Update on botulinum toxin for facial aesthetics

Botulinum Neurotoxin: The Ugly Duckling

“…Numerous reliable, well-designed double-blind studies concerning the clinical application of botulinum toxins [75, 80, 93, 94] have confirmed beyond doubt that toxin administration under clinical supervision is fairly safe. The de facto confirmation of the safety of such interventions advocating wider, clinically supervised use of botulinum neurotoxins is reinforced by the existence of a strong theoretical background.…”

“…Nevertheless, even with such large doses, antibodies are raised only in 3–5% of the neurological cases, although sometimes proportions of 15–20% are reported. These antibodies do not aggravate the patient’s current state, but they render the next toxin injection ineffective [74, 75]. In cases of antibody-induced failure of botulinum toxin treatment, another can be substituted for the inactive type after careful calculations.…”

Non-surgical treatment modalities of facial photodamage: practical knowledge for the oral and maxillofacial professional

“…Once diluted, the mixture should be stored in a refrigerator at 2-8 8C and used within 4 h. It is recommended to inject 0.1 ml of the properly reconstituted toxin into 5 sites on the face (e.g., 2 in each corrugator muscle and 1 in the procerus muscle) for a total dose of 20 U. The diluent volume and the injected amount may vary depending on the physician's preference and depending on the desired outcome 6 . The interval between injections should be no less than 3 months, and the lowest effective dose of toxin should be used.…”

“…Use of preserved saline as diluent, topical anaesthetics and smallgauge needles may minimize these effects. Immediate application of ice and pressure can also be helpful 6 . The most frequently reported adverse events are headache and blepharoptosis.…”

Cosmetic use of botulinum toxin type A in the elderly

“…In contrast to other products used for cosmetic procedures, BTX-A is minimally invasive, relatively easy and quick to administer, has a relatively immediate and noticeable effect and a quick recovery period, and is often more affordable than other cosmetic treatments (Klein 2004). Alternative procedures involve the use of injectable fillers (eg, silicone, collagen), resurfacing techniques (eg, dermabrasion, chemical peels, laser resurfacing), and surgery, which may lead to serious and permanent adverse effects, eg, photosensitivity, scarring, surgical morbidity, and involve a long recovery period (Lemperle et al 2001; Cather et al 2002). …”