Procedures in Cosmetic Dermatology: Botulinum Toxin

Offering a step-by-step, practical approach to this commonly performed cosmetic procedure, Procedures in Cosmetic Dermatology: Botulinum Toxin, 5th Edition, enables you to master the up-to-date cosmetic techniques that produce the superior results your patients expect. Edited by expert clinicians Drs. Alastair Carruthers and Jean Carruthers, along with Jeffrey S. Dover, Murad Alam, and Omar Ibrahim, it covers the science behind these neuromodulators and their usage areas in cosmetic dermatology, as well as the latest treatment options—all abundantly illustrated and evidence based. A substantial video library demonstrating injection techniques helps you successfully incorporate the latest procedures into your practice.

Cover image
Title page
Table of Contents
Series Editors
Copyright
Video contents
Series Preface
Series Preface First Edition
Preface
List of Contributors
Dedication
List of Tables
List of Illustrations
Part I. Basic Science and Clinical Use of Neuromodulators
1. Update on noncosmetic uses of botulinum neurotoxins
Introduction
Strabismus
Blepharospasm
Sialorrhea
Summary
Acknowledgements
Further reading
2. History of cosmetic botulinum toxin
Introduction
Serendipitous discovery
Patient zero and the first clinical trials
FDA approval
Longevity of response
The global face of BoNT-A
Further reading
3. Pharmacology of BOTOX® cosmetic
Introduction
Serotypes and structure
Manufacturing and formulation
Mechanism of action
Clinical pharmacology of onabotulinumtoxinA in aesthetics
Approvals
Exploration of potential new uses in dermatology
Summary and conclusions
Disclosures
Acknowledgments
Further reading
4. Abobotulinum toxin A: Science and clinical usage
Clinical studies performed for abobotulinumtoxinA
New clinical uses and research
Further reading
5. Basic science: Xeomin
Introduction
Properties of incobotulinumtoxinA
Clinical performance of incobotulinumtoxinA
Clinical experience with incobotulinumtoxinA
Conclusions
Further reading
6. Prabotulinum toxin A
Introduction
Manufacturing
Clinical
Real-world experience
Conclusions
Further reading
7. Basic science: Myobloc®
Pharmacology of botulinum toxin B
Immunogenicity of Myobloc
Liquid formulation of Myobloc
Myobloc in the aesthetics practice
Treatment considerations for Myobloc
Adverse events
Conclusions
Further reading
8. Basic science of botulinum toxin E
Introduction
Properties and structure
Mechanism of action
Exploration of potential new uses in dermatology
Summary and conclusions
Further reading
9. Neuronox®, Innotox®, and Coretox®
Introduction
Manufacturing process of Neuronox®, Innotox®, and Coretox®
Composition and formulation of Neuronox®, Innotox®, and Coretox®
Pharmacodynamics of Neuronox®, Innotox®, and Coretox®
Clinical experience with Neuronox®, Innotox®, and Coretox®
Use of Neuronox®, Innotox®, and Coretox® in Asians
Conclusion
Further reading
10. DaxibotulinumtoxinA for injection (DAXI)
DAXI clinical program: Treatment of glabellar lines
DAXI clinical data in therapeutic studies: Treatment of cervical dystonia and adult upper limb spasticity
Conclusion
Further reading
11. Comparison of botulinum toxins
Introduction
Background
Types of botulinum toxin A
Mechanism
Composition
Dosing
Efficacy
Duration
Diffusion
Safety
Limited treatment response
Storage
Conclusions
Further reading
12. Topical botulinum toxin type A
Introduction
Barriers to transdermal permeation
Cell-penetrating peptides
Nano-emulsion delivery systems
Cell penetrating protein delivery of topical botulinum toxin type A
Allergan botulinum toxin type A topical nanoparticle delivery system
Conclusions
Further reading
13. Reconstitution and dilution
Introduction
Reconstitution diluents
Foaming, shaking, and stirring
Concentration of toxin: Does it matter?
Conclusions
Further reading
14. Benzyl alcohol
Introduction
Saline with benzyl alcohol: Early evidence of anesthetic efficacy and historical concerns
Saline with benzyl alcohol: Randomized controlled trials with botulinum toxin
Saline with benzyl alcohol: Use in combination with lidocaine infiltration
Saline with benzyl alcohol: Use in comparison with lidocaine infiltration
Safety of saline with benzyl alcohol
Summary of key concepts
Further reading
Part II. Neuromodulator Injection Sites
15. Treatment of glabellar lines with neuromodulators
Introduction
Anatomy
Injection technique (see Videos 15.1A–C “Botulinum Toxin Glabella”)
Dosing
Novel botulinum neurotoxins
Special considerations
Potential adverse events
Conclusion
Further reading
16. Treatment of frontalis and horizontal forehead lines with neuromodulators
Introduction
Anatomy
Special considerations
Conclusion
Further reading
Frontalis injection techniques
More
17. Shaping the eyebrow and upper face (palpebral aperture) with neuromodulators
The periorbital region
The palpebral aperture
Further reading
18. Treatment of crow’s feet
Introduction
Anatomy of crow’s feet lateral orbital rhytides
The youthful eye
The aging eye
Pretreatment assessment
Treatment
Adjunctive treatments
Complications
Conclusions
Further reading
19. Treatment of infraorbital/upper and lower eyelids with neuromodulators
Introduction
Anatomy of the eye
Periorbital aging
Patient assessment and selection
Contraindications
Indications and techniques
Hypertrophic orbicularis, infraorbital rhytides, and widening of the eye
Lid ptosis, malposition, and asymmetry
Periorbital / orbicularis muscle and fissure asymmetry, synkinesis and miscellaneous spastic disorders
Other periorbital effects
Adjunctive treatments for the lid
Adverse events
Conclusions
Further reading
20. Treatment of the midface with botulinum toxin
Introduction
“Bunny” lines
Gummy smile
Zygomaticus complex
Nasal tip
Rosacea
Conclusion
Further reading
21. Treatment of orbicularis oris, mentalis, depressor anguli oris with neuromodulators
Introduction
Patient assessment
Orbicularis oris
Mentalis
Depressor anguli oris
Conclusion
Further reading
22. Platysma, nefertiti lift, and beyond
Introduction
Anatomy
Treatment techniques
Technical variations for lower face and platysma neuromodulator treatment
Frequency of treatment
Side effects
Combination treatments for neck and lower face rejuvenation
Conclusions
Further reading
23. The masseters: Hypertrophy, bruxism, and facial shaping with botulinum toxin
Introduction
Anatomic considerations
Dose and injection paradigm
Aesthetic benefit
Bruxism
Side effects and complications
Conclusions
Further reading
24. Treatment of darker skin types with neuromodulators
Introduction
Racial and ethnic differences in photoaging
Safety and efficacy of botulinum toxins in darker skin types
Approach to botulinum toxin in ethnic skin
Ethnic specific applications of botulinum toxin
Conclusions
Further reading
25. Combination noninvasive facial aesthetic treatments with botulinum toxin type A
Anatomy related to multiple therapeutic modalities
Combination therapy in the upper face
Combination therapy in the lower face
Injectables
Skin tightening
Vascular lesions and pigmentation
Topical agents
Sequence and timing of a multimodal approach
Summary
Further reading
26. Treatment of focal axillary hyperhidrosis with neuromodulators (and non-axillary regions)
Introduction
Epidemiology
Quality of life
Clinical assessment of hyperhidrosis
Botulinum toxin therapy
Axillary hyperhidrosis
Use of botulinum toxin type B for hyperhidrosis
Techniques for non-axillary hyperhidrosis
Future directions
Further reading
27. Botulinum toxin for the treatment of palmoplantar hyperhidrosis
Introduction: Epidemiology and pathophysiology
Patient evaluation
Botulinum toxin as a treatment for hyperhidrosis
Patient preparation and pain control
Reconstitution and injection techniques
Results and complications
Conclusions
Further reading
Part III. Future Directions for Aesthetic Neuromodulators
28. The future of neuromodulators in aesthetic medicine
Introduction
Conclusions
Further reading
29. Neuromodulator immunogenicity
Introduction
Pathogenesis of immunogenicity
Genetic predisposition to the immunogenicity
Antibody assay methods
Challenges and solution
Real-world evidence
Conclusions
Further reading
Index

AC

Alastair Carruthers

Dr. Alastair Carruthers is a Cosmetic Dermatologic surgeon, and Clinical Professor of Dermatology with the Faculty of Medicine at the University of British Columbia (UBC). During his 20 years of practice, Dr. Carruthers has made several major contributions to the field of dermatology. Foremost among these was the use of the BOTOX® procedure in cosmetic applications, a discovery he made with his wife, Dr. Jean Carruthers, in 1987. Since this time, they have been at the forefront of BOTOX® research, development and education, publishing numerous articles using their data. Dr. Carruthers has also made significant advances in the area of Tissue Augmentation. These materials, both temporary and permanent, are used to lift and support the structures beneath the skin. In 1998 Dr. Carruthers was the first dermatologist in North America to begin injecting Artecoll. Dr. Carruthers has over 100 published articles to his credit and has also contributed extensively to studies about the relationship between skin cancer and sun exposure.

Affiliations and expertise

Cosmetic Dermatologic Surgeon and Clinical Professor of Dermatology, Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia, Canada

JC

Jean Carruthers

Dr. Jean Carruthers is a Cosmetic Surgeon and a Clinical Professor of Ophthalmology with the Faculty of Medicine at the University of British Columbia (UBC). Dr. Carruthers has lectured worldwide on a variety of subjects pertaining to cosmetic ophthalmology, including the cosmetic use of the BOTOX® procedure, which she co-founded with her husband, Dr. Alastair Carruthers, in 1987. Since this time, they have remained at the forefront of BOTOX® research, development and education, publishing numerous articles using their data. Dr. Carruthers has published more than eighty peer reviewed scientific articles and twenty-eight scientific book chapters on a variety of topics, including the use of botulinum toxin and soft tissue augmenting agents, aesthetic lasers and cosmetic laser blepharoplasty. She is an International Editor for such publications as Dermatologic Surgery, the Journal of Cosmetic Laser Surgery and the American Journal of Cosmetic Surgery.

Affiliations and expertise

Cosmetic Surgeon and Clinical Professor of Ophthalmology, Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia, Canada

JD

Jeffrey S. Dover

Dr. Jeffrey S. Dover is the co-director of SkinCare Physicians of Chestnut Hill, a comprehensive facility specializing in dermatology, laser and cosmetic surgery, and he is Associate Professor of Clinical Dermatology at Yale University School of Medicine, and Associate Professor of Dermatology at Brown Medical School. Dr. Dover’s research interests are Photomedicine, lasers in medicine, cosmetic laser surgery, and medical education. He is the author of over 400 scientific publications. He has co-authored and edited over 45 textbooks, many of which have been translated into French, Italian, Spanish, Russian, Polish and Chinese and are sold to physicians all over the world. Dr. Dover is the founding editor of Journal Watch for Dermatology, produced by the publishers of the New England Journal of Medicine. He is also a Past President of both the American Society of Dermatologic Surgery and the American Society for Lasers in Medicine and Surgery.

Affiliations and expertise

Director, SkinCare Physicians, Chestnut Hill, Massachusetts; Associate Clinical Professor of Dermatology at Yale University School of Medicine, and Adjunct Associate Professor of Dermatology at Brown Medical School, Providence, Rhode Island

MA

Murad Alam

Dr. Murad Alam is an author of over 250 scientific publications and is the Editor of Archives of Dermatological Research. He is the Associate Editor of JAAD; Lasers in Medical Science; Journal of Cosmetic Dermatology; the International Journal of Women’s Dermatology, and he is the Assistant Editor of Dermatologic Surgery. Dr. Alam is series co-editor of the Procedures in Cosmetic Dermatology books and has overall edited 20 books. Dr. Alam is current President of the American Society for Dermatologic Surgery, and an incoming member of the Board of the American Academy of Dermatology. He is also the vice-president of the Blade and Light Society, an organization of volunteer dermatologic surgeons who perform charitable mission work to treat skin cancers and train surgical dermatologists in underserved countries. Dr. Alam’s clinical practice includes the treatment of skin cancer, as well as cosmetic dermatology, and laser surgery.

Affiliations and expertise

Professor and Vice Chair, Department of Dermatology; Professor, Departments of Surgery, Otolaryngology, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL

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Procedures in Cosmetic Dermatology: Botulinum Toxin

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Alastair Carruthers

Jean Carruthers

Jeffrey S. Dover

Murad Alam