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Consensus Recommendations on the Use of Botulinum Toxin Type A in Facial Aesthetics

Carruthers, Jean M.D.; Fagien, Steven M.D.; Matarasso, Seth L. M.D. theBotox Consensus Group

Plastic and Reconstructive Surgery: November 2004 - Volume 114 - Issue 6 - p 1S-22S
doi: 10.1097/01.PRS.0000144795.76040.D3
Consensus Statement

The use of botulinum toxin type A for facial enhancement is the most common cosmetic procedure currently undertaken in the United States. Overall clinical and study experience with botulinum toxin type A treatment for facial enhancement has confirmed that it is effective and safe in both the short and long term. Nevertheless, consistent guidelines representing the consensus of experts for aesthetic treatments of areas other than glabellar lines have not been published. Therefore, a panel of experts on the aesthetic uses of Botox Cosmetic (botulinum toxin type A; Allergan, Inc., Irvine, Calif.) was convened to develop consensus guidelines. This publication comprises the recommendations of this panel and provides guidelines on general issues, such as the importance of the aesthetic evaluation and individualization of treatment, reconstitution and handling of the botulinum toxin type A, procedural considerations, dosing and injection-site variables, and patient selection and counseling. In addition, specific considerations and recommendations are provided by treatment area, including glabellar lines, horizontal forehead lines, “crow’s feet,” “bunny lines” (downward radiating lines on the sides of nose), the perioral area, the dimpled chin, and platysmal bands. The review of each area encompasses the relevant anatomy, specifics on injection locations and techniques, starting doses (total and per injection point), the influence of other variables, such as gender, and assessment and retreatment issues. Factors unique to each area are presented, and the discussion of each treatment area concludes with a review of key elements that can increase the likelihood of a successful outcome. Summary tables are provided throughout.

Vancouver, Canada; Boca Raton, Fla.; and San Francisco, Calif.

From the Department of Ophthalmology, University of British Columbia; private practice; and the Department of Dermatology, University of California School of Medicine, San Francisco.

Received for publication July 19, 2004; revised August 20, 2004.

Drs. Carruthers, Fagien, and Matarasso are executive editors of this supplement.

This statement is sponsored by an unrestricted educational grant from Allergan, Inc., Irvine, Calif.

The members of the Botox Consensus Group are listed in the Appendix at the end of this article.

Off-Label Statement: It should be noted that the results reported in this article refer to the Allergan formulation of botulinum toxin type A (Botox, Botox Cosmetic, Vistabel) and cannot be generalized to other formulations or serotypes of botulinum toxin. Botulinum toxin type A is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adult patients less than or equal to 65 years of age. All other uses are considered off-label. The full prescribing information should be viewed prior to using any products discussed here.

Seth L. Matarasso, M.D., Department of Dermatology, University of California School of Medicine, San Francisco, California, 490 Post, No. 700, San Francisco, Calif. 94102,

©2004American Society of Plastic Surgeons