SAMCEP Society consensus on the treatment of upper facial lines with botulinum neurotoxin type A: A tailored approach

Abstract

BackgroundThe safety and efficacy of botulinum neurotoxin type A (BoNTA) treatments are well established, but injection techniques, target muscles, and toxin doses continue to evolve, with each refinement producing improvements in treatment outcomes. The recommendations in this consensus move away from standard templates and illustrate how to tailor treatments to individual patterns and strengths of muscle activity, and patient preferences.MethodsSeventeen experts in the fields of plastic surgery, dermatology, ophthalmology, otorhinolaryngology, and neurology convened in 2022 to develop consensus‐based recommendations for the use of botulinum toxin A for the treatment of horizontal forehead lines, glabellar frown lines, and crow's feet lines that reflect current clinical practice. The focus was on how to tailor injections to individual patients to optimize treatment outcomes.ResultsFor each upper face indication, consensus members describe how to perform a dynamic assessment to optimize the dose and injection technique for each patient. A tailored treatment protocol is presented for commonly observed patterns of dynamic lines. Units of Inco are defined and the precise location of injection points, illustrated with the use of anatomical images.ConclusionThis consensus provides up‐to‐date recommendations on the tailored treatment of upper facial lines based on the latest research and collective clinical experience of the expert injectors. Optimal outcomes require thorough patient evaluation, both at rest and during animation, using both visual and tactile cues; detailed understanding of facial muscular anatomy and how opposing muscles interact; and use of a BoNTA with high precision to target identified zones of excess muscle activity.

Treatment of Full Eyelid Ptosis Following Botox Injection: A Case Report

“…This includes injecting superficially the corrugator's lateral tail and brow area, especially the medial injection, due to the ease of leak and the proximity to the levator palpebrae superioris muscle. Moreover, injecting only three frown injections, excluding those in the lateral tail of the corrugator, will minimize the risk of eyelid ptosis [ 7 ]. Further, post-injection pressure application (i.e., gentle pressure on the glabella area post-injection) from bottom to top for about 30 seconds will minimize the diffusion of botulinum toxins inside the orbit.…”

“…The eyelid, like most moving structures in the body, has muscles that oppose each other. Eyelid retractors, the tarsal, and the levator palpebrae muscles are opposed by the palpebral part of orbicularis oculi, the protractors [ 13 - 14 ] Therefore, if the palpebral part of orbicularis oculi, anterior to the tarsal muscle, is injected, then we can lift a drooping eyelid by a millimeter or so [ 6 , 7 ]. Based on the fundamental knowledge of anatomy, muscle function, activity, and the mechanism of action of botulinum toxin type A, the authors of this article propose a protocol to treat eyelid ptosis.…”

Optimizing Botulinum Toxin A Administration for Forehead Wrinkles: Introducing the Lines and Dots (LADs) Technique and a Predictive Dosage Model

“…Moreover, such an approach might expose the patient to unnecessary pain and to excessive botulinum toxin A (BoNT-A) due to injections into the aponeurotic tissue rather than into the muscle belly [ 20 ]. Therefore, a one-size-fits-all approach falls short in addressing these individual variations [ 21 , 22 , 23 , 24 ].…”

Reporting Quality of Randomized Controlled Trial Abstracts on Aesthetic Use of Botulinum Toxin: How Much Do Abstracts Actually Tell Us?

“…The rising public awareness and acceptance of facial aesthetic enhancement have led to a growing demand for botulinum toxin treatments among individuals of all age groups, encompassing both women and men [12,13]. Over the years, botulinum toxin has become the most commonly performed aesthetic procedure, even in the group of patients aged 18 years or younger, overtaking rhinoplasty in previous years [14].…”