Extended Use of Botulinum Toxin Type A in Facial Aesthetic Surgery

Abstract

In facial aesthetic surgery, we perform operations that may at times have short-lived but positive aesthetic effects. When suboptimal results do occur in aesthetic surgery, for example, with laser skin resurfacing, they may relate less to inadequate execution and more to the failure to eliminate some or all causative factors such as exposure to the sun, poor nutrition, smoking, and hyperfunctional facial musculature. Lines typically occur from muscular contractions in facial expressions that involve a multitude of complex coordinated actions of various facial muscles. Hyperfunctional facial muscular contraction tends to be a long-standing, partially involuntary action. Pretreatment of target areas with botulinum toxin type A (Botox®; Allergan Inc., Irvine, CA) may not only temporarily eliminate the facial lines produced by increased muscular activity, but also may improve the effect of the surgical or laser resurfacing procedure. Pretreatment with Botox® before laser exfoliation may allow for smoother skin resurfacing by eliminating the hyperfunctional component during healing. We now better understand how to treat these facial lines with chemodenervation. In 1992 I reported on the use of botulinum toxin type A not only as a primary treatment for glabellar frown lines but also as a supplemental adjunct for autologous injectable collagen (Autologen®; Collagenesis Inc., Beverly, MA) for soft tissue augmentation in certain facial regions.1 Since then, I have found chemodenervation to be useful as a primary modality to temporarily eliminate facial lines and furrows caused by hyperfunctional muscles and as an adjunct and “fortifier” for a variety of facial aesthetic procedures, including laser skin resurfacing, canthoplasty, brow lifts, and soft tissue augmentation. After several years of experience in CO2 laser skin resurfacing, many of us have come to realize that in spite of excellent execution of skin resurfacing, rhytids tend to recur commonly in very …