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[Skin, wrinkles and botulinum toxin]
P J Nicolau1, M Chaouat, M Mimoun
1Service de chirurgie plastique, reconstructrice et esthétique et des brûlés, hôpital Rothschild, 33, boulevard de Picpus, 75571 Paris cedex 12, France. pjnicolau@mageos.com
Objective:
To present an up-to-date analysis about the use of botulinum toxin for treating facial lines and wrinkles.Method. - A systematic search of the literature was conducted to select the most recent or relevant publications on this topic, through Medline.
Results:
Out of the 583 articles retrieved, 90 were finally selected for the study.
Discussion:
Validity of using botulinum toxin for cosmetic use is demonstrated, together with contra-indications and different methods to objectivate the results. The different available types of toxin are presented and compared. Modalities of preparation, conservation, and waste disposal are detailed. Anatomical bases of muscular facial balance are reviewed, with techniques of injection presented for each site, and also with adjunctive procedures. Complications and side effects are described and analysed. Most complications can be prevented through: perfect knowledge of local anatomy;use of small volumes;orientation of the needle bevel towards the muscle body, injection within the muscle body if thick, more superficial if thin;application of ice on the skin pre- and post-injecting. Adding epinephrin or diluting with xylocaïne and epinephrin is not commonly used.
Conclusion:
Botulinum toxin has found its way as a major component of the therapeutic armamentarium. Its efficacy for facial rejuvenation has made it extremely popular, but its use does follow strict rules, and should be restricted to soundly trained practitioners.