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        Facial Plast Surg 2011; 27(6): 529-539
DOI: 10.1055/s-0031-1298786
   © Thieme Medical PublishersDOI: 10.1055/s-0031-1298786
Botulinum Toxin: Clinical Techniques, Applications, and Complications
Further Information
            
               
                  
            
         
      
      
   Publication History
Publication Date:
28 December 2011 (online)

ABSTRACT
This article outlines practice routines, clinical techniques, applications, and complications of botulinum toxin type A treatment of mimetic facial and neck muscles. Detailed descriptions are provided for each clinical indication that maximize the treatment of the intended muscle groups while minimizing potential complications.
KEYWORDS
Botulinum - glabellar rhytids - Botox
REFERENCES
- 1 
            Wise J B, Greco T. 
            Injectable treatments for the aging face. 
            Facial Plast Surg. 
            2006; 
            22 
            140-146 
            
            Reference Ris Wihthout Link
- 2 Allergan Inc. 2005. Prescribing information for Botox Cosmetic. Online 2006 July 25. Available at: http://www.botox.com Last accessed December 15, 2011 
            Reference Ris Wihthout Link
- 3 Scott A B. The role of botulinum toxin type A in the management of strabismus. In: Brin M F, Hallett M, Jankovic J, eds. Scientific and Therapeutic Aspects of Botulinum Toxin.  Philadelphia: Lippincott Williams and Wilkins; 2002: 189-195 
            Reference Ris Wihthout Link
- 4 Comella C L. Cervical dystonia: treatment with botulinum toxin serotype A as Botox or Dysport. In: Brin M F, Hallett M, Jankovic J, eds. Scientific and Therapeutic Aspects of Botulinum Toxin.  Philadelphia: Lippincott Williams and Wilkins; 2002: 359-364 
            Reference Ris Wihthout Link
- 5 Blitzer A, Zalvan C, Gonzalez-Yanez O, Brin M F. Botulinum toxin type A injections for the management of hyperfunctional larynx. In: Brin M F, Hallett M, Jankovic J, eds. Scientific and Therapeutic Aspects of Botulinum Toxin.  Philadelphia: Lippincott Williams and Wilkins; 2002: 207-216 
            Reference Ris Wihthout Link
- 6 Brin M F, Binder W, Blitzer A et al.. Botulinum toxin type A BOTOX for pain and headache. In: Brin M F, Hallett M, Jankovic J, eds. Scientific and Therapeutic Aspects of Botulinum Toxin.  Philadelphia: Lippincott Williams and Wilkins; 2011: 233-250 
            Reference Ris Wihthout Link
- 7 Schwartz M FB. Botulinum toxin A therapy for temporomandibular disorders. In: Brin M F, Hallett M, Jankovic J, eds. Scientific and Therapeutic Aspects of Botulinum Toxin.  Philadelphia: Lippincott Williams and Wilkins; 2002: 259 
            Reference Ris Wihthout Link
- 8 Tintner R JJ. Botulinum toxin type A in the management of oromandibular dystonia and bruxism. In: Brin M F, Hallett M, Jankovic J, eds. Scientific and Therapeutic Aspects of Botulinum Toxin.  Philadelphia: Lippincott Williams and Wilkins; 2002: 343-350 
            Reference Ris Wihthout Link
- 9 FDA requires boxed warning for all botulinum toxin products. FDA News Release 2009
            April 30. Available at: http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm149574.htm Last accessed December 15, 2011 
            Reference Ris Wihthout Link
- 10 
            Wohlfarth K, Sycha T, Ranoux D, Naver H, Caird D. 
            Dose equivalence of two commercial preparations of botulinum neurotoxin type A: time
            for a reassessment?. 
            Curr Med Res Opin. 
            2009; 
            25 
            1573-1584 
            
            Reference Ris Wihthout Link
- 11 
            Ranoux D, Gury C, Fondarai J, Mas J L, Zuber M. 
            Respective potencies of Botox and Dysport: a double blind, randomised, crossover study
            in cervical dystonia. 
            J Neurol Neurosurg Psychiatry. 
            2002; 
            72 
            459-462 
            
            Reference Ris Wihthout Link
- 12 
            Karsai S, Raulin C. 
            Current evidence on the unit equivalence of different botulinum neurotoxin A formulations
            and recommendations for clinical practice in dermatology. 
            Dermatol Surg. 
            2009; 
            35 
            1-8 
            
            Reference Ris Wihthout Link
- 13 
            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 
            (1, Suppl) 
            s7-s22 
            quiz s23-s25 
            
            Reference Ris Wihthout Link
- 14 
            Hexsel D, Rutowitsch M S, de Castro L C, do Prado D Z, Lima M M. 
            Blind multicenter study of the efficacy and safety of injections of a commercial preparation
            of botulinum toxin type A reconstituted up to 15 days before injection. 
            Dermatol Surg. 
            2009; 
            35 
            933-939 
            discussion 940 
            
            Reference Ris Wihthout Link
- 15 
            Hexsel D M, De Almeida A T, 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 
            523-529 
            discussion 529 
            
            Reference Ris Wihthout Link
- 16 
            Hui J I, Lee W W. 
            Efficacy of fresh versus refrigerated botulinum toxin in the treatment of lateral
            periorbital rhytids. 
            Ophthal Plast Reconstr Surg. 
            2007; 
            23 
            433-438 
            
            Reference Ris Wihthout Link
- 17 
            Parsa A A, Lye K D, Parsa F D. 
            Reconstituted botulinum type A neurotoxin: clinical efficacy after long-term freezing
            before use. 
            Aesthetic Plast Surg. 
            2007; 
            31 
            188-191 
            discussion 192-193 
            
            Reference Ris Wihthout Link
- 18 
            Yang G C, Chiu R J, Gillman G S. 
            Questioning the need to use Botox within 4 hours of reconstitution: a study of fresh
            vs 2-week-old Botox. 
            Arch Facial Plast Surg. 
            2008; 
            10 
            273-279 
            
            Reference Ris Wihthout Link
- 19 
            Thomas J P, Siupsinskiene N. 
            Frozen versus fresh reconstituted botox for laryngeal dystonia. 
            Otolaryngol Head Neck Surg. 
            2006; 
            135 
            204-208 
            
            Reference Ris Wihthout Link
- 20 
            Sloop R R, Cole B A, Escutin R O. 
            Reconstituted botulinum toxin type A does not lose potency in humans if it is refrozen
            or refrigerated for 2 weeks before use. 
            Neurology. 
            1997; 
            48 
            249-253 
            
            Reference Ris Wihthout Link
- 21 
            Alam M, Yoo S S, Wrone D A, White L E, Kim J Y. 
            Sterility assessment of multiple use botulinum A exotoxin vials: a prospective simulation. 
            J Am Acad Dermatol. 
            2006; 
            55 
            272-275 
            
            Reference Ris Wihthout Link
- 22 BOTOX (Botulinum Toxin Type A) Purified Neurotoxin Complex: Advanced Toxin Technology
            [product monograph]. Allergan Inc., assignee. BOTOX (Botulinum Toxin Type A) Purified
            Neurotoxin Complex: Advanced Toxin Technology [product monograph]. Irvine, CA: patent Rx 9161; 1998 
            Reference Ris Wihthout Link
- 23 
            Carruthers J, Fagien S, Matarasso S L. Botox Consensus Group .
            Consensus recommendations on the use of botulinum toxin type a in facial aesthetics. 
            Plast Reconstr Surg. 
            2004; 
            114 
            (6, Suppl) 
            1S-22S 
            
            Reference Ris Wihthout Link
- 24 
            Dodick D W, Turkel C C, DeGryse R E PREEMPT Chronic Migraine Study Group et al. 
            OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind,
            randomized, placebo-controlled phases of the PREEMPT clinical program. 
            Headache. 
            2010; 
            50 
            921-936 
            
            Reference Ris Wihthout Link
- 25 FDA approves Botox to treat chronic migraines. FDA News Release 2010 October 21. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229782.htm Last accessed December 15, 2011 
            Reference Ris Wihthout Link
- 26 
            Carruthers J, Carruthers A. 
            Aesthetic botulinum A toxin in the mid and lower face and neck. 
            Dermatol Surg. 
            2003; 
            29 
            468-476 
            
            Reference Ris Wihthout Link
- 27 
            Ascher B, Zakine B, Kestemont P, Baspeyras M, Bougara A, Santini J. 
            A multicenter, randomized, double-blind, placebo-controlled study of efficacy and
            safety of 3 doses of botulinum toxin A in the treatment of glabellar lines. 
            J Am Acad Dermatol. 
            2004; 
            51 
            223-233 
            
            Reference Ris Wihthout Link
- 28 
            Rzany B, Ascher B, Fratila A, Monheit G D, Talarico S, Sterry W. 
            Efficacy and safety of 3- and 5-injection patterns (30 and 50 U) of botulinum toxin
            A (Dysport) for the treatment of wrinkles in the glabella and the central forehead
            region. 
            Arch Dermatol. 
            2006; 
            142 
            320-326 
            
            Reference Ris Wihthout Link
- 29 
            Monheit G, Carruthers A, Brandt F, Rand R. 
            A randomized, double-blind, placebo-controlled study of botulinum toxin type A for
            the treatment of glabellar lines: determination of optimal dose. 
            Dermatol Surg. 
            2007; 
            33 
            (1 Spec No.) 
            S51-S59 
            
            Reference Ris Wihthout Link
- 30 
            Kane M A, Brandt F, Rohrich R J, Narins R S, Monheit G D, Huber M B. Reloxin Investigational Group .
            Evaluation of variable-dose treatment with a new U.S. Botulinum Toxin Type A (Dysport)
            for correction of moderate to severe glabellar lines: results from a phase III, randomized,
            double-blind, placebo-controlled study. 
            Plast Reconstr Surg. 
            2009; 
            124 
            1619-1629 
            
            Reference Ris Wihthout Link
- 31 
            Rzany B, ll-Muller D, Grablowitz D, Heckmann M, Caird D. 
            Repeated botulinum toxin A injections for the treatment of lines in the upper face:
            a retrospective study of 4,103 treatments in 945 patients. 
            Dermatol Surg. 
            2007; 
            33 
            S18-S25 
            
            Reference Ris Wihthout Link
- 32 
            Carruthers J A, Lowe N J, Menter M A BOTOX Glabellar Lines I Study Group et al. 
            A multicenter, double-blind, randomized, placebo-controlled study of the efficacy
            and safety of botulinum toxin type A in the treatment of glabellar lines. 
            J Am Acad Dermatol. 
            2002; 
            46 
            840-849 
            
            Reference Ris Wihthout Link
- 33 
            Carruthers J D, Lowe N J, Menter M A, Gibson J, Eadie N. Botox Glabellar Lines II Study Group .
            Double-blind, placebo-controlled study of the safety and efficacy of botulinum toxin
            type A for patients with glabellar lines. 
            Plast Reconstr Surg. 
            2003; 
            112 
            1089-1098 
            
            Reference Ris Wihthout Link
- 34 
            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 
            1297-1303 
            
            Reference Ris Wihthout Link
- 35 
            Sclafani A P, Jung M. 
            Desired position, shape, and dynamic range of the normal adult eyebrow. 
            Arch Facial Plast Surg. 
            2010; 
            12 
            123-127 
            
            Reference Ris Wihthout Link
- 36 
            Ahn M S, Catten M, Maas C S. 
            Temporal brow lift using botulinum toxin A. 
            Plast Reconstr Surg. 
            2000; 
            105 
            1129-1135 
            discussion 1136-1139 
            
            Reference Ris Wihthout Link
- 37 
            Blitzer A, Brin M F, Keen M S, Aviv J E. 
            Botulinum toxin for the treatment of hyperfunctional lines of the face. 
            Arch Otolaryngol Head Neck Surg. 
            1993; 
            119 
            1018-1022 
            
            Reference Ris Wihthout Link
- 38 
            Matarasso S L, Matarasso A. 
            Treatment guidelines for botulinum toxin type A for the periocular region and a report
            on partial upper lip ptosis following injections to the lateral canthal rhytids. 
            Plast Reconstr Surg. 
            2001; 
            108 
            208-214 
            discussion 215-217 
            
            Reference Ris Wihthout Link
- 39 
            Matarasso S L, Matarasso A. 
            Treatment guidelines for botulinum toxin type A for the periocular region and a report
            on partial upper lip ptosis following injections to the lateral canthal rhytids. 
            Plast Reconstr Surg. 
            2001; 
            108 
            208-214 
            discussion 215-217 
            
            Reference Ris Wihthout Link
- 40 
            Petropoulos I, Noussios G, Chouridis P, Kontzoglou G, Karagiannidis K. 
            Crow's feet treatment with botulinum toxin type A. 
            The Internet Journal of Aesthetic and Antiaging Medicine. 
            2008; 
            1 
            
            Reference Ris Wihthout Link
- 41 
            Ascher B, Rzany B J, Grover R. 
            Efficacy and safety of botulinum toxin type A in the treatment of lateral crow's feet:
            double-blind, placebo-controlled, dose-ranging study. 
            Dermatol Surg. 
            2009; 
            35 
            1478-1486 
            
            Reference Ris Wihthout Link
- 42 
            Lowe N J, Ascher B, Heckmann M, Kumar C, Fraczek S, Eadie N. Botox Facial Aesthetics Study Team .
            Double-blind, randomized, placebo-controlled, dose-response study of the safety and
            efficacy of botulinum toxin type A in subjects with crow's feet. 
            Dermatol Surg. 
            2005; 
            31 
            257-262 
            
            Reference Ris Wihthout Link
- 43 de Maio M RB. Botulinum Toxin in Aesthetic Medicine. Heidelberg, Germany: Springer-Verlag; 2007 
            Reference Ris Wihthout Link
- 44 
            Polo M. 
            Botulinum toxin type A in the treatment of excessive gingival display. 
            Am J Orthod Dentofacial Orthop. 
            2005; 
            127 
            214-218 
            quiz 261 
            
            Reference Ris Wihthout Link
- 45 
            Fagien S. 
            Botox for the treatment of dynamic and hyperkinetic facial lines and furrows: adjunctive
            use in facial aesthetic surgery. 
            Plast Reconstr Surg. 
            1999; 
            103 
            701-713 
            
            Reference Ris Wihthout Link
- 46 
            Matarasso A, Matarasso S L, Brandt F S, Bellman B. 
            Botulinum A exotoxin for the management of platysma bands. 
            Plast Reconstr Surg. 
            1999; 
            103 
            645-652 
            discussion 653-655 
            
            Reference Ris Wihthout Link
- 47 
            Hoefflin S M. 
            The platysma aponeurosis. 
            Plast Reconstr Surg. 
            1996; 
            97 
            1080 
            
            Reference Ris Wihthout Link
- 48 
            Kane M A. 
            Nonsurgical treatment of platysmal bands with injection of botulinum toxin A. 
            Plast Reconstr Surg. 
            1999; 
            103 
            656-663 
            discussion 664-665 
            
            Reference Ris Wihthout Link
- 49 
            Carruthers A, Carruthers J. 
            Clinical indications and injection technique for the cosmetic use of botulinum A exotoxin. 
            Dermatol Surg. 
            1998; 
            24 
            1189-1194 
            
            Reference Ris Wihthout Link
- 50 
            Clark R P, Berris C E. 
            Botulinum toxin: a treatment for facial asymmetry caused by facial nerve paralysis. 
            Plast Reconstr Surg. 
            1989; 
            84 
            353-355 
            
            Reference Ris Wihthout Link
- 51 
            Finn J C. 
            Botulinum toxin type A: fine-tuning treatment of facial nerve injury. 
            J Drugs Dermatol. 
            2004; 
            3 
            133-137 
            
            Reference Ris Wihthout Link
- 52 
            Carruthers J D, Carruthers A. 
            Botulinum A exotoxin in clinical ophthalmology. 
            Can J Ophthalmol. 
            1996; 
            31 
            389-400 
            
            Reference Ris Wihthout Link
- 53 
            Tsui J K. 
            Botulinum toxin as a therapeutic agent. 
            Pharmacol Ther. 
            1996; 
            72 
            13-24 
            
            Reference Ris Wihthout Link
- 54 Dysport (abobotulinumtoxinA) [package insert]. 4–29–2009. Brisbane, CA and Scottsdale
            AZ: Tercica, Inc. (a subsidiary of the Ipsen Group and Medicis Aesthetics Inc.) 
            Reference Ris Wihthout Link
- 55 
            Klein A W. 
            Contraindications and complications with the use of botulinum toxin. 
            Clin Dermatol. 
            2004; 
            22 
            66-75 
            
            Reference Ris Wihthout Link
Tom D. WangM.D. 
         Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head
         and Neck Surgery, Oregon Health and Science University
         
         3181 SW Sam Jackson Park Road, Portland, OR 97239
         
         Email: wangt@ohsu.edu
         
         
 
     
      
    