Keywords
Indications
Treatment
How to Cite
Abstract
Introduction: Botulinum toxin is derived from neurotoxins produced by Clostridium botulinum. With the ability to inhibit neurotransmission between peripheral nerves and muscle tissue, it is effective in aesthetic concerns by weakening muscle contraction. Although Food and Drug Administration (FDA) approval for cosmetic use is limited to glabellar, lateral canthal, and forehead lines, it is used for other indications. In-depth knowledge of muscle anatomy and function is crucial in effective and safe administration. Inadequacy can result in disfigurement and functional deficits that persist for months. Its dosage is not interchangeable between different formulations. Objective: to discuss cosmetic indications for the toxin in specific locations. Methodology: Integrative literature review from Scielo, PubMed and VHL databases, from March to May 2024, with descriptors “Botulinum toxin”, “cosmetic indications”, “treatment” and “specific sites”, registered in DeCS /MeSH and “AND” operator. Articles from 2019-2024 (total 51) were included, excluding other criteria and choosing 5 full articles. Results and Discussion: Appropriate candidates for injection are those in whom such aesthetic concerns can be alleviated by local muscle weakening and without contraindications; Elderly people generally do not benefit from the loss of skin elasticity. It must be ensured that the anatomical placement of the injections is correct and that the doses are appropriate based on the treatment site and the specific characteristics of the patient. Sites in the muscles that depress the eyebrow result in improvements in glabellar rhytids, with men needing larger doses due to the greater muscle mass in this area. All injections should be placed above the supraorbital rim to reduce the risk of upper eyelid ptosis. Successful treatment of horizontal forehead wrinkles requires simultaneous treatment of the frontalis muscle and the eyebrow depressors. Injections placed too low in the frontalis muscle can result in eyebrow ptosis. Lateral canthal wrinkles (crow's feet) can be successfully treated with multiple injections into the lateral orbicular oculi muscle, resting facial muscles, and lateral injections. In addition to facial treatment, botulinum toxin can be used to improve the appearance of the neck. Patients with platysmal bands or horizontal neck lines may benefit. Conclusion: There is a need for in-depth knowledge of facial anatomy and the functional relationships between facial and neck muscles to safely use botulinum toxin. Only in this way is there selective weakening of specific muscles, with favorable aesthetic results.
References
DasGupta BR. Structures of botulinum neurotoxin, its functional domains, and perspectives on the crystalline type A toxin. In: Therapy with Botulinum Toxin, Jankovic J, Hallet M (Eds), Marcel Dekker, 1994. p.15.
Schantz EJ, Johnson EA. Botulinum toxin: the story of its development for the treatment of human disease. Perspect Biol Med 1997; 40:317.
Burke GS. Notes on Bacillus botulinus. J Bacteriol 1919; 4:555.
Aoki KR, Guyer B. Botulinum toxin type A and other botulinum toxin serotypes: a comparative review of biochemical and pharmacological actions. Eur J Neurol 2001; 8 Suppl 5:21.
Dolly JO, Lisk G, Foran PG, et al. Insights into the extended duration of neuroparalysis by botulinum neurotoxin A relative to the other shorter-acting serotypes: differences between motor nerve terminals and cultured neurons. In: Scientific and Therapeutic Aspects of Botulinum Toxin, 1st ed, Brin MF, Jankovic J, Hallett M (Eds), Lippincott Williams & Wilkins, 2002. p.91.
Scott AB. Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Ophthalmology 1980; 87:1044.
Wabbels B, Reichel G, Fulford-Smith A, et al. Double-blind, randomised, parallel group pilot study comparing two botulinum toxin type A products for the treatment of blepharospasm. J Neural Transm (Vienna) 2011; 118:233.
Carruthers J, Stubbs HA. Botulinum toxin for benign essential blepharospasm, hemifacial spasm and age-related lower eyelid entropion. Can J Neurol Sci 1987; 14:42.
Borodic GE, Cheney M, McKenna M. Contralateral injections of botulinum A toxin for the treatment of hemifacial spasm to achieve increased facial symmetry. Plast Reconstr Surg 1992; 90:972.
Giordano CN, Matarasso SL, Ozog DM. Injectable and topical neurotoxins in dermatology: Basic science, anatomy, and therapeutic agents. J Am Acad Dermatol 2017; 76:1013.
Meunier FA, Schiavo G, Molgó J. Botulinum neurotoxins: from paralysis to recovery of functional neuromuscular transmission. J Physiol Paris 2002; 96:105.
Carruthers A, Carruthers J. Botulinum toxin type A: history and current cosmetic use in the upper face. Semin Cutan Med Surg 2001; 20:71.
Carruthers J, Carruthers A. Botulinum toxin A in the mid and lower face and neck. Dermatol Clin 2004; 22:151.
Lowe NJ, Yamauchi P. Cosmetic uses of botulinum toxins for lower aspects of the face and neck. Clin Dermatol 2004; 22:18.
Dayan SH, Maas CS. Botulinum toxins for facial wrinkles: beyond glabellar lines. Facial Plast Surg Clin North Am 2007; 15:41.
Fagien S, Carruthers JD. A comprehensive review of patient-reported satisfaction with botulinum toxin type a for aesthetic procedures. Plast Reconstr Surg 2008; 122:1915.
Carruthers A, Carruthers J, Lei X, et al. OnabotulinumtoxinA treatment of mild glabellar lines in repose. Dermatol Surg 2010; 36 Suppl 4:2168.
Blitzer A, Brin MF, Keen MS, Aviv JE. Botulinum toxin for the treatment of hyperfunctional lines of the face. Arch Otolaryngol Head Neck Surg 1993; 119:1018.
www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm175013.htm (Accessed on March 28, 2011).
Flynn TC. Botulinum toxin: examining duration of effect in facial aesthetic applications. Am J Clin Dermatol 2010; 11:183.
35. Murray C, Solish N. Botulinum toxin injections. In: Comprehensive Dermatologic Drug Therapy, 2nd ed, Wolverton, SE (Eds), Elsevier Inc, 2007. p.851.
Ranoux D, Gury C, Fondarai J, et al. Respective potencies of Botox and Dysport: a double blind, randomised, crossover study in cervical dystonia. J Neurol Neurosurg Psychiatry 2002; 72:459.
Simonetta Moreau M, Cauhepe C, Magues JP, Senard JM. A double-blind, randomized, comparative study of Dysport vs. Botox in primary palmar hyperhidrosis. Br J Dermatol 2003; 149:1041.
Trindade de Almeida AR, Marques E, de Almeida J, et al. Pilot study comparing the diffusion of two formulations of botulinum toxin type A in patients with forehead hyperhidrosis. Dermatol Surg 2007; 33:S37.
Cliff SH, Judodihardjo H, Eltringham E. Different formulations of botulinum toxin type A have different migration characteristics: a double-blind, randomized study. J Cosmet Dermatol 2008; 7:50.
Pickett A, Dodd S, Rzany B. Confusion about diffusion and the art of misinterpreting data when comparing different botulinum toxins used in aesthetic applications. J Cosmet Laser Ther 2008; 10:181.
Kane M, Donofrio L, Ascher B, et al. Expanding the use of neurotoxins in facial aesthetics: a consensus panel's assessment and recommendations. J Drugs Dermatol 2010; 9:s7.
Jost WH, Blümel J, Grafe S. Botulinum neurotoxin type A free of complexing proteins (XEOMIN) in focal dystonia. Drugs 2007; 67:669.
Dressler D. [Pharmacological aspects of therapeutic botulinum toxin preparations]. Nervenarzt 2006; 77:912.
Roggenkämper P, Jost WH, Bihari K, et al. Efficacy and safety of a new Botulinum Toxin Type A free of complexing proteins in the treatment of blepharospasm. J Neural Transm (Vienna) 2006; 113:303.
Dressler D. Routine use of Xeomin in patients previously treated with Botox: long term results. Eur J Neurol 2009; 16 Suppl 2:2.
Jankovic J. Clinical efficacy and tolerability of Xeomin in the treatment of blepharospasm. Eur J Neurol 2009; 16 Suppl 2:14.
Dressler D. Comparing Botox and Xeomin for axillar hyperhidrosis. J Neural Transm (Vienna) 2010; 117:317.
Sattler G, Callander MJ, Grablowitz D, et al. Noninferiority of incobotulinumtoxinA, free from complexing proteins, compared with another botulinum toxin type A in the treatment of glabellar frown lines. Dermatol Surg 2010; 36 Suppl 4:2146.
Prager W, Wissmüller E, Kollhorst B, et al. Comparison of two botulinum toxin type A preparations for treating crow's feet: a split-face, double-blind, proof-of-concept study. Dermatol Surg 2010; 36 Suppl 4:2155.
Rzany BJ, Ascher B, Avelar RL, et al. A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Single-Dose, Phase III, Non-Inferiority Study Comparing PrabotulinumtoxinA and OnabotulinumtoxinA for the Treatment of Moderate to Severe Glabellar Lines in Adult Patients. Aesthet Surg J 2020; 40:413.
Cheon HI, Jung N, Won CH, et al. Efficacy and Safety of Prabotulinumtoxin A and Onabotulinumtoxin A for Crow's Feet: A Phase 3, Multicenter, Randomized, Double-Blind, Split-Face Study. Dermatol Surg 2019; 45:1610.
Allergan, Inc. Botox Cosmetic (botulinum toxin type A) purified neurotoxin complex (prescribing information). Allergan, Inc, Irvine, CA 2005.
Feily A, Fallahi H, Zandian D, Kalantar H. A succinct review of botulinum toxin in dermatology; update of cosmetic and noncosmetic use. J Cosmet Dermatol 2011; 10:58.
Jeuveau (prabotulinumtoxinA-xvfs) for injection, for intramuscular use. US FDA approved product information; Santa Barbara, CA: Evolus Inc; February 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/761085s000lbl.pdf
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; 29:7.
Giordano CN, Matarasso SL, Ozog DM. Injectable and topical neurotoxins in dermatology: Indications, adverse events, and controversies. J Am Acad Dermatol 2017; 76:1027.
Brin MF, Boodhoo TI, Pogoda JM, et al. Safety and tolerability of onabotulinumtoxinA in the treatment of facial lines: a meta-analysis of individual patient data from global clinical registration studies in 1678 participants. J Am Acad Dermatol 2009; 61:961.
Carruthers J, Burgess C, Day D, et al. Consensus Recommendations for Combined Aesthetic Interventions in the Face Using Botulinum Toxin, Fillers, and Energy-Based Devices. Dermatol Surg 2016; 42:586.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 CAMILLA MAGANHIN LUQUETTI, Rodrigo Daniel Zanoni, Luís Barreira Alves Neto, Gabriela Parreira de Assis, Débora Buss Heidemann, Beatriz Brasileiro Diniz, Tassila Melo Souza de Farias, Sarah Oliveira Benine, João Marcos Mendes Santos, Débora Nery Diniz Pessanha, Mirele Siqueira Nunes, Carla Cristina Maganhin
