title: Aesthetic botulinum A toxin in the mid and lower face and neck.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Ophthalmology, University of British Columbia, Vancouver, Canada. drjean@carruthers.net
authors.forename: Jean
authors.initials: J
authors.lastname: Carruthers
authors.forename: Alastair
authors.initials: A
authors.lastname: Carruthers
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000494:pharmacology; D005145:Face; D005146:Facial Asymmetry / Q000188:drug therapy; D006801:Humans; D009122:Muscle Hypertonia / Q000188:drug therapy; D009333:Neck; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D015595:Skin Aging / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A