Botulinum Toxin: Surely, We Can Do Better? Optimizing Results Beyond On-Label Techniques and Teaching

Area of Science:

• Aesthetic Medicine
• Facial Anatomy
• Neuromodulation

Background:

• Facial expressions are vital for communication.
• Botulinum toxin (BoNTA) is used to reduce wrinkles but can cause adverse effects.
• Suboptimal BoNTA injections lead to undesirable aesthetic outcomes.

Purpose of the Study:

• Investigate if standard "on-label" BoNTA injection techniques contribute to poor results.
• Identify factors causing suboptimal outcomes in BoNTA treatments.
• Provide recommendations for improved injection techniques.

Main Methods:

• A consensus group reviewed relevant anatomy, expressions, and complications.
• Database interrogation and expert opinion were utilized.
• Analysis focused on "on-label" treatment protocols and their outcomes.

Main Results:

• Anatomical variations and generic injection patterns cause suboptimal results like brow ptosis and unnatural smiles.
• "On-label" protocols often fail to account for individual patient anatomy and function.
• Adjusting dose, depth, placement, and treating related muscles are key solutions.

Conclusions:

• Standard "on-label" BoNTA techniques can lead to unnatural facial appearances.
• Tailoring injection strategies to individual anatomy and function is critical for optimizing outcomes.
• Moving beyond generic protocols to personalized approaches is recommended for better results.