Neurotoxins: Current Concepts in Cosmetic Use on the Face and Neck--Lower Face

Botulinum toxin A was Food and Drug Administration approved in 2002 for the temporary correction of glabellar frown lines. Since that time, a variety of neuromodulators have established a convincing profile for both safety and efficacy in the treatment hyperdynamic rhytides of the upper face. With increasing clinical experience and expertise, these applications have been expanded to include targeted treatment of muscles in both the mid and lower face. This article details common techniques using botulinum toxin to treat orbicularis oris, depressor anguli oris, mentalis, and masseter muscles for the temporary correction of unwanted lower face hyperdynamic rhytides and facial contouring. Although we detail our suggested quantity of units per injection site based on onabotulinumtoxinA, all neuromodulators can be used in all of these suggested treatment areas with adjustment of the quantity of units based on the efficacy of the specific neuromodulator. A more compete discussion on the relative efficacy of all neuromodulators is beyond the scope of this article.