Aesthetic Treatment Research Articles

The Effects of Body Cold Exposure (Cryolipolysis) on Fat Mass and Plasma Cholesterol.

This study investigates the impact of cryolipolysis on reducing localized fat and altering plasma lipid profiles in 30 overweight and obese women. Conducted at the Health Technology Laboratory of the Evangelical University of Goiás, this clinical research adhered to stringent ethical guidelines. Participants underwent three cryolipolysis sessions, with comprehensive assessments of body composition and plasma lipids performed pre- and post-intervention. Significant findings include a reduction in abdominal fat mass by an average of 4.1 kg and a decrease in BMI by 0.7 points (p < 0.05). Notably, total cholesterol levels decreased by an average of 15.7 mg/dL, and LDL cholesterol saw a reduction of 10.2 mg/dL (p < 0.01), with no significant changes in HDL cholesterol or triglyceride levels. These results suggest that cryolipolysis, in conjunction with standardized dietary control, offers a non-invasive alternative to surgical fat reduction, potentially mitigating cardiovascular risks associated with obesity. The study confirms the efficacy of cryolipolysis in targeted fat reduction and underscores its role in improving key cardiovascular risk factors. These findings warrant further exploration into the long-term benefits of cryolipolysis in metabolic health management and not only for aesthetic treatments.

The Relationship of Aesthetic Dentistry Practices with Depression and Social Appearance Anxiety in Young Women.

This study aimed to evaluate the relationship between depression and social appearance anxiety in young female patients who applied for aesthetic dental treatment. The study was conducted in a single centre and included 56 female patients aged 18-35 years. The mean age of the participants was 22.27 ± 5.62 years. Participants were informed before treatment, and the Beck Depression Inventory (BDI), Social Appearance Anxiety Scale (SAAS), and Visual Analogue Scale (VAS) were administered. Immediately after the treatment and 1 month later, the SAAS and VAS were administered again. The Kruskal-Wallis test was used for the comparison of the data obtained and the Friedman test was used for temporal comparison. Multiple comparisons were made with Dunn's test. After aesthetic dental treatment, all participants' satisfaction with the appearance of their teeth increased, and social appearance anxiety decreased (p 0.001). The group with the lowest pretreatment satisfaction level was the group with moderate/high-level depressive symptoms. There was no correlation between the severity of depression and the increase in satisfaction after treatment (r &#61; 0.247; p &#61; 0.066). Satisfaction levels were similar in all depression groups after treatment. The group with the highest level of social appearance anxiety before and after treatment was the group with moderate/high-severity depressive symptoms. A moderate positive correlation was found between depression severity and social appearance anxiety (r &#61; 0.4; p &#61; 0.002). The severity of depressive symptoms seen before treatment does not affect the level of satisfaction after treatment. There is a decrease in social appearance anxiety after aesthetic dental treatment. There is a positive relationship between social appearance anxiety and depression severity.

Artificial Intelligence for Predicting the Aesthetic Component of the Index of Orthodontic Treatment Need.

The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) is internationally recognized as a reliable and valid method for assessing aesthetic treatment need. The objective of this study is to use artificial intelligence (AI) to automate the AC assessment. A total of 1009 pre-treatment frontal intraoral photos with overjet values were collected. Each photo was graded by an experienced calibration clinician. The AI was trained using the intraoral images, overjet, and two other approaches. For Scheme 1, the training data were AC 1-10. For Scheme 2, the training data were either the two groups AC 1-5 and AC 6-10 or the three groups AC 1-4, AC 5-7, and AC 8-10. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were measured for all approaches. The performance was tested without overjet values as input. The intra-rater reliability for the grader, using kappa, was 0.84 (95% CI 0.76-0.93). Scheme 1 had 77% sensitivity, 88% specificity, 82% accuracy, 89% PPV, and 75% NPV in predicting the binary groups. All other schemes offered poor tradeoffs. Findings after omitting overjet and dataset supplementation results were mixed, depending upon perspective. We have developed deep learning-based algorithms that can predict treatment need based on IOTN-AC reference standards; this provides an adjunct to clinical assessment of dental aesthetics.

Survival and complication rates of tooth- and implant-supported restorations after an observation period up to 36 years.

Tooth- and implant-supported fixed dental prostheses are well-documented and aesthetic treatment alternatives, and after a comprehensive periodontal treatment, a protocol with a good long-term prognosis if the maintenance program is strictly followed. To reexamine a pre-existing patient cohort in order to obtain estimated long-term survival and complication outcomes of fixed dental prostheses. For this study, patients treated with fixed dental prostheses between 1978 and 2002 were reexamined between 2019 and 2020. The restorations were divided in single crowns and fixed dental prostheses supported by teeth (TSC, FPTDP) and implants (ISC, FPIDP). Survival and complication rates were obtained. Kaplan-Meier functions were used to model complication probabilities, and average hazard ratios of different strata were compared using weighted Cox regression. The mean observation time of 40 patients and 223 reconstructions was 20.3 (±9.7, 1.2-36.2) years. The estimated survival rates were 84% (CI: 77%-92%) for TSC, 63% (CI: 51%-79%) for FPTDP, 87% (CI: 71%-100%) for ISC, and 64% (CI: 34%-100%) for FPIDP after 25 years. Biological complications included carious lesions (10.6%), periodontitis (7.9%), and peri-implantitis (6.8%). Technical complications included chipping (20.2%) and loss of retention (10.8%). Biological complications lead to abutment loss in more than two-thirds of cases, regardless of the type of abutment (tooth or implant). Technical complications are less associated with abutment loss than biological complications.

Full Face Tailored Treatments Using Hyaluronan Dermal Fillers: Biophysical Characterization for Safe and Effective Approaches

Hyaluronic acid (HA)-based dermal fillers are among the most popular non-invasive facial aesthetic treatments. To ensure an effective and safe treatment experience, knowledge of their biophysical and rheological characteristics, such as: HA concentration, molecular weight (MW), G′, and the degree of cross-linking is essential. Products with a higher MW, G′, and degree of cross-linking are more suitable for promoting volume and lift. Dermal fillers with a lower MW, G′, and degree of cross-linking can produce a soft filling effect that regulates hydration and elasticity. This review discusses how these rheological characteristics can inform treatment choice and their effects on clinical outcomes. The Aliaxin® line of HA dermal fillers, which are tailored to different clinical applications due to their rheological characteristics, highlights that extensive knowledge of the product can provide very safe and effective procedures for patients, whilst respecting their natural facial aesthetics. This review discusses studies using Aliaxin® dermal fillers for volumizing and hydrating treatments and fillers that can be used for lip augmentation. Treatment with Aliaxin® was overall very effective, with no reported adverse events. A full facial treatment using tailored dermal fillers may be a future approach to achieve an effective and safe harmonized and natural aesthetic.

Anatomy, Etiology, Management, and Medico-Legal Implications of Botulinum-induced Blepharoptosis

Abstract: Botulinum toxin injections, a popular aesthetic treatment, have over 7.4 million beneficiaries in the U.S. Despite their safety record, these injections pose potential complications. It is essential for aesthetic practitioners to manage these complications with the least impact on the patient. Upper eyelid ptosis, though rare, is a significant side effect of botulinum toxin injections. Through our study, we have identified the etiology, anatomy, and therapeutic management of botulinum- induced blepharoptosis. Hence, the goal of this study was to identify the basic aetiology of blepharoptosis and manage this complication, as well as discuss the basis of medico-legal implications involving this popular drug. The complex medico-legal implications of botulinum toxin-induced blepharoptosis call for continuous discourse, education, and clarity on drug-use legal standards. With evolving global and Italian legislation, practitioners must ensure they meet care standards, weighing treatment benefits against potential legal and ethical outcomes. Blepharoptosis is a rare but significant complication of botulinum-type injections. Etiology and thorough anatomy are crucial for avoiding this complication and handling it with the least impact on the patient. Medico-legal implications are currently not fully established, but the basis of aesthetic treatment standards, as well as continuing medical education, will ensure correct medico-legal coverage of such complications.

A 360° Approach to Patient Care in Aesthetic Facial Rejuvenation.

Aesthetic medicine has traditionally focused on addressing perceived problem areas, with lack of long-term planning and engagement. This article describes a patient-centric model for nonsurgical aesthetic medical practice, termed the 360° approach to facial aesthetic rejuvenation. The 360° approach was divided into 4 foundational pillars. Medical literature, the authors' clinical experiences, and results from patient satisfaction surveys were used to support the approach. Pillar 1 describes the development of a complete understanding of the patient, based on the use of active listening principles, to characterize the patient's current aesthetic concerns, lifestyle, medical and treatment history, treatment goals, attitude toward aesthetic treatment, and financial resources. Pillar 2 involves conducting a comprehensive facial assessment in contrast to a feature-specific assessment, considering multiple facial tissues and structures and their interrelationships, thus helping to prevent the unanticipated consequences of narrowly focused treatment. Pillar 3 describes leveraging all available treatments and techniques in the development of an initial treatment plan arising from the facial assessment. Pillar 4 adds a time dimension to treatment planning, working toward the goal of a long-term modifiable treatment timeline, with full patient support and involvement; this is designed to facilitate a durable, sustained relationship between the patient and aesthetic healthcare professional (HCP). Although implementation involves substantial commitment and time, the patient-oriented focus of the 360° approach can help achieve optimal patient outcomes and the development of enduring patient-HCP relationships.

Psychometric validation of the FACE-Q Aesthetics Satisfaction with Temples scale in individuals seeking minimally invasive treatment to improve temple hollowing.

The FACE-Q Aesthetics is used extensively to measure patient reported outcomes for minimally invasive and surgical facial aesthetic treatments. We recently developed a new FACE-Q scale to assess satisfaction with the appearance of the temples. The aim of this study was to field test the FACE-Q Satisfaction with Temples scale to examine its psychometric properties. The FACE-Q Satisfaction with Temples scale was administered to 171 adults (22 years or older) seeking minimally invasive treatment to improve temple hollowing as part of a clinical trial. The severity of temple hollowing was established through the clinician-reported Allergan Temple Hollowing scale (clinician-rated). The psychometric properties of the FACE-Q Satisfaction with Temples scale were established by testing Rasch Measurement Theory (RMT) assumptions and model fit; unidimensionality by principal component analysis; and construct validity by hypothesis testing. The study sample consisted of 171 adults (mean age 54.7 ± 9.9, range, 25-82 years). RMT analysis provided evidence for the scientific soundness of a 12-item Satisfaction with Temples scale. The data fit the Rasch model (χ2 = 20.47, df = 24, p = 0.67), all items had ordered thresholds, and good item fit. Scale reliability was high, with Person Separation Index and Cronbach alpha values with and without extremes ≥0.93. Principal component analysis revealed a single component with high factor coefficients. Construct validity was established as scores for the Satisfaction with Temples and Face Overall scales were correlated (r = 0.623, p < 0.001). The FACE-Q Satisfaction with Temples scale is a reliable and valid measure that can be used in clinical practice and research to measure outcomes following treatment for temple hollowing.

The integration of facial aesthetics and aesthetic dentistry

The aesthetics industry is still unregulated in the UK, and with the surge in people seeking facial aesthetic procedures, there has been a concomitant increase in the incidence of complications associated with these procedures. Dentists are especially well positioned to undertake facial aesthetic treatments providing that they have the appropriate training. Dentists generally have a strong foundational understanding of facial anatomy, in particular skeletal jaw structure, musculature, nerve and main vascular supply. In particular, dentists are exceptionally insightful around the peri-oral region and the smile. CPD/Clinical Relevance: There are many parallels and transferable skills between dentistry and facial aesthetics and dentists are well positioned to undertake facial aesthetic treatments after appropriate training.

Intradermal Botulinum Toxin A on Skin Quality and Facial Rejuvenation: A Systematic Review and Meta-analysis.

Botulinum toxin A (BTxA) has gained popularity as a nonsurgical aesthetic treatment for skin rejuvenation. However, previous studies on intradermal BTxA have shown inconsistent results. This systematic review and meta-analysis with trial sequential analysis aimed to assess the efficacy and safety of intradermal BTxA for facial rejuvenation. Following PRISMA guidelines, a comprehensive search was conducted in various databases from January 2008 to March 2023. Outcome measures included sebum production, pore size, skin hydration, skin texture, erythema index, facial wrinkles, and facelift. Eligible studies included human-based clinical trials and prospective cohort studies published in English, focusing on healthy populations requiring facial rejuvenation. Two authors independently screened the titles and abstracts, followed by a full-text review to determine study eligibility. Data extraction and quality assessment were performed by two authors using predefined criteria. Ten studies met the inclusion criteria, including five randomized controlled trials and five prospective cohort studies with 153 participants. Studies revealed positive effects of intradermal BTxA on various outcome measures related to facial rejuvenation. These effects included improvements in sebum production, pore size, erythema index, facial wrinkles, skin texture and elasticity, and overall facelift but not skin hydration. All failed to reach the required information size in the trial sequential analysis. Findings suggest positive outcomes in multiple attributes of skin quality and facial rejuvenation. However, more high-quality research is needed to establish definitive conclusions. These findings contribute to the evidence base for nonsurgical aesthetic treatments, emphasizing the importance of ongoing research in this field.

A prosthetic-surgical approach for aesthetic treatment of peri-implant soft tissue defects: A case report

Peri-implant soft tissue defects (PSTD) in the esthetic zone affect approximately 54% cases of post-implant insertion, leading to aesthetic concerns and increasing the risk of peri-implantitis. Various surgical techniques are aimed at addressing these issues, but the outcomes can be unpredictable, especially for severely mispositioned implants. This report details a combined prosthetic and surgical approach to treat a severely angulated single central maxillary implant with mid-labial mucosal recession. A 38-year-old female expressed dissatisfaction with the implant at 21 area, which appeared elongated due to peri-implant mucosal recession of almost 4 mm. Treatment involved two phases: 1) prosthetic phase involves replacing the original crown of implant at 21 area with a temporary crown to promote mucosal growth and 2) surgical phase that involves soft tissue surgery three months later using an envelope flap technique at the recipient site and a connective tissue graft harvested from the palate. Upon three months after the surgery, full coverage with thick mucosal tissue was achieved, and a new zirconia crown was placed. The outcome remained stable throughout the nine-month follow-up. This case demonstrates that PSTD in angulated implants in the esthetic zone can be effectively treated through a combination of prosthetic and surgical modalities.

Neurotoxins and Combination Therapies.

Facial aging involves multilevel changes, extending from the skin to deep support structures. A comprehensive treatment approach targeting the many aspects of facial dynamics and architecture is often necessary to achieve optimal correction, prevent changes before they occur, and/or help highlight inherited features. To explore the integration of botulinum toxin type A (BoNT-A) into multimodal aesthetic treatment plans. This article reviews evidence supporting the combination of BoNT-A with other minimally invasive cosmetic therapies, including dermal fillers, lasers, and energy-based devices as well as with plastic and reconstructive surgeries for more controlled healing and improved scar cosmesis. Combination treatment protocols including BoNT-A demonstrate higher patient satisfaction and retention rates compared to monotherapy or sequential treatments. Some guidelines for sequencing of treatments exist, but evidence is scant with certain combinations. Integrating BoNT-A into a larger aesthetic treatment plan is crucial for achieving natural and satisfying results in facial rejuvenation. Evidence supports better outcomes when incorporating with both surgical and nonsurgical modalities. Understanding how to address anatomy over time through different aesthetic therapies together allows for individually tailored, more deeply impactful treatment plans.

Exosomes Exposed: Overview Systematic Review on Evidence Versus Expectation in Aesthetic and Regenerative Medicine.

Exosomes, diminutive extracellular vesicles, are integral to intercellular communication, harbouring potential for applications in regenerative medicine and aesthetic interventions. The field, however, grapples with the complexities of harmonising exosome characterisation protocols and safeguarding therapeutic integrity. In this scholarly overview, systematic adherence to the Cochrane Collaboration and Preferred Reporting Items for Overviews of Reviews guidelines was observed, scrutinising the congruence of exosome-related therapies with the Minimal Information for Studies of Extracellular Vesicles standards delineated by the International Society for Extracellular Vesicles, alongside criteria set forth by the International Society for Cell Therapy and the International Society for Stem Cell Research. A meticulous search strategy spanning databases such as PubMed, Scopus, Web of Science, EMBASE, and Cochrane database was employed to encapsulate studies pertinent to the isolation, characterisation, and functional assessment of exosomes. The initial search yielded 225 articles, of which 17 systematic reviews were selected based on predefined criteria, encompassing 556 primary studies. Notwithstanding the acknowledged therapeutic promise of exosome modalities, the synthesis illuminated a prevalent deficiency in adherence to established reporting and experimental benchmarks, notably in exosome source characterisation and bioactive constituent delineation. A critical appraisal employing the AMSTAR-2 tool underscored a pervasive shortfall in methodological rigour. This review accentuates the imperative for stringent methodological standardisation within exosome research to fortify the validity and reproducibility of empirical findings. Amidst the burgeoning therapeutic optimism, the discipline must rectify methodological disparities and comply with regulatory mandates, ensuring the ethically sound and scientifically robust advancement of exosome-based therapeutic modalities. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

IncobotulinumtoxinA for Aesthetic Treatments: Review and Recommendations From Latin America.

As new aesthetic treatment techniques are developed, the understanding of botulinum toxin type A safety and treatment outcomes continues to evolve. This article was developed to provide a comprehensive up-to-date reference for clinicians using incobotulinumtoxinA (INCO; Xeomin/Bocouture, Merz Pharmaceuticals GmbH, Frankfurt, Germany) for aesthetic treatments. A Latin American panel of 11 physicians was assembled to discuss and develop recommendations on the use of INCO for aesthetic treatment based on the literature review and their private medical practice. The panel found that INCO is a highly purified botulinum toxin, without other clostridial proteins (hemagglutinins and nonhemagglutinins). IncobotulinumtoxinA has proven its efficacy and duration over time, maintaining response after multiple treatment cycles. This recommendation provides up-to-date information on the use of INCO for aesthetic treatment, focusing on the differential properties of this product regarding its purity, performance, customization, and patient satisfaction.

Aesthetic medicine treatments for young men

In the 21st century, a very important element of interpersonal contacts is the perception of another person. Appearance became the essence of these relationships. It is not only the clothes, but the physiognomy of the person we are in contact with. Aesthetic medicine treatments are most often used by women, but in the last decade this has changed, because men have also started to take care of the appearance of their face. That is why it is so important to address the topic of treatments that gentlemen undergo.

Medical aesthetic awareness among public in Malaysia and the factors that may influence it: A cross-sectional study.

Medical aesthetic practice is growing rapidly in Malaysia due to rising market demand, yet public understanding of these practices remains limited. This study evaluated the awareness and attitudes towards medical aesthetics among Malaysians. A cross-sectional survey was conducted among individuals aged > 18 years old in Malaysia from December 2021 to May 2022. The survey was distributed both online and in public settings. The survey comprised of respondents' sociodemographic, perception of physical attractiveness, knowledge and attitude towards medical aesthetic practices. The factors influencing respondents' attitudes towards medical aesthetic practices in the country were analysed using binary logistic regression, with the significance level set at P<0.05. A total of 382 respondents participated in this study with average age of 30.81 (±9.38) years, ranging from 18 to 68 years. The majority were women (77.5%), Malay (53.7%) and Muslim (57.1%). Although most respondents had no prior experience in medical aesthetic treatment (68.1%), 76.2% respondents demonstrated good knowledge and 70.2% had positive attitude towards these services. Additionally, 53.9% of the respondents highly valued the importance of physical attractiveness. The Buddhists and Hindus exhibited more positive attitude than the Muslims. Conversely, those who placed higher importance on physical attractiveness were 0.5 times less likely to develop a positive attitude towards medical aesthetic services. In conclusion, despite limited experience in medical aesthetic treatments and practice, most Malaysians possess good knowledge and positive attitudes towards medical aesthetics, indicating a growing interest and potential willingness to consider these services for enhancing their appearance.

Topical Treatment and Aesthetic Procedures in Management of Acne Vulgaris

Acne vulgaris is a common, chronic inflammatory skin disease affecting up to 80% of young adults and adolescents. The pathogenesis of acne is multifactorial and involves the pilosebaceous units of the skin. As a result of the disease process, skin lesions such as open and closed comedones, nodules, pustules, and papules appear on the skin. In recent years, acne has been increasingly observed in younger patients, which is associated with the earlier onset of puberty. Moreover, acne is increasingly diagnosed in individuals over 20 years of age, particularly in women, which is referred to as adult female acne (AFA). Effective and rapid implementation of treatment is crucial to prevent complications such as post-inflammatory hyperpigmentation and acne scars, as well as to mitigate the negative psychological impact of the disease on patients. The article discusses both topical treatment and aesthetic medicine procedures in the management of acne vulgaris. Topical treatments include the use of retinoids, antibiotics, benzoyl peroxide, clascoterone, dapsone, azelaic acid, and combination therapies. Aesthetic procedures such as chemical peels, microdermabrasion, photodynamic therapy, blue light therapy, and laser therapies can be beneficial as adjunctive treatments. The article also addresses the issue of acne as a comorbid condition in patients seeking aesthetic medicine treatments, even if it is not the primary reason for their visit.

Neuromodulators in Skin of Color: An International Review.

As the racial/ethnic diversity of the US population grows, it is imperative for dermatologists to recognize the nuances in the aesthetic treatment of diverse populations. This comprehensive review explores the safety and efficacy of botulinum toxin A (BTX-A) in skin of color (SOC) populations and highlights variations in aging patterns, skin properties, and aesthetic concerns in SOC populations. A review of PubMed/MEDLINE databases from 2004 to 2024 was performed using combinations of the terms botulinum toxin, SOC, Fitzpatrick, race/ethnicity, and Asian, Latin American, Caribbean, Middle Eastern, African, and Pacific countries. Twenty-three articles examining the use of BTX-A in SOC populations were identified. Twelve studies were from East Asia, 5 from the United States and/or Canada, 3 from South Asia/Southeast Asia, 2 from South America, and 1 from the Middle East. Available data suggest that BTX-A is efficacious and well tolerated in SOC populations. Increased SOC representation in clinical trials may guide the development of tailored treatment approaches to optimize aesthetic outcomes for patients with SOC. A comprehensive knowledge of the variations in aging patterns, skin properties, and aesthetic concerns across SOC populations is essential for providing culturally sensitive cosmetic dermatologic care for diverse populations.

Botulinum Toxin in Treatments for Abnormal Movements

Introduction: Botulinum toxin is crucial for reducing sequelae in movement disorders such as Parkinson's. It blocks muscle contractions and improves quality of life, being used in both aesthetic and medical treatments. Methodology: A non-experimental longitudinal design was adopted, observing variables at multiple time points without manipulation. A mixed approach (qualitative and quantitative) was used with adults over 30 years old without Parkinson's history. The review included documents from PubMed, Scopus, and Scielo, applying rigorous inclusion and exclusion criteria. Objective: To evaluate the efficacy of botulinum toxin in treating abnormal movements in Parkinson's and understand its long-term effects. Results: Botulinum toxin type A reduces tremors by blocking acetylcholine. It improves motor symptoms of Parkinson's and essential tremor but requires frequent and costly treatments. There is a risk of developing antibodies that decrease its effectiveness. Discussion: It offers significant benefits, but its high cost and the need for frequent treatments are challenges. Patients report satisfaction in short-term studies, but more long-term research is needed. Conclusions: Promising for movement disorders, especially Parkinson's, although limited by cost and duration of effect. Future research should seek to extend therapeutic effects and reduce costs.

Assessment of the Efficacy and Durability of IncobotulinumtoxinA in the Treatment of the Upper Face in Adult Women.

IncobotulinumtoxinA (Xeomin®) is used in the treatment of dynamic wrinkles and the aesthetic repositioning of facial structures. The duration of its muscular effect typically extends for around 4months. However, the residual aesthetic benefit can be observed for a longer period. To date, the long-term aesthetic benefit of incobotulinumtoxinA in facial aesthetics has not been systematically evaluated. This study aimed to evaluate longitudinally the duration and aesthetic benefits of incobotulinumtoxinA in the treatment of the upper face in adult women. A quasi-experimental, evaluator-blind, clinical trial involving 28 adult women (30-60years old) with facial movement lines, undergoing treatment of the upper face with incobotulinumtoxinA by two injectors, following an individualized protocol (ONE21 and glabellar contraction patterns) was performed. Participants were evaluated on the day of the intervention (day0) and days30, 120, 180, and 240, and subjected to standardized photographs. The following outcomes were evaluated blindly at each visit: Merz Aesthetics Facial Contraction Scale (MAS), GAIS (Global Aesthetic Improvement Scale), and patient satisfaction. Adverse effects were evaluated at each visit. Participants ranged in age from 30 to 60years, 93% were self-declared white, and most of their baseline MAS scores for dynamic lines were moderate and severe. All the parameters presented significative reduction from baseline until day180. At day240, the dynamic MAS scores were lower than baseline for forehead lines in 15.4% (95% confidence interval (CI) 0.8-30.0%) of the participants, for glabellar lines in 38.5% (95%CI 18.8-58.1%), and for crow's feet lines in 26.9% (95%CI 9.0-44.8%). Aesthetic improvement compared to baseline was identified in 35% (CI 95% 23‒50%) of the participants at day240, and 62% (CI 95% 42‒81%) of the sample kept reporting some satisfaction with the procedure. The aesthetic treatment of the upper face with incobotulinumtoxinA demonstrates enduring clinical benefits, and patient satisfaction lasting up to 180days in most participants. The length of efficacy, which exceeded those reported in the literature, may be attributed to the use of techniques based on individualized assessment such as ONE21 and glabellar patterns of contraction.