15 Neuromodulators and Injection Technique
Book
Editors: Bae, Yoon-Soo Cindy; Ciocon, David H.
Title: Procedural Dermatology: Postresidency and Fellowship Compendium, Volume 2
Print ISBN: 9783132424074; Online ISBN: 9783132437142; Book DOI: 10.1055/b000000254
1. Edition © 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG, Stuttgart,
Subjects: Dermatology;Allergology
Thieme Clinical Collections (English Language)
Summary
Cosmetic use of botulinum neurotoxins (BoNTs) in the field of dermatology has grown beyond the treatment of wrinkles to include facial and body contouring. BoNT treatment has gained popularity owing to factors such as little injury and privacy, dramatic effects, relatively low cost, and negligible downtime. Paradigm shifts such as low-dose modulation rather than high-dose paralysis, frequent combination with fillers, and superficial injection in selective cases presently occur in BoNT treatment. A need, however, exists for a patient-tailored treatment that will produce a more satisfying result without complications. This requires an in-depth knowledge of the products used, a thorough understanding of individual anatomy, both static and functional, and consideration of ethnicity, gender, and age. Herein, we present up-to-date knowledge and techniques regarding BoNT treatment. We have also presented the toxicity and immunogenicity of BoNT, and an in-depth discussion of BoNT treatment for glabellar frown lines, horizontal forehead lines, crow’s feet, bunny lines, plunging nose tip, nasal flare, gummy smile, asymmetric lip or smile, nasolabial folds, melomental folds (Marionette folds), perioral wrinkles, cobblestone chin, mouth corners, platysmal bands, horizontal neck lines, facial contouring treating benign masseteric hypertrophy and salivary gland enlargement, body contouring, hyperhidrosis, pain and pruritus, and wound healing.
Key words
botulinum toxin - wrinkle treatment - smile deformity - facial contouring - masseteric hypertrophy - salivary gland enlargement - body contouring - new use of botulinum toxin- 1 Brin MF. Development of future indications for BOTOX.. Toxicon 2009; 54 (5) 668-674 PubMed (PMID: 19470342)
- 2 Zhang S, Masuyer G, Zhang J et al. Identification and characterization of a novel botulinum neurotoxin.. Nat Commun 2017; 8: 14130 PubMed (PMID: 28770820)
- 3 Matarasso SL. Comparison of botulinum toxin types A and B: a bilateral and double-blind randomized evaluation in the treatment of canthal rhytides.. Dermatol Surg 2003; 29 (1) 7-13, discussion 13 PubMed (PMID: 12534505)
- 4 Flynn TC, Clark II RE. Botulinum toxin type B (MYOBLOC) versus botulinum toxin type A (BOTOX) frontalis study: rate of onset and radius of diffusion.. Dermatol Surg 2003; 29 (5) 519-522, discussion 522 PubMed (PMID: 12752521)
- 5 Dressler D, Bigalke H, Benecke R. Botulinum toxin type B in antibody-induced botulinum toxin type A therapy failure.. J Neurol 2003; 250 (8) 967-969 PubMed (PMID: 12928917)
- 6 Rasetti-Escargueil C, Lemichez E, Popoff MR. Variability of botulinum toxins: challenges and opportunities for the future.. Toxins (Basel) 2018; 10 (9) E374 PubMed (PMID: 30217070)
- 7 Davies JR, Liu SM, Acharya KR. Variations in the botulinum neurotoxin binding domain and the potential for novel therapeutics.. Toxins (Basel) 2018; 10 (10) E421 PubMed (PMID: 30347838)
- 8 Rogozhin AA, Pang KK, Bukharaeva E, Young C, Slater CR. Recovery of mouse neuromuscular junctions from single and repeated injections of botulinum neurotoxin A.. J Physiol 2008; 586 (13) 3163-3182 PubMed (PMID: 18467364)
- 9 Kutschenko A, Manig A, Reinert MC, Mönnich A, Liebetanz D. In-vivo comparison of the neurotoxic potencies of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA.. Neurosci Lett 2016; 627: 216-221 PubMed (PMID: 27268041)
- 10 Frevert J. Content of botulinum neurotoxin in Botox®/Vistabel®, Dysport®/Azzalure®, and Xeomin®/Bocouture®.. Drugs R D 2010; 10 (2) 67-73 PubMed (PMID: 20698714)
- 11 Frevert J. Pharmaceutical, biological, and clinical properties of botulinum neurotoxin type A products.. Drugs R D 2015; 15 (1) 1-9 PubMed (PMID: 25559581)
- 12 Kane MA, Gold MH, Coleman III WP et al. A randomized, double-blind trial to investigate the equivalence of incobotulinumtoxinA and onabotulinumtoxinA for glabellar frown lines.. Dermatol Surg 2015; 41 (11) 1310-1319 PubMed (PMID: 26509943)
- 13 Rappl T, Parvizi D, Friedl H et al. Onset and duration of effect of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA in the treatment of glabellar frown lines: a randomized, double-blind study.. Clin Cosmet Investig Dermatol 2013; 6: 211-219 PubMed (PMID: 24098087)
- 14 Kane MA, Monheit G. The practical use of AbobotulinumtoxinA in aesthetics.. Aesthet Surg J 2017; 37 (Suppl. suppl_1) S12-S19 PubMed (PMID: 28388719)
- 15 Kerscher M, Roll S, Becker A, Wigger-Alberti W. Comparison of the spread of three botulinum toxin type A preparations.. Arch Dermatol Res 2012; 304 (2) 155-161 PubMed (PMID: 22002325)
- 16 Seo K, Bae GY. Neuronox and Innotox. In: Carruthers A, Carruthers J, eds. Botulinum Toxin: Procedures in Cosmetic Dermatology. 4th ed. Toronto: Elsvier; 2018:57–63
- 17 Carruthers JD, Fagien S, Joseph JH, Humphrey SD, et al. DaxibotulinumtoxinA for injection for the treatment of glabellar lines: results from each of two multicenter, randomized, double-blind, placebo-controlled, phase 3 studies (SAKURA 1 and SAKURA 2). Plast Reconstr Surg. 2020; 145(1): 45–58
- 18 Hardas B, Brin MF. Topical botulinum toxin type A. In: Carruthers A, Carruthers J, eds. Botulinum Toxin: Procedures in Cosmetic Dermatology. 4th ed. Toronto: Elsvier; 2018:81–84
- 19 Toth SI, Smith LA, Ahmed SA. Extreme sensitivity of botulinum neurotoxin domains towards mild agitation.. J Pharm Sci 2009; 98 (9) 3302-3311 PubMed (PMID: 19226630)
- 20 Hsu TS, Dover JS, Arndt KA. Effect of volume and concentration on the diffusion of botulinum exotoxin A.. Arch Dermatol 2004; 140 (11) 1351-1354 PubMed (PMID: 15545544)
- 21 Hexsel DM, De Almeida AT, Rutowitsch M et al. Multicenter, double-blind study of the efficacy of injections with botulinum toxin type A reconstituted up to six consecutive weeks before application.. Dermatol Surg 2003; 29 (5) 523-529, discussion 529 PubMed (PMID: 12752522)
- 22 Parsa AA, Lye KD, Parsa FD. Reconstituted botulinum type A neurotoxin: clinical efficacy after long-term freezing before use.. Aesthetic Plast Surg 2007; 31 (2) 188-191, discussion 192–193 PubMed (PMID: 17122996)
- 23 Aranda MA, Herranz A, del Val J, Bellido S, García-Ruiz P. Botulinum toxin A during pregnancy, still a debate.. Eur J Neurol 2012; 19 (8) e81-e82 PubMed (PMID: 22805647)
- 24 Tzou CH, Giovanoli P, Ploner M, Frey M. Are there ethnic differences of facial movements between Europeans and Asians?. Br J Plast Surg 2005; 58 (2) 183-195 PubMed (PMID: 15710113)
- 25 Carruthers A, Carruthers J. Prospective, double-blind, randomized, parallel-group, dose-ranging study of botulinum toxin type A in men with glabellar rhytids.. Dermatol Surg 2005; 31 (10) 1297-1303 PubMed (PMID: 16188182)
- 26 Dailey RA, Philip A, Tardie G. Long-term treatment of glabellar rhytides using onabotulinumtoxinA.. Dermatol Surg 2011; 37 (7) 918-928 PubMed (PMID: 21575099)
- 27 Bai L, Peng X, Liu Y et al. Clinical analysis of 86 botulism cases caused by cosmetic injection of botulinum toxin (BoNT).. Medicine (Baltimore) 2018; 97 (34) e10659 PubMed (PMID: 30142749)
- 28 Naumann M, Boo LM, Ackerman AH, Gallagher CJ. Immunogenicity of botulinum toxins.. J Neural Transm (Vienna) 2013; 120 (2) 275-290 PubMed (PMID: 23008029)
- 29 Dressler D, Pan L, Adib Saberi F. Antibody-induced failure of botulinum toxin therapy: re-start with low-antigenicity drugs offers a new treatment opportunity.. J Neural Transm (Vienna) 2018; 125 (10) 1481-1486 PubMed (PMID: 30066275)
- 30 Moon IJ, Chang SE, Kim SD. First case of anaphylaxis after botulinum toxin type A injection.. Clin Exp Dermatol 2017; 42 (7) 760-762 PubMed (PMID: 28639343)
- 31 Rosenfield LK, Kardassakis DG, Tsia KA, Stayner G. The first case report of a systemic allergy to onabotulinumtoxinA (Botox) in a healthy patient.. Aesthet Surg J 2014; 34 (5) 766-768 PubMed (PMID: 24847156)
- 32 Yiannakopoulou E. Serious and long-term adverse events associated with the therapeutic and cosmetic use of botulinum toxin.. Pharmacology 2015; 95 (1–2) 65-69 PubMed (PMID: 25613637)
- 33 Shaari CM, Sanders I. Quantifying how location and dose of botulinum toxin injections affect muscle paralysis.. Muscle Nerve 1993; 16 (9) 964-969 PubMed (PMID: 8355728)
- 34 Shetty R. Dynamic relaxers of the face.. J Cutan Aesthet Surg 2018; 11 (2) 47-50 PubMed (PMID: 30210205)
- 35 Kruger TH, Wollmer MA. Depression: an emerging indication for botulinum toxin treatment.. Toxicon 2015; 107 (Suppl. Pt A) 154-157 PubMed (PMID: 26415901)
- 36 Finzi E. Update: botulinum toxin for depression: more than skin deep.. Dermatol Surg 2018; 44 (10) 1363-1365 PubMed (PMID: 30188327)
- 37 Isse NG, Elahi MM. The corrugator supercilii muscle revisited.. Aesthet Surg J 2001; 21 (3) 209-215 PubMed (PMID: 19331895)
- 38 Park JI, Hoagland TM, Park MS. Anatomy of the corrugator supercilii muscle.. Arch Facial Plast Surg 2003; 5 (5) 412-415 PubMed (PMID: 12975140)
- 39 Huilgol SC, Carruthers A, Carruthers JD. Raising eyebrows with botulinum toxin.. Dermatol Surg 1999; 25 (5) 373-375, discussion 376 PubMed (PMID: 10469075)
- 40 Ascher B, Talarico S, Cassuto D et al. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit): part I—upper facial wrinkles.. J Eur Acad Dermatol Venereol 2010; 24 (11) 1278-1284 PubMed (PMID: 20337830)
- 41 Keaney TC, Alster TS. Botulinum toxin in men: review of relevant anatomy and clinical trial data.. Dermatol Surg 2013; 39 (10) 1434-1443 PubMed (PMID: 24090254)
- 42 Anido J, Arenas D, Arruabarrena C et al. Tailored botulinum toxin type A injections in aesthetic medicine: consensus panel recommendations for treating the forehead based on individual facial anatomy and muscle tone.. Clin Cosmet Investig Dermatol 2017; 10: 413-421 PubMed (PMID: 29089780)
- 43 Jun JY, Park JH, Youn CS, Lee JH. Intradermal injection of botulinum toxin: a safer treatment modality for forehead wrinkles.. Ann Dermatol 2018; 30 (4) 458-461 PubMed (PMID: 30065587)
- 44 Flynn TC, Carruthers JA, Carruthers JA. Botulinum-A toxin treatment of the lower eyelid improves infraorbital rhytides and widens the eye.. Dermatol Surg 2001; 27 (8) 703-708 PubMed (PMID: 11493292)
- 45 Redaelli A, Limardo P. Minimally invasive procedures for nasal aesthetics.. J Cutan Aesthet Surg 2012; 5 (2) 115-120 PubMed (PMID: 23060706)
- 46 Hwang WS, Hur MS, Hu KS et al. Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin.. Angle Orthod 2009; 79 (1) 70-77 PubMed (PMID: 19123705)
- 47 Polo M. Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile).. Am J Orthod Dentofacial Orthop 2008; 133 (2) 195-203 PubMed (PMID: 18249285)
- 48 Sadiq SA, Khwaja S, Saeed SR. Botulinum toxin to improve lower facial symmetry in facial nerve palsy.. Eye (Lond) 2012; 26 (11) 1431-1436 PubMed (PMID: 22975654)
- 49 Haykal S, Arad E, Bagher S et al. The role of botulinum toxin a in the establishment of symmetry in pediatric paralysis of the lower lip.. JAMA Facial Plast Surg 2015; 17 (3) 174-178 PubMed (PMID: 25742503)
- 50 Snider CC, Amalfi AN, Hutchinson LE, Sommer NZ. New insights into the anatomy of the midface musculature and its implications on the nasolabial fold.. Aesthetic Plast Surg 2017; 41 (5) 1083-1090 PubMed (PMID: 28508263)
- 51 Pessa JE, Garza PA, Love VM, Zadoo VP, Garza JR. The anatomy of the labiomandibular fold.. Plast Reconstr Surg 1998; 101 (2) 482-486 PubMed (PMID: 9462785)
- 52 Carruthers J, Carruthers A. Aesthetic botulinum A toxin in the mid and lower face and neck.. Dermatol Surg 2003; 29 (5) 468-476 PubMed (PMID: 12752513)
- 53 Goldman A, Wollina U. Elevation of the corner of the mouth using botulinum toxin type a.. J Cutan Aesthet Surg 2010; 3 (3) 145-150 PubMed (PMID: 21430826)
- 54 Levy PM. Neurotoxins: current concepts in cosmetic use on the face and neck—jawline contouring/platysma bands/necklace lines.. Plast Reconstr Surg 2015; 136 (5) (Suppl. Suppl) 80S-83S PubMed (PMID: 26441117)
- 55 Kim NH, Chung JH, Park RH, Park JB. The use of botulinum toxin type A in aesthetic mandibular contouring.. Plast Reconstr Surg 2005; 115 (3) 919-930 PubMed (PMID: 15731696)
- 56 Tsai CY, Shyr YM, Chiu WC, Lee CM. Bone changes in the mandible following botulinum neurotoxin injections.. Eur J Orthod 2011; 33 (2) 132-138 PubMed (PMID: 20884720)
- 57 Libouban H, Guintard C, Minier N, Aguado E, Chappard D. Long-term quantitative evaluation of muscle and bone wasting induced by botulinum toxin in mice using microcomputed tomography.. Calcif Tissue Int 2018; 102 (6) 695-704 PubMed (PMID: 29222689)
- 58 Wu WT. Botox facial slimming/facial sculpting: the role of botulinum toxin-A in the treatment of hypertrophic masseteric muscle and parotid enlargement to narrow the lower facial width.. Facial Plast Surg Clin North Am 2010; 18 (1) 133-140 PubMed (PMID: 20206096)
- 59 Bae GY, Yune YM, Seo K, Hwang SI. Botulinum toxin injection for salivary gland enlargement evaluated using computed tomographic volumetry.. Dermatol Surg 2013; 39 (9) 1404-1407 PubMed (PMID: 23815364)
- 60 Dessy LA, Mazzocchi M, Rubino C, Mazzarello V, Spissu N, Scuderi N. An objective assessment of botulinum toxin A effect on superficial skin texture.. Ann Plast Surg 2007; 58 (5) 469-473 PubMed (PMID: 17452827)
- 61 Pessa JE, Nguyen H, John GB, Scherer PE. The anatomical basis for wrinkles.. Aesthet Surg J 2014; 34 (2) 227-234 PubMed (PMID: 24353247)
- 62 Shah AR. Use of intradermal botulinum toxin to reduce sebum production and facial pore size.. J Drugs Dermatol 2008; 7 (9) 847-850 PubMed (PMID: 19112798)
- 63 Humphrey S, Jacky B, Gallagher CJ. Preventive, cumulative effects of botulinum toxin type A in facial aesthetics.. Dermatol Surg 2017; 43 (Suppl. Suppl 3) S244-S251 PubMed (PMID: 33065950)
- 64 Zhou RR, Wu HL, Zhang XD et al. Efficacy and safety of botulinum toxin type A injection in patients with bilateral trapezius hypertrophy.. Aesthetic Plast Surg 2018; 42 (6) 1664-1671 PubMed (PMID: 30206648)
- 65 Kim DY, Kim JM. Safety and efficacy of prabotulinumtoxinA (Nabota®) injection for cervical and shoulder girdle myofascial pain syndrome: a pilot study.. Toxins (Basel) 2018; 10 (9) E355 PubMed (PMID: 30177597)
- 66 Wanitphakdeedecha R, Ungaksornpairote C, Kaewkes A, Sathaworawong A, Vanadurongwan B, Lektrakul N. A pilot study comparing the efficacy of two formulations of botulinum toxin type A for muscular calves contouring.. J Cosmet Dermatol 2018; 17 (6) 984-990 PubMed (PMID: 30203534)
- 67 Durand PD, Couto RA, Isakov R et al. Botulinum toxin and muscle atrophy: a wanted or unwanted effect.. Aesthet Surg J 2016; 36 (4) 482-487 PubMed (PMID: 26780946)
- 68 Grando SA, Zachary CB. The non-neuronal and nonmuscular effects of botulinum toxin: an opportunity for a deadly molecule to treat disease in the skin and beyond.. Br J Dermatol 2018; 178 (5) 1011-1019 PubMed (PMID: 29086923)
- 69 Weinberg T, Solish N, Murray C. Botulinum neurotoxin treatment of palmar and plantar hyperhidrosis.. Dermatol Clin 2014; 32 (4) 505-515 PubMed (PMID: 25152344)
- 70 Park J, Park HJ. Botulinum toxin for the treatment of neuropathic pain.. Toxins (Basel) 2017; 9 (9) E260 PubMed (PMID: 28837075)
- 71 Boozalis E, Sheu M, Selph J, Kwatra SG. Botulinum toxin type A for the treatment of localized recalcitrant chronic pruritus.. J Am Acad Dermatol 2018; 78 (1) 192-194 PubMed (PMID: 29241783)
- 72 Dhawan A, Dhawan S, Vitarella D. The potential role of botulinum toxin in improving superficial cutaneous scarring: a review.. J Drugs Dermatol 2018; 17 (9) 956-958 PubMed (PMID: 30235381)
- 73 Shome D, Khare S, Kapoor R. An algorithm using botox injections for facial scar improvement in Fitzpatrick type IV-VI skin.. Plast Reconstr Surg Glob Open 2018; 6 (8) e1888 PubMed (PMID: 30324067)
- 74 Hao R, Li Z, Chen X, Ye W. Efficacy and possible mechanisms of botulinum toxin type A on hypertrophic scarring.. J Cosmet Dermatol 2018; 17 (3) 340-346 PubMed (PMID: 29569821)
- 75 Iannitti T, Palmieri B, Aspiro A, Di Cerbo A. A preliminary study of painless and effective transdermal botulinum toxin A delivery by jet nebulization for treatment of primary hyperhidrosis.. Drug Des Devel Ther 2014; 8: 931-935 PubMed (PMID: 25075176)
- 76 Kim WO. Treatment of focal hyperhidrosis with needleless injections of botulinum toxin into sites other than the axilla, palm, and sole.. Dermatol Surg 2017; 43 (Suppl. Suppl 3) S367-S369 PubMed (PMID: 28872558)
- 77 Cao Y, Yang JP, Zhu XG et al. A comparative in vivo study on three treatment approaches to applying topical botulinum toxin A for crow’s feet.. BioMed Res Int 2018; 2018: 6235742 PubMed (PMID: 30057908)
- 78 Friedman O, Koren A, Niv R, Mehrabi JN, Artzi O. The toxic edge- a novel treatment for refractory erythema and flushing of rosacea.. Lasers Surg Med 2019; 51 (4) 325-331 PubMed (PMID: 30311683)
- 79 Schlessinger J, Gilbert E, Cohen JL, Kaufman J. New uses of abobotulinumtoxinA in aesthetics.. Aesthet Surg J 2017; 37 (Suppl. suppl_1) S45-S58 PubMed (PMID: 28388720)
- 80 Kim MJ, Kim JH, Cheon HI et al. Assessment of skin physiology change and safety after intradermal injections with botulinum toxin: a randomized, double-blind, placebo-controlled, split-face pilot study in rosacea patients with facial erythema.. Dermatol Surg 2019; 45 (9) 1155-1162 PubMed (PMID: 30730346)