Tailored botulinum toxin type A injections in aesthetic medicine: consensus panel recommendations for treating the forehead based on individual facial anatomy and muscle tone

Abstract

BackgroundFacial lines and wrinkles are strongly influenced by individual differences in anatomy and muscle activity and no single injection protocol will suit all patients. However, there is only limited information in the published literature on how to develop a tailored approach to botulinum toxin treatment.MethodsAn expert panel of physicians was convened to establish a consensus on developing an individualized approach to treatment of the forehead with incobotulinumtoxinA. Separate treatment protocols were developed for men and women and subdivided by background level of muscle activity: kinetic, hyperkinetic, and hypertonic. Each muscle tone category was then further subdivided to take account of individual characteristics that can influence treatment.ResultsConsensus members describe how to perform a dynamic assessment to optimize the dose and injection technique for each patient. A tailored treatment protocol is described for men and women with a wide range of forehead presentations. For each presentation, units of toxin as well as the precise location of injection points were defined by creating a 12-zone map of the forehead.ConclusionThese recommendations depart from traditional consensus documents by providing detailed incobotulinumtoxinA injection protocols for the forehead based on the major parameters that differ between patients, including muscular anatomy, size, and tone. It is expected that the use of this document will lead to more satisfactory, natural, and individualized aesthetic outcomes for patients.

Association Between Secondary Botulinum Toxin A Treatment Failure in Cosmetic Indication and Anti-Complexing Protein Antibody Production

“…Botulinum toxins (BoTs) have been a principal tool for both clinical and aesthetic physicians. Cosmetic medicine leverages its ability to weaken hyperkinetic lines caused by muscular contractions [ 1 ]. BoTs are also used in facial sculpting and shaping, and to correct facial asymmetry [ 2 – 12 ].…”

Maximizing botulinum toxin injections for cosmetic and therapeutic applications with a single use, disposable, exact dose injection assist device

“…In sharp contrast, product waste was ~4% with the device for 1-unit doses. This is a specifically salient finding considering the current embrace of lower dose, multi-injection regimens to accommodate individualized treatment plans 3,4. The undesirable economic consequences of neurotoxin product waste have been documented previously with regard to the selection of syringe type,11 but this is the first study to quantify the amount of product waste associated with needle and injection site drips.…”

“…Alongside the steep growth trajectory in botulinum toxin utilization has been an evolving understanding of the need to tailor personalized treatment plans to accommodate differing facial anatomies, muscle tone, genders, ethnicities, and patient preferences 3–5. In recently published consensus recommendations for esthetic use, Sundaram et al6 described a “paradigm shift” away from the previous emphasis on facial paralysis toward achieving a more relaxed, natural appearance with the elimination of lines in repose while maintaining some movement and facial animation during emotive expression.…”

“…In recently published consensus recommendations for esthetic use, Sundaram et al6 described a “paradigm shift” away from the previous emphasis on facial paralysis toward achieving a more relaxed, natural appearance with the elimination of lines in repose while maintaining some movement and facial animation during emotive expression. It is now widely acknowledged that a one-size-fits-all approach to botulinum toxin administration produces less than optimal esthetic results 3…”

Consensus on the Use of Hyaluronic Acid Fillers from the Cohesive Polydensified Matrix Range: Best Practice in Specific Facial Indications

“…While botulinum toxin is effective at reducing glabellar and forehead lines, it will be less effective in foreheads that require volumetric augmentation and in subjects with visible wrinkles at rest. 7 …”