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Aesthetic Botulinum A Toxin in the Mid and Lower Face and Neck

CARRUTHERS, JEAN, MD*; CARRUTHERS, ALASTAIR, MD

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BACKGROUND Botulinum toxin type A (Botox formulation) is used extensively for smoothing hyperkinetic lines in the upper face. The use of botulinum toxin for aesthetic indications in the mid and lower face and neck is now becoming increasingly popular.

OBJECTIVE To review our current approaches to botulinum toxin treatment for cosmetic indications in the mid and lower face and neck.

METHODS Procedures and outcomes are described for the primary and adjunctive use of botulinum toxin.

RESULTS Cosmetic treatment with botulinum toxin successfully changes the contour of the palebral aperture; smoothes lines, including “bunny” lines, perioral rhytides, and horizontal neck lines; softens creases, including the mental crease and melomental folds; and alleviates facial asymmetry and nasal flare. The doses of botulinum toxin used in the mid and lower face are generally lower than those used in the upper face. Caution must be used in injecting botulinum toxin in the perioral area to avoid an incompetent mouth.

CONCLUSION Botulinum toxin treatment is valuable for aesthetic improvements in the mid and lower face and neck. In some areas, particularly the perioral region, the use of botulinum toxin in combination with other therapeutic modalities provides optimal results.

*Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada

Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada

Address correspondence and reprint requests to: Jean Carruthers, MD, Department of Ophthalmology, University of British Columbia, 943 West Broadway, Suite 740, Vancouver, BC, Canada V5Z4E1, or e-mail: drjean@carruthers.net

THE CARRUTHERS ARE BOTH CONSULTANTS, STOCKHOLDERS, AND RESEARCHERS FOR ALLERGAN AND ELAN PHARMACEUTICALS.

© 2003 by the American Society for Dermatologic Surgery, Inc.
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