BOTULINUM TOXIN IN AESTHETIC MEDICINE PDF
PDF | Background: Several formulations of Botulinum toxin serotype A (BoNT-A) for aesthetic indications are available, with numbers likely to. Request PDF | On Jul 1, , B Sommer and others published Botulinum Toxin in Aesthetic Medicine. Botulinum Toxin in Aesthetic Medicine. Digitally watermarked, DRM-free; Included format: PDF; ebooks can be used on all reading devices; Immediate eBook.
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Botulinum Toxin in Aesthetic Medicine. Bearbeitet von. Mauricio de Maio, Berthold Rzany. 1st ed. Corr. 2nd printing Buch. xix, S. Hardcover. Sitemap. [PDF Free Download] Botulinum Toxin in Aesthetic Medicine Full Online - by Mauricio de Maio. Botulinum Toxin in Aesthetic Medicine. The use of botulinum toxin A (BoNT-A) in aesthetic medicine has increased markedly since the first applications in this setting during the mids. Current .
For each presentation, units of toxin as well as the precise location of injection points were defined by creating a zone map of the forehead.
Conclusion: These recommendations depart from traditional consensus documents by providing detailed incobotulinumtoxinA injection protocols for the forehead based on the major parameters that differ between patients, including muscular anatomy, size, and tone.
It is expected that the use of this document will lead to more satisfactory, natural, and individualized aesthetic outcomes for patients.
All share the same mode of action, with differences between products occurring because of proprietary manufacturing processes, purification methods, and inactive ingredients in the formulation. INCO is the only product free from complexing proteins or neurotoxin-associated proteins.
These play no role in the neuronal mode of action of the toxin complex and have no effect on product diffusion. A lack of complexing proteins also reduces the potential antigenicity of a product and thus the risk of developing secondary neutralizing antibodies.
For INCO only, European regulatory authorities reached a consensus in on approvability for the combined treatment of upper facial lines glabellar frown lines, lateral periorbital lines, and horizontal forehead lines.
Results from head-to-head clinical trials have demonstrated that INCO and ONA have similar efficacy and tolerability when used in a dose conversion ratio for the treatment of glabellar frown lines 3 , 4 and lateral periorbital lines. The most important goal of botulinum toxin treatment in aesthetic medicine is to achieve a balance between dynamic wrinkles caused by hyperactive muscles while maintaining natural facial animation.
This is influenced by a number of factors including individual anatomy, structure, action and mass of the muscles, and personal aesthetic preferences.
Tailored treatment taking into account all these factors is required for optimal results and consequently patient satisfaction with treatment and their physician. Why is this expert consensus required in aesthetics? Clinical data and consensus articles provide helpful guidance on aesthetic indications, but their consideration of individual patient differences is more limited.
The current document was put together to help physicians develop an individualized approach to botulinum toxin treatment of the forehead.
Consensus methodology Twelve experts in the fields of aesthetic medicine, dermatology, and plastic surgery convened four times between July and February in Madrid, Spain, to develop independent, consensus-based recommendations for the use of INCO for aesthetic indications in patients with varying degrees of muscular activity and wrinkle severity. During these meetings, the group developed a series of recommendations covering the clinical history and physical evaluation of the patient as well as a muscular map of each treatment area illustrating the points of injection.
The following text summarizes the recommendations for the treatment of the forehead.
Botulinum Toxin in Aesthetic Medicine
The content reflects the opinions of the authors only. The recommendations of the group for the treatment of other facial muscles will be published in a separate paper. Consensus recommendations Patient evaluation and classification A number of patient characteristics and anatomical features help define their suitability for botulinum toxin injection.
The positions, strength, and insertion points of the facial muscles can be determined by inspecting them at rest, by observing their movements while the patient makes varying facial expressions, and by palpating them.
Signs for areas of stronger contraction include greater dynamic movement, deeper lines, and larger apparent mass during use.
Consensus members classified patients into three groups based on their facial muscle contractions and line severity prior to treatment: kinetic, hyperkinetic, and hypertonic. Hyperkinetic patients have more excessive muscle contraction and may require more frequent treatment and higher doses to achieve the desired effect. Finally, hypertonic patients are those with an inability to relax specific muscles and with visible wrinkles at rest.
They may still be candidates for treatment, but should be advised that while botulinum toxin treatment may result in some improvements, the wrinkles will not completely disappear and additional use of an injectable dermal filler may be necessary.
Deep static lines due to loss of skin elasticity are not suitable for botulinum toxin injection. The aim of treatment is to eliminate lines when the patient is at rest, but to leave the ability for some movement and minimal wrinkling when the patient is animated or actively expressing emotion. Contraction of the frontalis raises the eyebrows and the upper eyelid, wrinkling the forehead in the process.
The simultaneous treatment of all upper facial lines is an approved indication for INCO and is effective and commonly performed in aesthetic practice. Before beginning the treatment, the physician should evaluate the patient for expressivity, muscle mass, symmetry, lateral versus medial movement, compensation for brow ptosis, and brow width and height.
The intensity of contractions along the height of the frontalis can differ substantially from individual to individual, and variations in muscle function should be taken into account when deciding on the dose of botulium toxin and where the injections will be placed. This can be detected by light palpation over the area while the patient actively raises and lowers the eyebrows. Treatment of the frontalis muscles can not only reduce horizontal forehead lines but can also affect eyebrow shape and height.
Brow shape is influenced by the complex interplay between the frontalis and the lateral lateral orbicularis oculi and medial procerus, corrugator supercilii, medial orbicularis oculi brow depressors, and the use of botulinum toxin treatments to shape the brow is not considered in this document.
Botulinum Toxin in Aesthetic Medicine
To precisely define the location of injection points for individual patients, the consensus group divided the forehead into 12 zones positioned 1.
Injection points and units vary between men and women due to differences in anatomy and patient preferences, and they were considered separately when designing a treatment protocol for the forehead.
Eyebrows are naturally positioned lower in men, and excessive relaxation of the lower frontalis can result in brow ptosis. Men and women were then subdivided by muscle tone prior to treatment kinetic, hyperkinetic, and hypertonic. Each muscle tone category was further subdivided to take account of individual characteristics that can influence treatment.
In this manner, a tailored treatment protocol was developed for women Table 1 and men Table 2 with a wide range of forehead presentations. If required, a second line of injections can be placed above the first with the addition of two injection points at F2 and F3, and subcutaneous injection of 1 U of botulinum toxin at each point. Tendency to develop Mephisto sign The so-called Mephisto sign occurs in some patients when lateral movement of the frontalis remains after treatment and produces visible wrinkles.
It is more common when treatment of the forehead is restricted to the area between the midpupillary lines.
Botulinum Toxin in Aesthetic Medicine
Women with strong lateral frontalis fibers should receive 1 U intramuscularly at F6 and F7 and 1 U subcutaneously at points F9 and F Palpebral weakness Upper eyelid ptosis may occur when treatment of the frontalis muscle unmasks subtle pre-existing weakness of the levator palpebrae superioris muscle.
Botulinum toxin product labels recommend evaluation of the upper eyelid, especially in patients with a history of glabellar trauma or surgery, for the presence of levator palpebra muscle separation or weakness.
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The relationship of NAb formation to clinical response is not clear: some patients express NAbs without being nonresponsive. If required, a second line of injections can be placed above the first with the addition of two injection points at F2 and F3, and subcutaneous injection of 1 U of botulinum toxin at each point.
The relationship of NAb formation to clinical response is not clear: Be alert to the perioral vasculature, including branches of the upper labial artery. Deep static lines due to loss of skin elasticity are not suitable for botulinum toxin injection.
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