Botulinum Toxins in Clinical Aesthetic Practice SERIES IN COSMETIC AND LASER THERAPY Series Editors David J. Goldberg, Nicholas J. Lowe, and Gary P. Lask Published in association with the Journal of Cosmetic and Laser Therapy David J. Goldberg, Fillers in Cosmetic Dermatology, ISBN 9781841845098 Philippe Deprez, Textbook of Chemical Peels, ISBN 9781841842954 C. William Hanke, Gerhard Sattler, Boris Sommer, Textbook of Liposuction, ISBN 9781841845326 Paul J. Carniol, Neil S. Sadick, Clinical Procedures in Laser Skin Rejuvenation, ISBN 9780415414135 David J. Goldberg, Laser Hair Removal, Second Edition, ISBN 9780415414128 Benjamin Ascher, Marina Landau, Bernard Rossi, Injection Treatments in Cosmetic Surgery, ISBN 9780415386517 Avi Shai, Robert Baran, Howard I. Maibach, Handbook of Cosmetic Skin Care, Second Edition, ISBN 9780415467186 Jenny Kim, Gary Lask, Comprehensive Aesthetic Rejuvenation: A Regional Approach, ISBN 9780415458948 Neil Sadick, Paul Carniol, Deborshi Roy, Luitgard Wiest, Illustrated Manual of Injectable Fillers, ISBN 9780415476447 Paul Carniol, Gary Monheit, Aesthetic Rejuvenation Challenges and Solutions: A Global Perspective, ISBN 9780415475600 Neil Sadick, Diane Berson, Mary P. Lupo, Zoe Diana Draelos, Cosmeceutical Science in Clinical Practice, ISBN 9780415471145 Anthony Benedetto, Botulinum Toxins in Clinical Aesthetic Practice, Second Edition, ISBN 9780415476362 Robert Baran, Howard I. Maibach, Textbook of Cosmetic Dermatology, Fourth Edition, ISBN 9781841847009 David J. Goldberg, Alexander L. Berlin, Disorders of Fat and Cellulite, ISBN 9780415477000 Kenneth Beer, Mary P. Lupo, Vic A. Narurkar, Cosmetic Bootcamp Primer: Comprehensive Aesthetic Management, ISBN 9781841846989 Walter P. Unger, Ronald Shapiro, Robin Unger, Mark Unger, Hair Transplantation, Fifth Edition, ISBN: 9781616310066 Botulinum Toxins in Clinical Aesthetic Practice Second Edition Edited by Anthony V. Benedetto DO FACP Clinical Associate Professor of Dermatology Department of Dermatology University of Pennsylvania School of Medicine Philadelphia, Pennsylvania, USA and Dermatologic SurgiCenter Philadelphia, Pennsylvania, USA First published in 2006 by Taylor & Francis This edition published in 2011 by Informa Healthcare, Telephone House, 69-77 Paul Street, London EC2A 4LQ, UK. Simultaneously published in the USA by Informa Healthcare, 52 Vanderbilt Avenue, 7th Floor, New York, NY 10017, USA. © 2011 Informa UK Ltd, except as otherwise indicated. No claim to original U.S. Government works. Reprinted material is quoted with permission. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, unless with the prior written permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting l imited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP, UK, or the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA (http://www.copyright.com/ or telephone 978-750-8400). Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. This book contains information from reputable sources and although reasonable efforts have been made to publish accurate infor- mation, the publisher makes no warranties (either express or implied) as to the accuracy or fitness for a particular purpose of the information or advice contained herein. The publisher wishes to make it clear that any views or opinions expressed in this book by individual authors or contributors are their personal views and opinions and do not necessarily reflect the views/opinions of the publisher. Any information or guidance contained in this book is intended for use solely by medical professionals strictly as a supple- ment to the medical professional’s own judgement, knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures, or diagnoses should be independently verified. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own pro- fessional judgements, so as appropriately to advise and treat patients. Save for death or personal injury caused by the publisher’s negligence and to the fullest extent otherwise permitted by law, neither the publisher nor any person engaged or employed by the publisher shall be responsible or liable for any loss, injury or damage caused to any person or property arising in any way from the use of this book. A CIP record for this book is available from the British Library. ISBN-13: 978-0-415-47636-2 Orders may be sent to: Informa Healthcare, Sheepen Place, Colchester, Essex CO3 3LP, UK Telephone: +44 (0)20 7017 5540 Email: [email protected] Website: http://informahealthcarebooks.com/ For corporate sales please contact: [email protected] For foreign rights please contact: [email protected] For reprint permissions please contact: [email protected] Typeset by Exeter Premedia Services Private Ltd., Chennai, India Printed and bound in the United Kingdom Dedication This book is dedicated to those physicians who are committed to providing patients with the best medical care using state-of-the-art techniques; and to the coauthors who have contributed valuable time and expertise in the creation of this book. Lastly, to Dianne, whose encouragement and loving support permitted me to accomplish that which at times has appeared insurmountable. Contents List of contributors viii Foreword ix Alastair Carruthers Preface x Anthony V. Benedetto Prologue The search for beauty: historical, cultural, and psychodynamic trends xi Caroline S. Koblenzer 1 Pharmacology, immunology, and current developments 1 K. Roger Aoki 2 Facial anatomy and the use of botulinum toxin 15 James M. Spencer 3 Cosmetic uses of Botulinum toxin A in the upper face 24 Anthony V. Benedetto 4 Cosmetic uses of Botulinum toxin A in the mid face 101 Anthony V. Benedetto 5 Cosmetic uses of Botulinum toxin A in the lower face, neck, and upper chest 140 Anthony V. Benedetto 6 Skin resurfacing with Microbotox and the treatment of keloids 190 Woffles T. L. Wu 7 Facial and lower limb contouring 206 Woffles T. L. Wu 8 Botulinum toxin type A treatment for Raynaud’s phenomenon and other novel dermatologic therapeutic applications 223 Irèn Kossintseva, Benjamin Barankin, and Kevin C. Smith 9 Botulinum toxins-A other than BOTOX® 234 Gary D. Monheit 10 Botulinum toxin B 240 Neil S. Sadick and Yekaterina Kupava 11 Botulinum toxin in the management of focal hyperhidrosis 248 Dee Anna Glaser 12 Medicolegal considerations of cosmetic treatment with botulinum toxin injections 263 David J. Goldberg Appendix 1 Muscles of facial expression 267 Appendix 2 The preparation, handling, storage, and mode of injection of onabotulinumtoxinA 272 Appendix 3 Patient treatment record 274 Appendix 4 Informed consent for the treatment of facial and body wrinkles with BoNTA 275 Appendix 5 Side-effects and contraindications to BoNTA injections 276 Index 279 vii List of contributors K. Roger Aoki PhD Irèn Kossintseva MD Vice President, Neurotoxins Research Program, Department of Biological University of British Columbia, Vancouver, British Columbia, Canada Sciences, Allergan, Inc., Irvine, California, USA Yekaterina Kupava Anthony V. Benedetto DO FACP Sadick Research Group, New York, New York, USA Clinical Associate Professor of Dermatology, Department of Dermatology, University of Pennsylvania School of Medicine, Gary D. Monheit MD and Medical Director, Dermatologic SurgiCenter, Philadelphia, Monheit Dermatology Associates, South Birmingham, Total Skin Pennsylvania, USA & Beauty Dermatology Center, and Clinical Associate Professor, Department of Dermatology, Department of Ophthalmology, University Benjamin Barankin MD FRCP of Alabama at Birmingham, Birmingham, Alabama, USA Dermatologist, The Dermatology Centre, Toronto, Ontario, Canada Neil S. Sadick MD Dee Anna Glaser MD Sadick Dermatology & Aesthetic Surgery, New York, New York, USA Professor & Vice Chairman, Director Cosmetic & Laser Surgery, Department of Dermatology, Saint Louis University School of Medicine, Kevin C. Smith MD FACP FRCPC (Dermatology) Saint Louis, Missouri, USA Dermatologist, Niagara Falls Dermatology and Skin Care Centre, Niagara Falls, Ontario, Canada David J. Goldberg MD JD Director, Skin Laser & Surgery Specialists of NY/NJ, New Jersey, James M. Spencer MD MS Clinical Professor of Dermatology and Director of Laser Research, Clinical Professor of Dermatology, Department of Dermatology, Mount Mount Sinai School of Medicine, New York, and Adjunct Professor of Sinai School of Medicine, New York, New York, and Medical Director, Law, Fordham University School of Law, New York, New York, USA Spencer Dermatology & Skin Surgery Center, Saint Petersburg, Florida, USA Caroline S. Koblenzer MD Clinical Professor of Dermatology, Department of Dermatology, Woffl es T. L. Wu MD University of Pennsylvania School of Medicine, Philadelphia, Woffl es Wu Aesthetic Surgery & Laser Centre, Camden Medical Centre, Pennsylvania, USA Singapore viii Foreword It is an honor and a pleasure to write a Foreword for the new edition of Dr. Benedetto is a well-known expert in both dermatology and Dr. Benedetto’s book Botulinum Toxins in Clinical Aesthetic Practice. a esthetic medicine. His especial area of expertise is the surgical or pro- The first edition of this book, under the title Botulinum Toxin in Clini- cedural side of dermatology and he has spent many years perfecting cal Dermatology was very well received and much admired. However, skin cancer treatment techniques and treating many thousands of skin time has moved on and it is time to update the information which was cancer patients successfully. However, he has also achieved a deserved available in the earlier book. The amount of information about the reputation in the cosmetic world, especially in the use of botulinum botulinum n eurotoxins and especially about their cosmetic use has toxin. For many years he has been interested in the application of botu- increased dramatically in the last few years with new papers being pub- linum toxin, not just to the upper face but also to the lower face and lished daily. It is important to have a synthesis of this new information especially in individuals with facial asymmetry. and its integration into the previously available knowledge. In addi- This elegant book is appropriate for all who are interested in this tion, the range of individuals who are administering the toxin has field of knowledge. It will be appreciated not only by health care increased significantly. Hence the new edition of this book. workers who administer the toxin but also by those who enjoy its I have particularly appreciated Dr. Benedetto’s selection of his co- beneficial effects. The former will improve their skill in the use of the authors; each is an acknowledged expert in the area in which they are material and the latter will learn more about how botulinum toxin writing. Dr. Benedetto has written many of the “core” chapters himself can be used for good. I encourage all of you who are interested in this but has called on the assistance of other experts in important topics topic to read this excellent book. such as cosmetic indications which are less used in North America. Readers will be delighted by the clear anatomic diagrams and apprecia- Alastair Carruthers tive of the clear advice on the handling and dilution of the currently Vancouver, Canada available toxins—subjects which have caused much confusion. September 2010 ix