Italian consensus report on the aesthetic use of onabotulinum toxin A

Abstract

The use of onabotulinum toxin A in the aesthetic field requires careful initial assessment of the patient in its complexity and individuality. Moreover, this treatment needs the use of standardized procedures to achieve the effectiveness and safety of onabotulinum toxin A in clinical practice.

Full‐face treatment with onabotulinumtoxinA: Results from a single‐center study

“…Hence, it appears that the use of BoNTA across several areas of the face and neck in the same session is safe, as long as recommended doses are not substantially exceeded within each treatment area. The doses used in specific areas of the face and neck in the present work were largely in line with international recommendations, as well as a recent Italian consensus . The “microbotox” technique—in which multiple microdroplets of diluted onabotulinumtoxinA are injected into the dermis or the interface between the dermis and the superficial muscle layer—can also be applied across the whole face.…”

“…Examples of the success of these treatments are shown in Figures . Furthermore, local and international consensus recommendations now place increasing focus on these areas . A recent analysis of 161 patients treated in the lower face with BoNTA—based on two intramuscular injections into the mentalis and two horizontal lines of superficial injections above and below the mandible—demonstrated improved lower facial contouring, as well as relaxation of horizontal lines below the lateral mandibular border and vertical smile lines lateral to the oral commissures and melomental folds .…”

“…The doses used in specific areas of the face and neck in the present work were largely in line with international recommendations, 25 as well as a recent Italian consensus. 13 The "microbotox" technique 26 -in which multiple microdroplets of diluted onabotulinumtoxinA are injected into the dermis or the interface between the dermis and the superficial muscle layer-can also be applied across the whole face.…”

“…Although the currently approved indications in the European Union relate to moderate‐to‐severe glabellar, crow's feet, and forehead lines, off‐label use in clinical practice often extends well beyond these areas. For example, a recent Italian consensus provided recommendations on the use of onabotulinumtoxinA for glabellar lines, crow's feet lines, forehead lines, brow lifting/shaping, hypertrophy of the lower eyelid orbicularis oculi, bunny lines, sagging nasal tip, gummy smile, hypertrophy of the masseter muscle, perioral lines, marionette lines, mentalis muscle hypertonia, and hypertonic platysma bands …”

“…For example, a recent Italian consensus provided recommendations on the use of onabotulinumtoxinA for glabellar lines, crow's feet lines, forehead lines, brow lifting/shaping, hypertrophy of the lower eyelid orbicularis oculi, bunny lines, sagging nasal tip, gummy smile, hypertrophy of the masseter muscle, perioral lines, marionette lines, mentalis muscle hypertonia, and hypertonic platysma bands. 13 This wide range of viable treatment areas creates the possibility of "full-face" treatment with onabotulinumtoxinA. To obtain an anti-aging effect on the face and neck using BoNTA, based on a full-face approach, it is essential to evaluate the direct and indirect effects of all the muscles involved in creating the visible effects at surface level.…”