ONE21 technique for an individualized assessment and treatment of upper face wrinkles in five pairs of identical twins with IncobotulinumtoxinA

Abstract

Background Facial aging is a complex process, which, beyond a genetic predisposition, involves both physical and environmental factors. Even identical twins with the same genetic load may differ substantially in facial wrinkles and aging, demanding a personalized treatment approach. Objective To demonstrate the ONE21 technique as an excellent tool to a customized assessment and IncobotulinuntoxinA treatment to address phenotype discordances and epigenetic drifts in identical twins, expressed by different patterns of upper face muscle contractions and wrinkles intensity. Patients/Methods Five pairs of identical Caucasian twin sisters, from 30 to 45 years of age, were evaluated for hyperfunctional upper facial wrinkles (forehead, glabella, and periorbital), assessing the individual anatomy, muscle function and habitual facial movements of each patient. All the subjects were treated with the ONE21 technique using IncobotulinumtoxinA and reevaluated 30 days after the procedure. Results Though the clinical‐anatomical pattern of the forehead contraction was similar between the pairs, the strength of the muscles, the number and depth of wrinkles differed. This varied presentation demanded distinct points of distribution and dosages of incobotulinumtoxinA for all the twins, according to the ONE21 approach. The results 30 days after treatment were satisfactory in all the subjects. Conclusion The ONE21 technique allows an objective and careful evaluation of the wrinkles of the upper face, based on an individualized assessment, which may vary even in identical twins.

The Anatomical Layering Assessment: The Construction of Beauty

“…The ONE21 technique is a customizable injection protocol that allows for individualized assessment and treatment of the upper third of the face with neurotoxin ( Figure 4D ). 30 The protocol can be customized according to the aesthetic demands of each patient and their anatomical particularities. 31 …”

“…The ONE21 technique is a customizable injection protocol that allows for individualized assessment and treatment of the upper third of the face with neurotoxin (Figure 4D). 30 The protocol can be customized according to the aesthetic demands of each patient and their anatomical particularities. 31 When used to correct the imbalance between the activity of the elevators and depressor muscles of the face, INCO is injected into the mentalis, DAO and in the facial platysma (the depressors), pending the muscle balance in favor of the elevator facial muscles and thus, resulting in a chemical facial lifting.…”

Optimizing Botulinum Toxin A Administration for Forehead Wrinkles: Introducing the Lines and Dots (LADs) Technique and a Predictive Dosage Model

“…Moreover, such an approach might expose the patient to unnecessary pain and to excessive botulinum toxin A (BoNT-A) due to injections into the aponeurotic tissue rather than into the muscle belly [ 20 ]. Therefore, a one-size-fits-all approach falls short in addressing these individual variations [ 21 , 22 , 23 , 24 ].…”

IncobotulinumtoxinA for the Treatment of Glabella and Forehead Dynamic Lines: A Real-Life Longitudinal Case Series

“…Nevertheless, the variation of muscles used in the contraction of the face, as well as their intensity, can demand an individualized regimen of treatment to maximize the results. 7–9 …”

“…Nevertheless, the variation of muscles used in the contraction of the face, as well as their intensity, can demand an individualized regimen of treatment to maximize the results. [7][8][9] Despite the expert recommendations, in clinical practice, the protocols of aesthetic use of botulinum toxin (eg, dosages and points of injection) vary highly between countries, the assessment of injectors, and the patient's demands. [10][11][12] Actually, pragmatic and real-life studies offer the best evidence of the effectiveness of a treatment, measuring the extent to which an intervention does what is intended in routine circumstances.…”