Tips and Tricks

To ensure that no complication may result from injecting BNT-A for a facelift effect, a two-step treatment is advisable until the exact dose is defined for each patient. Generally, the depressors should be treated with a full dose and the elevators should get stronger with the absence of their antagonists' forces.

The younger the patient is, the stronger the elevators are, and as a consequence, the easier it is to obtain a better result. With older patients, the rule is not to let the drooping muscles (the depressors) recover. In this way the elevators will become stronger and the depressors will not pull down the facial structures.

Ahn MS et al. (2000) Temporal brow lift using botulinum toxin A. Plast Reconstr Surg. 105(3^1129-35; discussion pp 1136-9 Atamoros FP (2003) Botulinum toxin in the lower one third of the face. Clin Dermatol 21(6)^05-12 Balikian RV, Zimbler MS (2005) Primary and adjunctive uses of botulinum toxin type A in the periorbital region. Facial Plast Surg Clin North Am 13(4^583-90 Bulstrode NW, Grobbelaar AO (2002) Long-term prospective follow-up of botulinum toxin treatment for facial rhytides. Aesthetic Plast Surg 26(5):356-9 Carruthers J, Carruthers A (2004) Botox: beyond wrinkles. Clin Dermatol 22(1):89-93 Carucci JA, Zweibel SM (2001) Botulinum A exotoxin for rejuvenation of the upper third of the face. Facial Plast Surg 17(1):11-20 Chen AH, Frankel AS (2003) Altering brow contour with botulinum toxin. Facial Plast Surg Clin North Am

Cook BE Jr et al. (2001) Depressor supercilii muscle: anatomy, histology, and cosmetic implications. Ophthal Plast Reconstr Surg 17(6):404-11 de Almeida AR, Cernea SS (2001) Regarding browlift with botulinum toxin. Dermatol Surg 27(9):848 de Maio M (2004) The minimal approach: an innovation in facial cosmetic procedures. Aesthetic Plast Surg

Frankel AS, Kamer FM (1998) Chemical browlift. Arch

Otolaryngol Head Neck Surg 124(3):321-3 Harrison AR (2003) Chemodenervation for facial dysto-nias and wrinkles. Curr Opin Ophthalmol 14(5):241-5 Huilgol SC et al. (1999) Raising eyebrows with botulinum toxin. Dermatol Surg 25(5)373-5; discussion 376 Klein AW (2004) Botox for the eyes and eyebrows. Der-

matol Clin 22(2):145-9 Koch RJ et al. (1997) Contemporary management of the aging brow and forehead. Laryngoscope 107(6)710-5 Kokoska MS et al. (2002) Modifications of eyebrow position with botulinum exotoxin A. Arch Facial Plast Surg 4(4):244-7 Le Louarn C (1998) Botulinum toxin and facial wrinkles: a new injection procedure. Ann Chir Plast Esthet

Le Louarn C (2001) Botulinum toxin A and facial lines: the variable concentration. Aesthetic Plast Surg.25(2):73-84 Le Louarn C (2004) Functional facial analysis after botulin on toxin injection. Ann Chir Plast Esthet 49(5)^27-36

Lee CJ et al. (2006) The results of periorbital rejuvenation with botulinum toxin A using two different protocols. Aesthetic Plast Surg 30(1^65-70 Matarasso A, Hutchinson O (2003) Evaluating rejuvenation of the forehead and brow: an algorithm for selecting the appropriate technique. Plast Reconstr Surg 112(5):1467-9 Mendez-Eastman SK (2003) BOTOX: a review. Plast Surg

Nurs Summer; 23(2^64-9 Michelow BJ, Guyuron B (1997) Rejuvenation of the upper face. A logical gamut of surgical options. Clin Plast Surg 24(2):199-212 Muhlbauer W, Holm C (1998) Eyebrow asymmetry: ways of correction. Aesthetic Plast Surg 22(5)366-71 Ozsoy Z et al. (2005) A new technique applying botuli-num toxin in narrow and wide foreheads. Aesthetic Plast Surg 29(5):368-72 Redaelli A, Forte R (2003) How to avoid brow ptosis after forehead treatment with botulinum toxin. J Cosmet Laser Ther 5(3-4^220-2 Sadick NS (2004) The cosmetic use of botulinum toxin type B in the upper face. Clin Dermatol 22(1^29-33 Sclafani AP, Kwak E (2005) Alternative management of the aging jawline and neck. Facial Plast Surg

6.3 Treatment with Microinjections

Berthold Rzany

Fig. 6.21. Injection points for the crow's feet area using the microinjection technique

reactions as very small doses are injected quite superficially. This allows the treatment of areas like the cheeks, which for a long time had been thought to be untreatable.

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