Upper- and mid-face anti-aging treatment and prevention using onabotulinumtoxin A: the 2010 multidisciplinary French consensus - part 1

Abstract

Years of experience using onabotulinum result in sophisticated treatment approaches, more specific targeted injections, and a better understanding of facial aging, leading to satisfying therapeutic results for both patients and clinicians.

Evolution of Facial Aesthetic Treatment Over Five or More Years

“…In addition, physicians may have refined their dose and injection technique over time because of an understanding of the effects of treatment on different facial muscles. 13,14 Alternatively, the decline in dose may reflect reduced tolerance of flattened or lowered eyebrows with time.…”

“…This pattern coincides with the appearance of studies of CFL and FHL treatment in the literature [15][16][17][18] and reflects the increasing expertise in total face assessment and an understanding of facial anatomy as it relates to different techniques. 13,14 The adoption of other treatment modalities (i.e., injectable fillers followed by prescription topical creams and procedures with energy-based devices) also reflects the appearance of physician experience in the literature and, ultimately, of approvals for the various products or devices. Specifically, the first hyaluronic acid dermal fillers were approved in Europe and Canada in 1996, Australia in 1997, and the United States in 2003 19 ; tretinoin products were approved for facial wrinkles in the late 1990s; and energy-based devices for facial aesthetic purposes were approved in the early 2000s.…”

IncobotulinumtoxinA in aesthetics: Russian multidisciplinary expert consensus recommendations

“…Before reaching consensus on the use of incobotulinumtoxinA in facial aesthetics, the expert group reviewed and analyzed the existing literature and previous consensus recommendations (eg, two global consensuses, German guidelines and a French consensus)16,22–25,30,31 and discussed the extensive practical experience among the panel in the use of incobotulinumtoxinA in aesthetics. A list of relevant literature for the experts to review was compiled through searching PubMed (National Center for Biotechnology Information, Bethesda, MD, USA).…”

Newer Understanding of Specific Anatomic Targets in the Aging Face as Applied to Injectables

“…The injection of toxin should affect a diminished muscular contraction of the desired muscle, while not negatively decreasing adjacent muscle contraction. 3,6,12 The relative contraction of the brow elevator (frontalis muscle) and the brow depressors (corrugators, procerus, and orbicularis oculi muscle) affects the position and shape of the eyebrow. The purpose of frontalis muscle injection is usually to diminish transverse forehead rhytids.…”

“…1 Treatment with botulinum toxin can lessen the contraction of hyperdynamic periorbital muscles, improve the eyelid aperture and brow position, and decrease periorbital rhytids. 2,3 The position and orientation of the eyebrow is related to the relative strength and contraction of the brow depressors versus the brow elevators. The main elevators of the eyebrow are the paired frontalis muscles.…”