Review Article| Volume 24, ISSUE 2, P95-103, September 2016

Botulinum Toxin Use in the Upper Face

      Botulinum toxin is a potent exotoxin that disrupts neuromuscular transmission by inhibiting the release for acetylcholine from the presynaptic membrane resulting in attenuation of muscle contraction.


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        • Carruthers J.A.
        • Carruthers J.A.
        Treatment of glabellar frown lines C. Botulinum-A exotoxin.
        J Dermatol Surg Oncol. 1992; 18: 17-21
      1. The American Society for Aesthetic Plastic Surgery (ASAPS) 2013 facts and statistics report. Available at: Accessed December 15, 2015.

        • Erickson B.P.
        • Lee W.W.
        • Cohen J.
        • et al.
        The role of neurotoxins in the periorbital and mid facial areas.
        Facial Plast Surg Clin North Am. 2015; 23: 243-255
        • Matarasso A.
        • Shafer D.
        Botulinum toxin injections for facial rejuvenation.
        in: Nahai F. The art of aesthetic surgery: principles and techniques. 2nd edition. Quality Medical Publishing, St Louis (MO)2011: 243-246
        • Feily A.
        • Fallahi H.
        • Zandian D.
        • et al.
        A succinct review of botulinum toxin in dermatology; update of cosmetic and non-cosmetic use.
        J Cosmet Dermatol. 2011; 10: 58-67
        • Klein A.W.
        Contraindications and complications with the use of botulinum toxin.
        Clin Dermatol. 2004; 22: 66-75
        • Matarasso A.
        • Centeon R.F.
        • Boswell C.B.
        Botulinum toxin for management of focal hyperhydrosis.
        Aesthet Surg J. 2002; 23: 67-69
        • Sorensen E.P.
        • Urman C.
        Cosmetic complications: rare and serious events following botulinum toxin and soft tissue filler administration.
        J Drugs Dermatol. 2015; 14: 486-491
      2. Botox Cosmetic (2014) OnabotulinumtoxinA: full prescribing information. Allergan Inc., Irvine.

      3. Xeomin (2013) IncobotulinumtoxinA: full prescribing information. Merz Pharmaceuticals, LLC, Greensboro.

      4. Dysport (2010) AbobotulinumtoxinA: full prescribing information. Medicis Aesthetics Inc., Scottsdale.

        • Chen J.J.
        • Dashtipour K.
        Abo-, inco-, ona-, and rimabotulinum toxins in clinical therapy: a primer.
        Pharmacotherapy. 2013; 33: 304-318
        • Liu A.
        • Carruthers A.
        • Cohen J.L.
        • et al.
        Recommendations and current practices for reconstitution and storage of botulinum toxin type A.
        J Am Acad Dermatol. 2012; 67: 373-378
        • Hui J.I.
        • Lee W.W.
        Efficacy of fresh versus refrigerated botulinum toxin in the treatment of lateral periorbital rhytids.
        Ophthal Plast Recontr Surg. 2007; 23: 433-438
        • Lowe N.J.
        • Shah A.
        • Lowe P.L.
        • et al.
        Dosing, efficacy and safety plus the use of computerized photography for botulinum toxins type A for upper facial lines.
        J Cosmet Laser Ther. 2010; 12: 106-111
        • Carruthers A.
        • Carruthers J.
        • Cohen J.
        Dilution volume of botulinum toxin type A for the treatment of glabellar rhytids: does it matter?.
        Dermatol Surg. 2007; 33: S97-S104
        • Carruthers J.
        • Fagien S.
        • Mattarasso S.L.
        • et al.
        Consensus recommendations on the use of botulinum toxin type A in facial esthetics.
        Plast Reconstr Surg. 2004; 114: 1S-22S
        • Jankovic J.
        Botulinum toxin: clinical implications of antigenicity and immunoresistance.
        in: Brin M.F. Jankovic J. Hallet M. Scientific and therapeutic aspects of botulinum toxin. Lippencott Williams and Wilkins, Philadelphia2002: 409-415
        • Huang W.
        • Rogashefsky A.S.
        • Foster J.A.
        Browlift with botulinum toxin.
        Dermatol Surg. 2000; 26: 55-60
        • Frankel A.S.
        • Kamer F.M.
        Chemical browlift.
        Arch Otolaryngol Head Neck Surg. 1998; 124: 3221-3223
        • Prager W.
        • Huber-Vorlander J.
        • Taufig A.Z.
        • et al.
        Botulinum toxin type A treatment in the upper face: retrospective analysis of daily practice.
        Clin Cosmet Investig Dermatol. 2012; 5: 53-58
        • Matarasso A.
        • Matarasso S.L.
        Treatment guidelines for botulinum toxin type A for peri-ocular injection and a report of upper lip ptosis following injections of lateral canthal rhytids.
        Plast Reconstr Surg. 2001; 108: 208-214
        • Flynn T.C.
        • Carruthers J.A.
        • Carruthers J.A.
        Botulinum toxin treatment of lower eyelid improves infra-lid rhytids and widens the eye.
        Dermatol Surg. 2001; 27: 703-708
        • Carruthers J.
        • Carruthers A.
        Botulinum toxin in facial rejuvenation: an update.
        Dermatol Clin. 2009; 27: 417-425
        • Klein A.W.
        Complications, adverse reactions, and insights with the use of botulinum toxin.
        Dermatol Surg. 2003; 29: 549-556
        • Goschel H.
        • Wolfarth K.
        • Frevert J.
        • et al.
        Botulinum A toxin therapy. Neutralizing and non-neutralizing antibodies-therapeutic consequences.
        Exp Neurol. 1997; 147: 96-102
        • Crowner B.E.
        • Torres-Rusotto D.
        • Carter A.P.
        • et al.
        Systemic weakness after therapeutic injections of botulinum toxin A: a case series and review of the literature.
        Clin Neuropharmacol. 2010; 33: 243-247

      Further readings

        • Carruthers A.
        • Carruthers J.
        • Said S.
        Dose ranging study of botulinum toxin type A in the treatment of glabellar rhytids.
        Dermatol Surg. 2005; 32: 414-422
        • Cartee T.V.
        • Monheit G.D.
        An overview of botulinum toxins: past, present and future.
        Clin Plast Surg. 2011; 38: 409-426
        • Flynn T.C.
        Botulinum toxin: examining duration of effect in facial esthetic applications.
        Am J Clin Dermatol. 2010; 11: 183-199
        • Guyuron B.
        • Tucker T.
        • Kriegler J.
        Botulinum toxin and migraine surgery.
        Plast Reconstr Surg. 2003; 112: 171S-173S
        • Hsu T.S.
        • Dover J.S.
        • Arndt K.A.
        Effect of volume and concentration on the diffusion of botulinum exotoxin A.
        Arch Dermatol. 2004; 140: 1351-1354
        • Matarasso S.L.
        Complications of botulinum exotoxin for hyperfunctional lines.
        Dermatol Surg. 1998; 24: 1249-1254