Aesthetic botulinum A toxin in the mid and lower face and neck.
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.
Carruthers
Jean
J
Department of Ophthalmology, University of British Columbia, Vancouver, Canada. drjean@carruthers.net
Carruthers
Alastair
A
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
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A