Abstract Botulinum toxin can be effective in balancing the muscles of the perioral area as they age. The author avoids paralysing the muscles of the upper lip by eliminating upper lip rhytids with CO 2 laser resurfacing and fine fillers instead. Elongation of the upper lip by reduction of resting tone with botulinum toxin usually has an ageing effect on the face. Botulinum toxin is very…

Abstract A thorough knowledge of the anatomy of the forehead and scalp is essential. Movement of muscles on the forehead are relayed through the brain and redirected to affect the innervation of the full forehead and scalp. This knowledge is used to develop the art of predicting expected results when any single muscle is paralysed with botulinum toxin. The author uses botulinum toxin on the forehead…

Abstract The crow’s feet are the wrinkles at the corners of the eyes due to contraction of the orbicularis oculi when smiling. The same part of the muscle is responsible for depressing the lateral part of the eyebrows and for resting tone at the side of the orbits, ‘supporting’ the face. The inferomedial part of the orbicularis muscle also works as a pump, to draw tears…

Abstract Patients with neuromuscular diseases, such as myasthenia gravis, must be warned that botulinum toxin could potentiate their weakness. Some drugs, such as aminoglycosides and anaesthetic agents, will interfere with the effect of botulinum toxin and could result in an overdose. Other drugs, such as antimalarials and cyclosporin, may reduce the effect of the treatment and also the duration. Patient expectations must be informed and realistic.…

Abstract It is important to carefully select patients for botulinum toxin rejuvenation treatment. It must be clear to the patient what the injection will do and how it works. The patient must also be fit to comprehend his or her choices. Some patients misunderstand that botulinum toxin can lift a muscle directly, as opposed to paralysing it. Other patients confuse botulinum toxin with fillers. Realistic expectations…

Abstract Most faces are asymmetrical, with asymmetrical bone structure and therefore overlying muscle volume. The art is to see the difference in sizes and actions of the muscle groups to predict possible difference in innervation of bilateral muscles once the botulinum toxin has blocked the nerve conduction to the muscle. For example, BOTOX will paralyse the frown muscle on one side more than the other if…

Abstract The main serotypes of botulinum toxin comprise different concentration measurements. Each must be reconstituted specifically for its own brand, and doses must not be interchanged. However, BOTOX and Xeomin have been prepared from the same concentration system, and dilutions and dosages in the authors experience are very similar. Dysport and Azzalure derive from a different system. The author stresses that intuitive treatment of a muscle…

Abstract Botulinum toxin is used for cosmetic (45%) and noncosmetic (55%) indications. It is effective as a skeletal muscle relaxant, an antispasticity agent, for essential tremor and for trigeminal neuralgia. Botulinum toxin acts at the autonomic junctions to treat hyperhidrosis and reduce sialorrhoea. It works on involuntary muscle contraction and is effective for internal organ spasticity. It modifies the effect of pain mediators and is effective…

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