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The Convergence of Medicine and Neurotoxins: A Focus on Botulinum Toxin Type A and Its Application in Aesthetic Medicine—A Global, Evidence-Based Botulinum Toxin Consensus Education Initiative

Part II: Incorporating Botulinum Toxin into Aesthetic Clinical Practice

Carruthers, Jean MD, FRCSC, FRC(Ophth)1; Fournier, Nathalie MD2; Kerscher, Martina MD3; Ruiz-Avila, Javier MD4; Trindade de Almeida, Ada R. MD5; Kaeuper, Gina MAcc6

doi: 10.1111/dsu.12148

Background The new world of safe aesthetic injectables has become increasingly popular with patients. Not only is there less risk than with surgery, but there is also significantly less downtime to interfere with patients' normal work and social schedules. Botulinum toxin (BoNT) type A (BoNTA) is an indispensable tool used in aesthetic medicine, and its broad appeal has made it a hallmark of modern culture. The key to using BoNTA to its best effect is to understand patient-specific factors that will determine the treatment plan and the physician's ability to personalize injection strategies.

Objectives To present international expert viewpoints and consensus on some of the contemporary best practices in aesthetic BoNTA, so that beginner and advanced injectors may find pearls that provide practical benefits.

Methods and Materials Expert aesthetic physicians convened to discuss their approaches to treatment with BoNT. The discussions and consensus from this meeting were used to provide an up-to-date review of treatment strategies to improve patient results. Information is presented on patient management and assessment, documentation and consent, aesthetic scales, injection strategies, dilution, dosing, and adverse events.

conclusion A range of product- and patient-specific factors influence the treatment plan. Truly optimized outcomes are possible only when the treating physician has the requisite knowledge, experience, and vision to use BoNTA as part of a unique solution for each patient's specific needs.

1University of British Columbia, Vancouver, British Columbia, Canada

2Centre Laser Dermatologie and Phlébologie, La Croisée, Clapiers, France

3Division of Cosmetic Sciences, University of Hamburg, Hamburg, Germany

4Cosmetic Dermatology, Trichology and Hair Disorders Specialist, Dermedica Clinic, México City, Mexico

5Clínica Dermatológica do Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil

6Freelance Writer, Knoxville, Tennessee,

Address correspondence and reprint requests to: Jon Kaeuper, Fortis Spectrum, 5150 Palm Valley Road, Suite 200, Ponte Vedra Beach, FL 32082, email:

This activity is supported by an educational grant from Merz. Jean Carruthers is a consultant for Merz and Allergan. Nathalie Fournier has ownership interest in EKKYO. Martina Kerscher is a consultant and contracted researcher for Merz, Loreal, Galderma, Q-Med, Proctor and Gamble, Anteis, and Kythera Biopharmaceuticals. Ada Regina Trinadade de Almeida is a consultant for Allergan.

© 2013 by the American Society for Dermatologic Surgery, Inc.
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