Botulinum toxin type A (BoNTA) is now used extensively for rejuvenation of the forehead, glabellar and periocular regions and there is increasing focus on treatment of the lower face. Although there is well-documented evidence for the efficacy of botulinum toxin in the correction of platysmal bands, little work has been done to explore its potential role in rejuvenation of the jawline. To date, effects in this area have been reported as a consequence of platysmal banding treatment and are inconsistent. Hesitancy to explore treatment may be due to evidence of a greater, more durable response to the toxin in the lower facial muscles as well as reports of increased potential migration and subsequent side effects. This paper describes a new technique using BoNTA (Vistabel); Allergan, Irvine, CA, USA) to drape the skin of the jawline contour and provide the visual effect of a 'mini lift'. Experience with 130 patients with doses of BoNTA up to 20 U is described. Patient satisfaction is extremely high and the specificity of dosing and technique has led to a low incidence of adverse effects. The 'Nefertiti lift' is a minimally invasive, effective and acceptable alternative for those patients seeking an effective way to push back surgery.

In 1981 Skinner et al (1) proposed the term KID syndrome for a previously disparate group of congenital disorders principally made up of keratitis (K), ichthyosis (I), and deafness (D). The coexistence of congenital deafness associated with ichthyosis had been previously recognized (2,3), yet similarities among affected patients were overlooked because of both the paucity of cases and their seeming diversity. The patient reported by Skinner is similar to one whom we have been following at the Clinique Universitaire de Dermatologie in Geneva since 1978. After having reviewed the literature, we believe that KID syndrome is a useful, unifying clinical term.

The smooth, cohesive HA gel with preincorporated lidocaine increased subject comfort during treatment and improved the injection experience.

This split-face, single-blind study compared the comfort and ease of injection of a new hyaluronic acid facial filler containing pre-incorporated lidocaine (Juvederm ULTRA 3) versus the established hyaluronic acid facial filler Restylane-Perlane. A total of 126 individuals were treated with both products, randomly assigned to the right or left naso-labial fold. Injector assessment-indicated mean injection pain, pain of massaging the injected area and post-injection discomfort (based on a scale of 0=no pain to 10=extreme pain) were 2.1, 0.9 and 0.4 for Juvederm ULTRA 3, and 4.1, 3.3 and 1.7 for Restylane-Perlane, respectively (p<0.0001). Patient assessment of the same parameters were 2.8, 1.3 and 0.4 for Juvederm ULTRA 3, and 4.9, 3.6 and 1.8 for Restylane-Perlane (p<0.0001). Injectors indicated that 92% of Juvederm ULTRA 3 injections were 'very easy', compared with 21% for Restylane-Perlane. Post-treatment smoothness was comparable, but 95% of individuals preferred Juvederm ULTRA 3 for overall injection comfort. A total of 95% of individuals indicated that Juvederm ULTRA 3 was a more comfortable and gentle experience.

The addition of 0.3% lidocaine does not affect product longevity and the small volume required for 'touch-up' also suggests that longevity is maintained.