Botulinum toxin type A for aging face and aesthetic uses

Abstract

Botulinum neurotoxin type A injection to correct and/or reverse the physical effects of aging process has become one of the most frequently requested cosmetic procedures at an outpatient setting. Careful clinical evaluation together with proper use of the techniques, including pre- and post-procedures recommendations, reconstitution of the products, techniques, and doses, are described in this article. This article also covers the main indications of botulinum neurotoxin type A for aging face and other aesthetic uses, as well as some possible adverse reactions and their management.

The Practical Use of AbobotulinumtoxinA in Aesthetics

“…19 The clinician is responsible for understanding each patient’s unique needs, goals, and expectations. 32 This responsibility has been emphasized in several consensus recommendations. 22,33-35 …”

“…32,38 These can be treated with a single midline injection high on the nasal dorsum or 2 injections on the lateral aspect of the nasal wall above the nasofacial groove. 19,32,36 Injection sites are generally kept high on the nose and superficial in order to avoid excessive paralysis of the deeper and more inferior levator labii superioris and levator labii alaeque nasi, which are important elevators of the upper lip (Figure 3). Excessive chemodenervation of these muscles may lead to upper lip ptosis.…”

“…32,55 The number of injection points and total dose should be decided on an individual patient basis. 32 …”

“…54 This has been successfully treated with 2 injection points into the mentalis muscle, close to the mandibular bone to avoid asymmetry or lower lip ptosis. 1,32,33 Doses should generally be injected deep into the target muscle because of the reasonable amount of fat that exists in the chin area. 36 ABO can be given at 2 injection sites in a paramedian position (5 mm lateral to the midline) overlying the inferior mandibular border.…”

Neuronal entry and high neurotoxicity of botulinum neurotoxin A require its N-terminal binding sub-domain

“…Exploiting their high specificity for cholinergic nerves, the large complex of BoNT/A containing haemagglutinin and other non-toxic proteins isolated from Clostridium botulinum , and to a lesser extent the type B counterpart, has proved successful in treating hyper-excitability disorders of muscles and secretory glands1. Also, the /A complex has been used for aesthetic/facial applications23. Furthermore, it benefits patients who suffer from certain types of migraine/headache4 due, at least in part, to blockade by BoNT/A or its complex of the exocytosis of substance P and calcitonin gene-related peptide from sensory fibres567.…”