A new evidence-based review published in Plastic and Reconstructive Surgery has led to refinements in treatment planning and implementation using botulinum toxin.
A multidisciplinary group of plastic surgeons and dermatologists, including Dr Hema Sundaram and Dr Massimo Signorini, convened the Global Aesthetics Consensus Group to develop updated consensus recommendations with a worldwide perspective for the use of botulinum toxin and hyaluronic acid dermal fillers.
The group, using a interrogative, diagnostic approach, concluded that the use of botulinum toxin has evolved from the upper face to also encompass the lower face, neck and mid-face. They found that injection dosage and placement are based on analysis of target muscles in the context of adjacent ones and associated soft and hard tissues, and that the indication for selection of botulinum toxin as a primary intervention is when excessive muscular contraction is the primary aetiology of the facial disharmony to be addressed.
The recommendations of the group are said to demonstrate a paradigm shift toward neuromodulation rather than paralysis, including lower dosing of the upper face, more frequent combination treatment with hyaluronic acid fillers, and intracutaneous injection where indicated to limit depth and degree of action.
The Global Aesthetics Consensus Group advocates an aetiology-driven, patient-tailored approach, to enable achievement of optimal efficacy and safety in patient populations that are rapidly diversifying with respect to ethnicity, gender, and age.