title: Cosmetic upper-facial rejuvenation with botulinum.
abstract: OBJECTIVE
  This study was conducted to evaluate the cosmetic use of botulinum toxin type A (Botox), which blocks the release of acetylcholine at the presynaptic neuromuscular junction leading to an irreversible, but temporary chemical denervation muscular paralysis and weakness. This produces a significant cosmetic improvement of wrinkling in the upper face due to hyperfunctional animation.
  
  
  METHODS
  A prospective clinical study representing our experience with this new technique is presented. Patient selection and evaluation, classification of animation lines, techniques, results and complications are discussed. In a 15-month period, 23 patients with seven anatomic sites were injected. Twenty-three patients had the lateral aspect and the inferior aspect of their squint lines injected, and 26 patients had their glabellar frownlines injected.
  
  
  RESULTS
  Significant improvement occurred to the average depth and length of the glabellar frownlines. The subjective improvement by the patients was also significant. Regarding the crow's feet, the lateral canthal lines showed more improvement than the inferior lateral canthal lines because the latter has a greater component of zygomaticus major and minor muscle, which contributes to the inferior lateral squint line.
  
  
  CONCLUSIONS
  Botox is a safe, easy-to-use, effective modality for the temporary elimination of hyperfunctioning upper-facial muscles.
authors.affiliation: Department of Otolaryngology, University of Toronto, Ontario.
authors.forename: D A
authors.initials: DA
authors.lastname: Ellis
authors.forename: A K
authors.initials: AK
authors.lastname: Tan
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D000075202:Contraindications; D016903:Drug Monitoring; D005149:Facial Expression; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D015361:Rhytidoplasty / Q000009:adverse effects / Q000379:methods*; D015595:Skin Aging / Q000187:drug effects* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A