What it means for a patient
- Botulinum toxin type A treats lines caused by muscle movement in several areas of the face and neck.
- Doses and injection points differ by area and by patient factors such as gender.
- The panel stresses an aesthetic evaluation and treatment tailored to each patient.
- Neck bands (platysmal bands) are among the areas covered.
- This is an expert consensus statement. It does not report new trial data.
Why this paper matters
It set out expert guidelines for Botox Cosmetic beyond the glabellar lines, with starting doses and injection technique for each area. It covers patient selection and counseling along with technique.
Overview
Botulinum toxin type A for facial enhancement was the most common cosmetic procedure in the United States at the time. Clinical and study experience had shown it to be effective and safe in the short and long term. Expert consensus guidelines for areas other than the glabellar (frown) lines had not been published. A panel of experts on the aesthetic uses of Botox Cosmetic (Allergan) was convened to write them.
Findings
- General guidance covers aesthetic evaluation and individualized treatment.
- It also covers reconstitution and handling of the toxin, procedure, dosing and injection-site variables, and patient selection and counseling.
- Area-specific guidance covers glabellar lines, horizontal forehead lines, crow's feet and bunny lines (lines on the sides of the nose).
- It also covers the area around the mouth, the dimpled chin and platysmal bands in the neck.
- For each area: relevant anatomy, injection locations and technique, and starting doses (total and per injection point).
- For each area: the influence of other variables such as gender, and assessment and retreatment.
- Each area ends with key elements that can increase the chance of a successful outcome.
- Summary tables are provided throughout.
- The abstract does not list the doses.
Terms
- Botulinum toxin type A: a purified protein that temporarily relaxes muscles when injected.
- Glabellar lines: vertical frown lines between the eyebrows.
- Crow's feet: lines at the outer corners of the eyes.
- Bunny lines: lines that run down the sides of the nose when it wrinkles.
- Perioral: around the mouth.
- Platysmal bands: vertical cords in the neck formed by the platysma muscle.
- Reconstitution: mixing the freeze-dried toxin with saline before injection.
- Retreatment: a repeat injection when the effect wears off.
- Consensus statement: recommendations agreed by a panel of experts.