Global Aesthetics Consensus

Abstract

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.CLINCAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, V.

Use of Botulinum Toxin in Orofacial Clinical Practice

“…It combats spasms, synkinesis and the hyperactivity of skin muscles responsible for facial expressions. Although often used, no unified treatment protocol has been established [17].…”

Polymeric injectable fillers for cosmetology: Current status, future trends, and regulatory perspectives

“…Both material design and injection technique are critical to achieve desirable clinical efficacy . For correction of fine lines and wrinkles, small size particles or soft fillers are typically injected to superficial zone of skin.…”

Noninvasive Facial Rejuvenation. Part 2: Physician-Directed—Neuromodulators and Fillers

“…The dosage of BONT depends on numerous factors, including injection site, patient sex, previous effective dosage, and clinician preference. ►Table 1 provides dosages for each functional anatomical unit based on the consensus guidelines of Sundaram et al 13 Our recommended Botox injection procedures to the upper face in women and men, respectively, are illustrated in ►Figs. 1 and 2.…”

“…This may be due to patients' preference for a more natural appearance or it may be due to increased physician experience. 13 In addition, evidence suggests that the overall dosage per patient over time is consistent. Carruthers et al found that over a 5 year or more time period, the dosage of Botox remained approximately equal, while the interinjection time period increased.…”