxinA, rimbotulinumtoxinB) and novel BoNTs on the market. This paper is a narrative review of the consensus statements of expert practitioners and various literature on the injection points and techniques, highlighting both the Asian and Caucasian population separately. This paper can serve as a practical illustrative guide and reference for optimal, safe injection areas and effective doses for application of BoNT in the face and oral and maxillofacial area. The history of BoNT indications, contraindications, and complications, and the merits of ultrasonography (US)-assisted injections are also discussed.