Different Products

So far, there are several BNT-A products and one BNT-B product on the market. The BNT-A products differ in their amount of protein as well as in the amount of albumin added (Table 1.1). At the moment Botox, also marketed in some countries as Botox Aesthetic Vistabel Vistabex for aesthetic indications, and Dysport share the majority of the aesthetic market. The new German BNT-A preparation Xeo-min is only available in a few countries so far, and lacks clinical data on its efficacy in aesthetic...

Tips and Tricks

Have the patient squeeze his eyes tight while you try to palpate the lateral parts of the m. orbicularis oculi. The injection point should be close to this area, but always above the orbital rim. Respect the learning curve try technique 1 first, then technique 2 and after that technique 3 with three injection sites and with enough experience go to the five points. Ahn MS et al. (2000) Temporal brow lift using botulinum toxin A. Plast Reconstr Surg i05(3) ii29-35 discussion pp 1136-9 Balikian...

Patient Selection

Characteristics of the m. nasalis and the m. depressor septi Table 5.6. Characteristics of the m. nasalis and the m. depressor septi Draws the nasal tip downwards and thereby constricts the nostrils columella at the medial crural footplate. Two points are marked, one at each side of the medial crura, and the injection is started (Fig. 5.59). As the fibers of the m. depressor septi nasi are intertwined with those of the m. orbicularis oris, the injection should be superficial....

Allergies to Botulinum ToxinA

There are hardly any reports about hypersensitivity or allergic responses after aesthetic BNT treatments. LeWitt describes a persistent rash at the facial injection site (LeWitt et al. 1997). Cote reports about two cases of allergic reactions filed to the US FDA between 12 1989 and 5 2003 after use of BNT-A for cosmetic indications (Cote et al. 2005). Although the reported data is quite scarce and not very detailed, the German package label for e.g. Botox states that reports about anaphylactic...

The Microlift Procedure BNTA as an Important Ally

The minimal approach technique (de Maio, 2004) was an innovation in facial cosmetic procedures that is faster, less painful, and less costly than surgical facelifts. The technique utilizes a variety of biodegradable injectable products and BNT-A to improve appearance with a fast and relatively painless lunchtime procedure. This lift has been expanded to the microlift procedure. The microlift facelift appeals to the patient seeking a more long-lasting improvement than fillers and surface...

Anatomy

The facial nerve (cranial nerve pair VII) is responsible for stimulating the mimic muscles, creating a balance between the synergic and antagonistic forces that act upon the facial structures. It is also responsible for the muscular tonus when a person is in a relaxed state, and the voluntary and involuntary contraction of the muscles of each side of the face. The facial nerve emerges in the stylomastoid foramen and gives origin to its many ramifications. The first ramification is the posterior...

Botulinum Toxin and Facelift

The advent of botulinum toxin has evidently changed the surgical approach to the face from the 1980s when very aggressive surgery with a coronal approach to the forehead was the rule, leading patients to complain about a very long downtime and sometimes an unnatural facial look. Fig. 8.4a,b. Patient with low lateral eyebrows and deep nasolabial folds. Before, and 15 days after, BNT-A in the upper third fillers and BNT-A in the nasolabial fold and suspension surgical threads in the eyebrows....

Antagonists and Synergists

Have the mm. corrugatores, m. procerus and mm. depressores supercilii as the main opponents. Although the mm. orbiculares oculi may also counteract the frontalis medial fibers, it is the mm. depressores supercilii that influences this level. The mm. orbiculares oculi lateral fibers (the ones that produce the crow's feet) tend to depress the lateral aspect of the eyebrow. (Table 6.6 and Figs. 6.10 and 6.iia-c) Please note that the mm. depressores supercilii is considered 6 by some as only a...

Botulinum Toxin and Chemical Peels

Photodamage is the primary trigger for extrinsic aging. It results from cumulative exposure to g ultraviolet light and is responsible for many unwanted aging signs. The most common clinical signs include aging spots on a shallow colored skin, keratoses, static rhytids, telangiectasia and loss of elasticity. The degree of photodamage varies from patient to patient and can be mild, moderate or severe. Fillers and botulinum toxin alone will not be able to solve every skin wrinkle. The best way to...

References

Alam M, Dover JS, Arndt KA (2002) Pain associated with injection of botulinum A exotoxin reconstituted using isotonic sodium chloride with and without preservative a double-blind, randomized controlled trial. Arch Dermatol 138(4) 10-4 Alam M, Arndt KA, Dover JS (2002) Severe, intractable headache after injection with botulinum a exotoxin report of 5 cases. J Am Acad Dermatol 46(i) 62-5 Allergan Inc. (2004) Press release http www.sharehold- Ascher B, Zakine B, Kestemont P, Baspeyras M, Bou-gara...

Depressor Nasi Septi Muscle

Orbicularis Oris Chirurgie

Injection of BNT-A at the base of the collu-mella. The fibers of the m. depressor septi nasi run close to the medial crural footplate. This location is ideal for patients with normal or short upper lips Fig. 5.61. Injection of BNT-A at the base of the collu-mella. The fibers of the m. depressor septi nasi run close to the medial crural footplate. This location is ideal for patients with normal or short upper lips Fig. 5.62. The m. depressor septi nasi fibers run upwards to the tip of...

Efficacy Optimal Dosage

Injektion Points Glabella

Key question 1 What is the optimal dosage for treating the glabella This is an important question. The glabella is probably the most frequently treated area. Fortunately there are several clinical trials available that try to answer this question. The question will be discussed for both brands separately. What should efficacy measure BNT targets the activity of the mimic muscles. Therefore, the ability of the toxin to reduce muscular movements should be measured. Usually it is not the muscular...

Info

Orbicularis Oculi Botulinum

Injection points for brow lift technique 2 . Fig. 5.26. Injection points for brow lift technique 3 . Here the central forehead region is treated Here the lateral brow is treated with three injection Fig. 5.25. Injection points for brow lift technique 2 . Fig. 5.26. Injection points for brow lift technique 3 . Here the central forehead region is treated Here the lateral brow is treated with three injection One injection point approximately 0.5 cm above the orbital rim Figs. 5.24 and...

Introduction

The aging process is a sum of genetic and environmental influences. Intrinsic aging is mainly represented by chronological processes and leads to atrophy with skin excess and laxity, eye bags and the presence of gravitational folds Fig. 2.1 . The most effective treatment here might be surgery with muscle repositioning and skin and eye bags excess removal. Extrinsic aging is mainly caused by photo-damage which harms the skin - epidermis and dermis - leading to static wrinkles, dryness and aging...

Acknowledgments

Neither our first, nor this, our second book, would have been possible without the work of many others. We would therefore like to take the opportunity to thank our patients who helped us get to where we are now, especially those who contributed their photographs to this book. At Springer, we would like to thank Mrs. Marion Philipp and Mrs. Ellen Blasig, and from the German team Mr. Hendrik Zielke for his help with the content and format, especially for helping us build the chapters on the...