Updates in the Treatment of the Lower Face and Neck With Botulinum Toxin Injections

How to improve infraorbital hollows with neuromodulators-A clinical prospective interventional study about the application of facial biomechanics

BACKGROUND

A previous injection algorithm termed the "Toxin Lift" was recently introduced and described volume increases in the midface following neuromodulator treatments of the jawline. Increase in midfacial volume due to soft tissue repositioning could also affect the severity of infraorbital hollows.

OBJECTIVE

The objective is therefore to evaluate whether the severity of infraorbital hollows can be improved by injecting neuromodulators in the supra-mandibular segment of the platysma.

MATERIALS AND METHODS

A total of 35 volunteers (11 males/24 females) with a mean age of 39.8 (9.6) years and a mean BMI of 25.2 (5.2) kg/m2 were investigated. Bilateral infraorbital regions were evaluated via clinical assessment and semi-quantitative 3D imaging. The applied injection technique targeted the platysma via four injection points administering 5 I.U. per injection point resulting in a total of 20 I.U. per facial side.

RESULTS

Volume increase of the infraorbital region was 0.13 cc at 15 days (p = 0.001) and was 0.02 cc at 30 days (p = 0.452) whereas the skin displacement in cranial direction was 0.54 mm at 15 days (p < 0.001) and was 0.31 mm at 30 days (p < 0.001). Clinical evaluation revealed a highly statistically significant improvement of the tear trough, palpaebromalar groove, and of the lid-cheek junction when compared to baseline with all p < 0.001.

CONCLUSION

The results of this clinical prospective interventional analysis revealed that the "Toxin Lift" injection technique is capable to improve the clinical appearance of infraorbital hollows. The effects can be explained by the concepts of facial biomechanics.

Microdroplet botulinum toxin: A review

Microbotox is the administration of multiple microdroplets of botulinum toxin in intradermal plane. It is increasingly becoming popular owing to its more favorable outcome and better safety profile than the conventional technique. The intention is to treat fine lines and wrinkles without imparting an undesired “frozen face like” appearance. Besides facial rejuvenation, it has found its way into the management of other indications such as rosacea, hyperhidrosis, keloid, and seborrhea. Being a relatively newer method, knowledge about the various dilution methods, desired volume, and correct depth of injection involved in this technique remain scarce. In this article, the authors have highlighted various indications, procedures, adverse effects, and contraindications of microbotox.

Microbotox for the treatment of wide facial pores: A promising therapeutic approach

BACKGROUND

Microbotox is the injection of multiple microdroplets of diluted onabotulinum toxin A into the upper dermis. It has been previously used in one study only to decrease pore size and to improve skin texture.

AIMS

To evaluate the efficacy and safety of microbotox in the treatment of wide facial pores.

METHODS

Thirty-five patients with wide facial pores received a single session of microbotox. Objective measurements regarding improvement of pore size (0-4 scale) were recorded by two-blinded dermatologists. The improvements were confirmed by dermoscopic examination. Patient satisfaction was measured by Likert satisfaction scale (1-5 scale). Follow-up of the patients was done for 1 year.

RESULTS

After a single treatment session, the total average of improvement was 87.2%. The average improvement of pore size was 3.7 (0-4 scale). The average patient satisfaction after the end of therapy was 4.7. Dermoscopic evaluation confirmed the reduction in the size and number of pores. There were no serious or long-term side effects.

CONCLUSIONS

A single treatment session of microbotox appears to be safe and effective for the reduction of facial pore size. Improvement of skin texture and oiliness was also observed.