Facial rejuvenation with botulinum

The authors present a prospective clinical study representing a 15-month experience with the use of Botulinum toxin type A (Botox) for facial rejuvenation. Patient selection and evaluation, classification of animation lines, techniques, results, and complications are discussed. After listing the main factors responsible for the aging process and describing the four basic patterns of facial animation of the upper face, the authors discuss current surgical and nonsurgical methods employed by facial plastic surgeons to correct hyperfunctional animation lines. Observation of the absence of hyperfunctional facial lines in patients affected by Bell's palsy prompted the use of Botox in treating selected healthy aesthetic surgical patients. The pharmacology and contraindications for use of botulinum toxin A are presented. The authors then present the results of their series of 23 patients who were selected based on certain criteria. The study included both subjective and objective evaluations of the results comparing preoperative and postoperative upper facial hyperfunctional lines. Photo documentation was obtained from all patients. All patients received a history and physical and received pretreatment education. Each patient was evaluated for length and depth of wrinkles based on a standard evaluation form that is included in the article. Storage and preparation of Botox for injection is detailed and the injection technique described. EMG monitoring was utilized to determine the most active part of the muscle. Patients were evaluated for posttreatment results 1 week to 10 days after treatment. The results were evaluated according to the pretreatment evaluation category. The patients then gave a subjective evaluation of the results. In the discussion of their results, the authors differentiate between hyperfunctioning facial lines and wrinkles. Since the underlying cause of hyperfunctional lines is excess pull of the skin by facial muscles, the use of Botox to induce temporary muscle paralysis offers a solution to these muscle actions. Also addressed is the difficulty in determining the exact minimal dose of Botox required for the particular patient. The exact duration of the clinical effect of Botox injection is not known, however, the length of effect was approximately 6 months depending on location treated. In conclusion, the authors determined that Botox is a safe, easy to perform, and effective treatment for eliminating the hyperfunctional facial muscle action that is responsible for wrinkling.