Certain asymmetries can also be tackled with the use of BT by utilizing the action of antagonist muscle groups. This is exemplified by treating the elevators causing a stronger pull of the depressors and vice versa. īT is also used to create a balance in a particular anatomical area among the group of antagonist muscles by an indirect action. The face can look less angry after treatment of the glabellar frown lines or less worrisome after the treatment of the forehead horizontal lines. Targeting them can also lead to a change in the emotional attributes of the face. The upper face muscles are muscles of expression. Retraction and depression of lower lip tenses skin of anterior neck Platysmal bands, horizontal neck lines (“Venus rings”), Crepey neck, turkey neck Slimming the lower face and defining the jawline Perioral lines (“Lipstick lines” “Smoker’s lines”)ĭimpled chin (“Popply/Pebbled chin”), softening the mental crease Lip elevator complex (LLSAN, LLS, and LAO) Upper lip elevation, brow depression Wrinkles skin of dorsum of nose Procerus, corrugator supercilii, depressor supercilii, lateral fibers of orbicularis oculi Lateral lines (Crow’s feet), lower eye wrinkles, opening of palpebral aperture Horizontal forehead lines (“worry lines”) The target muscles and their mechanisms of action are also mentioned. The various indications for which BT type A can be used are enumerated in Table 1. Static rhytides can only soften with the treatment. Younger patients with good skin elasticity benefit more. īT injections are appropriate for those patients who have cosmetic concerns related to hyperactivity of muscles or groups of them. The FDA approval for abobotulinum A and incobotulinum A is limited to the treatment of glabellar lines only. The US FDA approved indications of onabotulinum type A are moderate-to-severe glabellar frown lines associated with procerus and/or corrugator muscle overactivity, moderate-to-severe lateral canthal lines associated with orbicularis muscle overactivity, and moderate-to-severe horizontal forehead lines associated with frontalis overactivity. The increasing awareness of minimally invasive procedures as anti-aging tools is leading to increased BT treatments being performed due to its effectiveness, minimal side effects, and minimal downtime. The cosmetic indications are treated with BT type A and the subtypes mostly used are onabotulinum, abobotulinum, and incobotulinum.Ī smooth, wrinkle-free face is synonymous with youthfulness.

It is also used to soften skin lines, to contour and lift the face. It is the most requested for minimally invasive cosmetic procedure worldwide.īT is mainly used as a cosmetic procedure for smoothening or softening dynamic wrinkles on the face. The recent published statistics report by the American Society of Plastic Surgery reported over 7.4 million BT type A treatments in 2019. This article aims to review and present the different cosmetic indications and injection techniques of BT on the face that has been reported in literature so far.

The understanding of the usage of BT has evolved a lot, from its different types to newer indications, techniques employed for injection to variations in dosages to side effects. Some of these are US Food and Drug Administration (FDA) approved, while others are considered off-label. With its discovery as a substance that can be used to treat dynamic glabellar frown lines in 1992, botulinum toxin (BT) is now increasingly being used for treating dynamic rhytides elsewhere on the face, contouring the face and even lifting it. The authors present an overview of the various cosmetic indications of BT for the face and neck along with the approach to injection techniques for various muscle groups involved. These indications and techniques have evolved with a better understanding of the face and neck musculature and their interactions and actions as well as efficacy of the BT formulations. Ever since then, BT has proved to be effective and safe for the treatment of dynamic facial rhytides and is currently being used for various indications. This changed the global scene of facial rejuvenation, heralding a new era. In 2002, the US Food and Drug Administration approved the use of BT type A for the treatment of glabellar furrows. By the late 1980s through the 1990s, BT was used rampantly as an off-label indication to treat glabellar frown lines. Jean Carruthers while treating one such patient noticed an improvement in the glabellar furrows with an effect on the brow of the patient as well. Alan Scott in the late 1970s after which, it was regularly being used for the cosmetic correction of benign essential blepharospasm by the Carruthers couple. It was initially used for the treatment of strabismus by Dr. Botulinum toxin (BT) is a proteinaceous substance that is derived from the bacterium Clostridium botulinum.

Muscle injection