The Practical Use of AbobotulinumtoxinA in Aesthetics.

Botulinum toxin (BoNT) has been approved for aesthetic use since 2002. Since then, clinical studies and expert use have informed our understanding of how BoNT exerts its clinical effect and the practical use of this product across a number of aesthetic applications. This review discusses the clinical properties and characteristics of abobotulinumtoxinA, which patients are suitable for its use, and how it can be utilized to treat facial rhytides.

Sleep Wrinkles: Facial Aging and Facial Distortion During Sleep.

Wrinkles are just one indicator of facial aging, but an indicator that is of prime importance in our world of facial aesthetics. Wrinkles occur where fault lines develop in aging skin. Those fault lines may be due to skin distortion resulting from facial expression or may be due to skin distortion from mechanical compression during sleep.

OnabotulinumtoxinA for Treatment of Moderate to Severe Crow's Feet Lines: A Review.

Lateral canthal lines or crow's feet lines (CFL) may be treated with onabotulinumtoxinA. We identified several key concepts important to understanding the use of onabotulinumtoxinA for treatment of moderate-to-severe CFL. To contextualize and integrate data on the recommended dose and injection patterns of onabotulinumtoxinA for treatment of CFL, we summarized data from pivotal clinical studies in the development of onabotulinumtoxinA for treatment of CFL.

A Randomized, Double-Blind Trial to Investigate the Equivalence of IncobotulinumtoxinA and OnabotulinumtoxinA for Glabellar Frown Lines.

Background: IncobotulinumtoxinA and onabotulinumtoxinA are indicated for the temporary improvement in the appearance of glabellar frown lines (GFL). This is the first randomized direct comparator study to date, at the Food and Drug Administration-recommended dose of 20 units (U), for the treatment of GFL.

Objective: To investigate the dose equivalence of incobotulinumtoxinA (20 U) and onabotulinumtoxinA (20 U) for the treatment of moderate-to-severe GFL.

Heterogeneity of crow's feet line patterns in clinical trial subjects.

Background: Patterns of crow's feet lines (CFLs) vary among individuals.

Objective: To characterize distribution and predictors of CFL patterns.

Methods: Patterns of CFLs (full fan, lower fan, central fan, and upper fan) were evaluated at maximum smile and at rest from photographs of subjects with moderate-to-severe CFLs.

The convergence of medicine and neurotoxins: a focus on botulinum toxin type A and its application in aesthetic medicine--a global, evidence-based botulinum toxin consensus education initiative: part I: botulinum toxin in clinical and cosmetic practice.

Background: The U.S. Food and Drug Administration has approved four distinct formulations of botulinum toxin (BoNT) serotypes A and B (BoNTA and BoNTB) for medical use.

Current aesthetic use of abobotulinumtoxinA in clinical practice: an evidence-based consensus review.

The amount and complexity of scientific and clinical evidence for aesthetic use of botulinum neurotoxin type A (BoNT-A) has expanded rapidly in recent years, especially for abobotulinumtoxinA, necessitating reassessment of current knowledge about aesthetic use of abobotulinumtoxinA and other BoNT-A preparations. A committee of 13 plastic surgeons, facial plastic surgeons, and dermatologists engaged in a live discussion of information from a systematic literature review and an Internet-based survey of their beliefs and practices. The committee achieved consensus on most issues.

Development and validation of a new clinically-meaningful rating scale for measuring lateral canthal line severity.

Background: Several scales have been employed for evaluating the effects of cosmetic treatments in the periorbital area. The Food and Drug Administration (FDA) has recently issued new recommendations specifying a rigorous process to validate new aesthetic scales.

Objectives: The authors describe and validate a new clinical rating scale: the Investigator's Global Assessment of Lateral Canthal Line (IGA-LCL) severity scale.

Time to onset of response of abobotulinumtoxina in the treatment of glabellar lines: a subset analysis of phase 3 clinical trials of a new botulinum toxin type A.

Background: A new botulinum neurotoxin type A formulation, abobotulinumtoxinA (BoNTA-ABO; Medicis Aesthetics Inc., Scottsdale, AZ), was approved in 2009 in the United States for treatment of moderate to severe glabellar lines in adults younger than 65. OBJECTIVE To determine onset of response based on participant assessments recorded from days 1 through 7.

Randomized sham-controlled trial to evaluate the safety and effectiveness of a high-intensity focused ultrasound device for noninvasive body sculpting.

Background: High-intensity focused ultrasound presents a noninvasive approach to body sculpting for nonobese patients. The purpose of this study was to evaluate the safety and effectiveness of a high-intensity focused ultrasound device for sculpting of the abdomen and flanks.

Methods: Adults (aged 18 to 65 years) with subcutaneous abdominal fat greater than or equal to 2.

An analysis of efficacy data from four phase III studies of botulinum neurotoxin type A-ABO for the treatment of glabellar lines.

Background: A new formulation of a botulinum neurotoxin type A (BoNTA-ABO; Dysport [abobotulinumtoxinA], Medicis Aesthetics, Scottsdale, AZ) has recently been approved in the United States for the treatment of moderate to severe glabellar lines.

Objective: We describe the results of four phase III studies of BoNTA-ABO for the treatment of glabellar lines.

Methods: Of the four studies reported here, three were double-blind, multicenter, randomized, placebo-controlled studies and one was an open-label extension study.

High-intensity focused ultrasound effectively reduces waist circumference by ablating adipose tissue from the abdomen and flanks: a retrospective case series.

Background: Currently available technologies for performing aesthetic body sculpting are either noninvasive but require multiple treatments to achieve relatively superficial effects or very effective but also invasive and sometimes associated with serious complications. A new, noninvasive alternative is to ablate adipose tissue using high-intensity focused ultrasound (HIFU). When focused within subcutaneous adipose tissue, HIFU quickly raises the local temperature, resulting in instantaneous cell death via coagulative necrosis within the targeted area but no damage to the surrounding tissue.

Effect of injection techniques on the rate of local adverse events in patients implanted with nonanimal hyaluronic acid gel dermal fillers.

Background: One question associated with dermal fillers is whether the rate and variability of local adverse events following treatment are related to injection technique and needle trauma or to the intrinsic chemical composition.

Objective: The objective was to determine if there is a relationship between dermal filler injection technique and the incidence of local adverse events.

Methods And Materials: A prospective, blinded, controlled study enrolled 283 patients who were randomized to receive midface volume correction of the nasolabial folds and oral commissures with the nonanimal-stabilized hyaluronic acid (NASHA) gel filler Restylane or Perlane (Medicis Pharmaceutical Corp.

Botox injections for lower facial rejuvenation.

Botox is an excellent adjunct for rejuvenation of the lower face. It should be considered in addition to surgery, resurfacing, skin care, and filler materials to improve the appearance of the lower face. Excellent control and familiarity with the toxin is essential before injecting these rewarding although technically more demanding areas of the face.

Advanced techniques for using Restylane in the lower eyelids.

The author describes injecting hyaluronic acid (Restylane) in the lower eyelids. The key to the superficial injection technique he prefers, which he describes as "technically difficult," is to minimize the volume injected per pass. Furthermore, he discourages massage, which increases eyelid swelling, unless absolutely necessary.

Treatment of tear trough deformity and lower lid bowing with injectable hyaluronic acid.

Tear trough deformity of the lower eyelid is one of the most difficult depressions to correct surgically. The thin skin of the trough, the overhanging abundant lower lid fat, the underlying cheek mound, and the tethering effect of the orbitomalar ligament create a surgical challenge. Until now, noninvasive methods used to treat this depression have been problematic, yielding a poor benefit-to-risk ratio in most hands.

The functional anatomy of the lower face as it applies to rejuvenation via chemodenervation.

Botulinum toxin type A (Botox) injections have revolutionized nonsurgical rejuvenation of the upper face since their introduction in the early 1990s. Their use in the lower face has not become nearly as popular. The key to using Botox to improve the appearance of the lower face lies in understanding the functional anatomy of the lower face musculature.

The effect of botulinum toxin injections on the nasolabial fold.

The use of botulinum toxin A (Botox; Allergan, Irvine, Calif.) for cosmetic purposes was first described in the medical literature in 1992. The author has been using botulinum toxin A in his practice for cosmetic purposes since 1991.