Dermatology
Botulinum Toxin
Built from Dermatology, 5th Edition
What’s inside
11 sections · 127 slides
How botulinum toxin works
What botulinum toxin is, how it blocks a nerve signal, and the serotypes and formulations available today.
- What botulinum toxin is
- How BoNT blocks a nerve signal
- Two families of SNARE-cutting toxins
- Sites of botulinum toxin action on the SNARE complex
- BoNT's other effects beyond muscle
- BoNT-A formulations available worldwide
- OnaA: formulation profile
- AboA: formulation profile
- DAXI: formulation profile
- IncoA: formulation profile
- PraboA: formulation profile
- RimaB: formulation profile
- BoNT-A (Prosigne): formulation profile
- BoNT-A (Neuronox): formulation profile
- onaA versus aboA: does spread differ?
- incoA: BoNT-A without extra proteins
- praboA and comparisons with rimaB
- onaA compared with rimaB for facial lines
- Topical BoNT-A: promise so far
- Topical BoNT-A for crow's feet, before and after
- A note on dosing in this chapter
Principles of cosmetic treatment
Why muscle-caused wrinkles respond to BoNT-A, and the basic injection technique used across the face.
- Why hyperkinetic lines form
- Who responds best to BoNT-A
- Basic injection technique
- The typical course of effect
Treating the upper face
Glabellar frown lines, crow's feet, horizontal forehead lines, brow shape, and the eyelid muscle.
- Anatomy of the frown: glabellar lines
- Glabellar injection sites and technique
- Reading the upper-face dosing table
- Use of onaA in the upper face: dosing and techniques.
- Glabellar treatment results
- Glabellar frown lines before and after BoNT-A
- Crow's feet: anatomy and goal
- Crow's feet injection technique
- Crow's feet before and after BoNT-A
- Crow's feet response three weeks after treatment
- Horizontal forehead lines: a balancing act
- Injection sites for horizontal forehead lines
- Forehead treatment goal and results
- Horizontal forehead lines before and after BoNT-A
- Brow lift and shaping
- The "jelly roll" under the eye
- Injection sites for a hypertrophic lower eyelid muscle
- Hypertrophic orbicularis oculi before and after treatment
Treating the midface
Bunny lines, nostril flare, the nasolabial fold, and a drooping nasal tip.
- Bunny lines and nostril flare
- Injection sites for bunny lines
- Reading the midface dosing table
- Use of onaA in the midface: dosing and techniques.
- The nasolabial fold: use with caution
- Nasal tip droop
Treating the lower face and neck
Perioral lines, facial asymmetry, mouth frown, the mental crease, the jaw muscle, and platysmal bands.
- Aging changes around the mouth
- Treating perioral lines
- Injection sites for perioral rhytides
- Reading the lower-face dosing table
- Use of onaA in the lower face and neck: dosing and techniques.
- Use of onaA in the lower face and neck: dosing and techniques. (continued)
- Perioral results and combination therapy
- Radial lip lines before and after BoNT-A
- Facial asymmetry: two opposite problems
- Hemifacial spasm versus Bell palsy
- Bell palsy before and after BoNT-A to the unaffected side
- Facial asymmetry after forehead osteoma surgery
- Other asymmetry scenarios
- Mouth frown: the down-turned smile
- Injection sites for mouth frown
- Mouth frown before and after BoNT-A
- Mouth frown treatment of the DAO muscle
- Mouth frown with combined DAO and mentalis treatment
- Cautions around the mouth
- Marionette lines
- The mental crease
- Mental crease before and after treatment
- The orange-peel chin
- Injection sites for the orange-peel chin
- Masseteric hypertrophy
- Masseteric hypertrophy before and after BoNT-A
- Platysmal bands: what they are
- Who is a good candidate for neck treatment
- Platysmal bands before and after BoNT-A
- Injection sites for platysmal bands
- A caution about the neck
- Injection sites for horizontal necklace lines
Adjunctive use with other procedures
Combining BoNT-A with surgery, lasers, light-based devices, and soft-tissue fillers for better results.
- BoNT-A before and during surgery
- Combining with lasers and light devices
- Combined intense pulsed light and BoNT-A treatment
- Combining with soft-tissue fillers
Medical uses beyond cosmetics
Hyperhidrosis, Raynaud phenomenon, migraine, and depression - how blocking nerve signals helps beyond the face.
- Where BoNT-A is used beyond wrinkles
- Underarm sweating: axillary hyperhidrosis
- Underarm technique and topical option
- Palmar hyperhidrosis: sweaty palms
- Palmar hyperhidrosis before and after BoNT-A
- Injection sites for palmar hyperhidrosis
- Hailey-Hailey disease
- Raynaud phenomenon: what happens
- How BoNT-A helps Raynaud phenomenon
- Raynaud phenomenon before and after BoNT-A injection
- Migraine prevention
- Injection sites for migraine prevention
- Migraine dosing and a caveat
- Depression: an emerging, unexpected link
Complications
Most complications come from toxin spreading beyond its target - and are largely preventable with careful technique.
- How complications happen
- Eyelid and brow complications
- Blepharoptosis after BoNT-A treatment
- Managing eyelid droop (ptosis)
- The "cockeyed" eyebrow
- The cockeyed eyebrow appearance
- Lower face and neck complications
- Antibody formation: a real but rare risk
- Rare allergic and serious reactions
Safety
Long-term trial data, FDA adverse-event review, and how dose level changes the risk.
- Long-term safety data
- What the FDA's adverse-event data showed
- Regulatory response
Future directions
Emerging evidence that BoNT-A may do more than relax muscle - it may change the skin itself.
- BoNT-A and skin quality
- Protecting skin from sun damage
- Oily skin and enlarged pores
Summary
Pulling together the cosmetic and medical roles of botulinum toxin, and its safety record.
- The cosmetic story, revisited
- The medical story, revisited
- Safety, in one sentence
- References
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- Dermatology, 5th Edition (2-Volume Set)