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      Treating glabellar lines with botulinum toxin type A-hemagglutinin complex: A review of the science, the clinical data, and patient satisfaction

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          Botulinum toxin type A treatment is the foundation of minimally invasive aesthetic facial procedures. Clinicians and their patients recognize the important role, both negative and positive, that facial expression, particularly the glabellar frown lines, plays in self-perception, emotional well-being, and perception by others. This article provides up-to-date information on fundamental properties and mechanisms of action of the major approved formulations of botulinum toxin type A, summarizes recent changes in naming conventions (nonproprietary names) mandated by the United States Food and Drug Administration, and describes the reasons for these changes. The request for these changes provides recognition that formulations of botulinum toxins (eg, onabotulinumtoxinA and abobotulinumtoxinA) are not interchangeable and that dosing recommendations cannot be based on any one single conversion ratio. The extensive safety, tolerability, and efficacy data are summarized in detail, including the patient-reported outcomes that contribute to overall patient satisfaction and probability treatment continuation. Based on this in-depth review, the authors conclude that botulinum toxin type A treatment remains a cornerstone of facial aesthetic treatments, and clinicians must realize that techniques and dosing from one formulation cannot be applied to others, that each patient should undergo a full aesthetic evaluation, and that products and procedures must be selected in the context of individual needs and goals.

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          Most cited references 62

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          Facial expression and emotion.

           P Ekman (1993)
          Cross-cultural research on facial expression and the developments of methods to measure facial expression are briefly summarized. What has been learned about emotion from this work on the face is then elucidated. Four questions about facial expression and emotion are discussed: What information does an expression typically convey? Can there be emotion without facial expression? Can there be a facial expression of emotion without emotion? How do individuals differ in their facial expressions of emotion?
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            Inhibiting and facilitating conditions of the human smile: a nonobtrusive test of the facial feedback hypothesis.

            We investigated the hypothesis that people's facial activity influences their affective responses. Two studies were designed to both eliminate methodological problems of earlier experiments and clarify theoretical ambiguities. This was achieved by having subjects hold a pen in their mouth in ways that either inhibited or facilitated the muscles typically associated with smiling without requiring subjects to pose in a smiling face. Study 1's results demonstrated the effectiveness of the procedure. Subjects reported more intense humor responses when cartoons were presented under facilitating conditions than under inhibiting conditions that precluded labeling of the facial expression in emotion categories. Study 2 served to further validate the methodology and to answer additional theoretical questions. The results replicated Study 1's findings and also showed that facial feedback operates on the affective but not on the cognitive component of the humor response. Finally, the results suggested that both inhibitory and facilitatory mechanisms may have contributed to the observed affective responses.
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              Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies--consensus recommendations.

              Facial aesthetics and rejuvenation are evolving rapidly due to changes in products, procedures, and patient demographics. Clinicians can benefit from ongoing guidance on products, tailoring treatments to individual patients, treating multiple facial areas, and using combinations of products and ways to optimize outcomes. A multidisciplinary group of aesthetic treatment experts convened to review the properties and uses of botulinum toxin type A (BoNTA) and hyaluronic acid fillers and to update consensus recommendations for facial rejuvenation using these two types of products. The group considered paradigm shifts in facial aesthetics; optimal techniques for using BoNTA and hyaluronic acid fillers alone and in combination; the influence of patient sex, ethnicity, cultural ideals, and skin color on treatment; general techniques; patient education and counseling; and emerging trends and needs in facial rejuvenation. The group provided specific recommendations by facial area, focusing on relaxing musculature, restoring volume, and recontouring using BoNTA and hyaluronic acid fillers alone and in combination. For the upper face, BoNTA remains the cornerstone of treatment, with hyaluronic acid fillers used to augment results. These fillers are central to the midface because of the need to restore volume. BoNTA and hyaluronic acid in combination can improve outcomes in the lower face. Optimal outcomes in facial aesthetics require in-depth knowledge of facial aging and anatomy, an appreciation that rejuvenation is a three-dimensional process involving muscle control, volume restoration, and recontouring, and thorough knowledge of properties and techniques specific to each product in the armamentarium.

                Author and article information

                Clin Interv Aging
                Clinical Interventions in Aging
                Dove Medical Press
                26 April 2010
                : 5
                : 101-118
                [1 ]Aalst Dermatology Clinic, Aalst, Belgium;
                [2 ]Aesthetic Eyelid Plastic Surgery, Boca Raton, FL, USA;
                [3 ]Aesthetic Dermatology, Frankfurt, Germany;
                [4 ]University of California, San Francisco, USA
                Author notes
                Correspondence: Koenraad De Boulle, Aalst Dermatology Clinic, 43 Leopoldlaan, Aalst, Belgium 9300, Tel 32 53 781899, Fax 32 53 771915, Email koendeboulle@ 123456telenet.be
                © 2010 De Boulle et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.



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