International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit) – part II: wrinkles on the middle and lower face, neck and chest
Abstract:These recommendations provide a guideline for physicians who wish to perform safe and efficacious treatment with BoNT-A (Speywood Unit) on the less commonly treated middle and lower face, neck and chest region.
“…If the zygomaticus major has reduced lifting power due to a lack of underlying structural support, the relative role of the risorius muscle increases and produces a more horizontal smile. If zygomaticus major lifting capacity is further diminished, the depressor anguli oris (DAO) muscle predominates, and a “DAO smile,” with the corners of the mouth downturned, is observed [11, 26]. The lack of underlying structure leading to DAO smile may result from changes over time in aging, or it may occur in youth due to structural deficiency.…”
Section: Understanding Muscle Movement In the Facementioning
confidence: 99%
“…At the same time, any mechanical advantage of the lever effect over the lateral SOOF is reduced as SOOF volume is depleted. Consequently, the zygomaticus major can no longer adequately counterbalance the downward gravitational pull and the contracting force of the DAO [11, 26]. Fig.…”
Section: Addressing Muscle Movement With Injectable Fillersmentioning
Consideration of facial muscle dynamics is underappreciated among clinicians who provide injectable filler treatment. Injectable fillers are customarily used to fill static wrinkles, folds, and localized areas of volume loss, whereas neuromodulators are used to address excessive muscle movement. However, a more comprehensive understanding of the role of muscle function in facial appearance, taking into account biomechanical concepts such as the balance of activity among synergistic and antagonistic muscle groups, is critical to restoring facial appearance to that of a typical youthful individual with facial esthetic treatments. Failure to fully understand the effects of loss of support (due to aging or congenital structural deficiency) on muscle stability and interaction can result in inadequate or inappropriate treatment, producing an unnatural appearance. This article outlines these concepts to provide an innovative framework for an understanding of the role of muscle movement on facial appearance and presents cases that illustrate how modulation of muscle movement with injectable fillers can address structural deficiencies, rebalance abnormal muscle activity, and restore facial appearance.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
“…If the zygomaticus major has reduced lifting power due to a lack of underlying structural support, the relative role of the risorius muscle increases and produces a more horizontal smile. If zygomaticus major lifting capacity is further diminished, the depressor anguli oris (DAO) muscle predominates, and a “DAO smile,” with the corners of the mouth downturned, is observed [11, 26]. The lack of underlying structure leading to DAO smile may result from changes over time in aging, or it may occur in youth due to structural deficiency.…”
Section: Understanding Muscle Movement In the Facementioning
confidence: 99%
“…At the same time, any mechanical advantage of the lever effect over the lateral SOOF is reduced as SOOF volume is depleted. Consequently, the zygomaticus major can no longer adequately counterbalance the downward gravitational pull and the contracting force of the DAO [11, 26]. Fig.…”
Section: Addressing Muscle Movement With Injectable Fillersmentioning
Consideration of facial muscle dynamics is underappreciated among clinicians who provide injectable filler treatment. Injectable fillers are customarily used to fill static wrinkles, folds, and localized areas of volume loss, whereas neuromodulators are used to address excessive muscle movement. However, a more comprehensive understanding of the role of muscle function in facial appearance, taking into account biomechanical concepts such as the balance of activity among synergistic and antagonistic muscle groups, is critical to restoring facial appearance to that of a typical youthful individual with facial esthetic treatments. Failure to fully understand the effects of loss of support (due to aging or congenital structural deficiency) on muscle stability and interaction can result in inadequate or inappropriate treatment, producing an unnatural appearance. This article outlines these concepts to provide an innovative framework for an understanding of the role of muscle movement on facial appearance and presents cases that illustrate how modulation of muscle movement with injectable fillers can address structural deficiencies, rebalance abnormal muscle activity, and restore facial appearance.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
“…Type A toxin is also the serotype most commonly used in the pharmaceutical industry (16) to treat a wide variety of neuronal disorders (27). In addition, type A toxin is used as a cosmetic treatment to smooth wrinkles by paralyzing facial muscles (2,3) . Within serotype A, five different subtypes have been identified (A1, A2, A3, A4, and A5) (7,9,14).…”
Botulinum neurotoxins (BoNTs) produced by Clostridium botulinum are of considerable importance due to their being the cause of human and animal botulism, their potential as bioterrorism agents, and their utility as important pharmaceuticals. Type A is prominent due to its high toxicity and long duration of action. Five subtypes of type A BoNT are currently recognized; BoNT/A1, -/A2, and -/A5 have been purified, and their properties have been studied. BoNT/A3 is intriguing because it is not effectively neutralized by polyclonal anti-BoNT/A1 antibodies, and thus, it may potentially replace BoNT/A1 for patients who have become refractive to treatment with BoNT/A1 due to antibody formation or other modes of resistance. Purification of BoNT/A3 has been challenging because of its low levels of production in culture and the need for innovative purification procedures. In this study, modified Mueller-Miller medium was used in place of traditional toxin production medium (TPM) to culture C. botulinum A3 (CDC strain) and boost toxin production. BoNT/A3 titers were at least 10-fold higher than those produced in TPM. A purification method was developed to obtain greater than 95% pure BoNT/A3. The specific toxicity of BoNT/A3 as determined by mouse bioassay was 5.8 ؋ 10 7 50% lethal doses (LD 50 )/mg. Neutralization of BoNT/A3 toxicity by a polyclonal anti-BoNT/A1 antibody was approximately 10-fold less than the neutralization of BoNT/A1 toxicity. In addition, differences in symptoms were observed between mice that were injected with BoNT/A3 and those that were injected with BoNT/A1. These results indicate that BoNT/A3 has novel biochemical and pharmacological properties compared to those of other subtype A toxins.
“…4) 12 ; pero también se pueden contraer las fibras de la porción inferior del orbicular de los ojos, las fibras del frontalis justo encima de las cejas o al nivel de la línea de implantación del pelo, etc. Estas arrugas deben ser tratadas con toxina botulínica para su corrección.…”
Section: No Inyectar Las Arrugas Producidas Por La Toxinaunclassified
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