Consensus Recommendations on the Aesthetic Usage of Botulinum Toxin Type A in Asians

Abstract

The use of botulinum toxin has rapidly expanded into various aesthetic applications. Any guideline representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) in Asians has not been published. To provide consensus recommendations on common aesthetic problems which are treated by neurotoxin in Asians. A panel of experienced Korean dermatologists was convened to develop a clinical consensus on common aesthetic problems involving the face, neck, and calves in Asians, based on their own extensive experience. The consensus recommendations address general questions regarding treatment and provide specific guidelines on each common aesthetic indication. The recommended final concentration of BTA was 50U/mL after reconstitution with physiologic saline. For horizontal forehead lines, the members recommended nine injections in two rows into the frontalis with 1U/point. For glabellar lines, the members recommended three injection points (a total of 8U). For crow's feet, the members recommended three injections per side (7U/side) at the lateral part of the orbicularis oculi. For infraorbital wrinkles, one to two points per side in the superficial subcutaneous space approximately 1cm below the lash line were recommended (1-2U/side). For nasal flare, one injection point in the middle of each ala nasi was recommended (a total of 2U). For depressed nasal tip, a single injection deep within the columella was recommended, with a dose of 3U. For benign masseter hypertrophy, the members recommended a six-point injection to the masseter (three points per side for a total of 50-60U). For the treatment of calf hypertrophy, the members recommended a total dose of 100 to 120U (50-60U/side), divided between six injection points (approximately 8-10U/point). This guideline provides a framework for physicians who wish to perform safe and efficacious injections of BTA in Asians.