Use of botulinum toxin type A in facial aesthetics
Injectable fillers

Use of botulinum toxin type A in facial aesthetics 

The use of botulinum toxin type A enhancement is the most common cosmetic procedure currently undertaken in the world .overall clinical and study experience with botulinum toxin type A treatment for facial enhancement has confirmed that it is effective and safe in both the short and the long term . BOTOX may be used alone or in conjunctution with a resurfacing procedure , such as a laser treatment , or an improving skin texture , such as injectable fillers ,or a  recon touring procedure , such as a face lift .

Knowing your options
BOTOX is used for facial enhancement , to improve the appearance of wrinkles ,such as : glabellar lines , horizontal forehead lines , “crow’s feet” , “bunny lines”  (downward radiating lines on the sides of nose) , the perioral area , the dimpled chin , and platys bands .
Aesthetic planning involves understanding and assessing the patient’s desires and preferences in the context of an overall treatment plan .the evolving emphasis on facial shaping and enhancement argues against treating any one area in isolation , without regard to its effect on other areas .correspondingly , the muscles of facial expression do not act in isolation but have complex anatomic and physiologic interactions .for example , treatment of glabellar lines , “crow’s feet” or forehead lines can alter eyebrow shape and position , which are considered central to aesthetic evaluations of the upper face .therefore ,potential effects on eyebrow shape and position should be considered in advance of any and all treatments in the upper face .gender differences are important for eyebrow shape : typically , women have a more arched eyebrow , which is considered to be aesthetically pleasing ; the male brow is flatter .just as the eyebrows are central to the appearance of the upper face , the lips are fundamental to the appearance of the mid- and lower face . thus ,treatment of the perioral area or dimpled chin needs to consider the shape and position of the mouth and the type of smile .

What to expect from treatment
The most important fact to remember about BOTOX is that the results are not permanent
The quality of the botulinum toxin type A treatment experience depends to a certain extent on proper patient selection and education .patients who present  with severe , deep wrinkles may have unrealistic expectations as to the outcome of botulinum toxin type A treatment .clinicians can help avert dissatisfaction by setting overall aesthetic goals  with patients , developing an overall treatment plan , and establishing realistic expectations for the outcome .
Because the starting dose is low and balance of the upper face depends on eyebrow position , reassessment in 2 weeks for additional treatments or subtle corrections is highly recommended , but not necessary .
Retreatment intervals for horizontal forehead lines range from 3 to 6 months .usually treatment is needed less often for this area than for the glabellar complex .

Risks related to BOTOX  
 Patients should never massage the treatment area .some regions benefit by gentle massage by the physician at the time of injection .the direction of the massage is important .
Patients should be advised to contract the injected area for approximately 90 minutes to 2 hours, which may expedite uptake or the toxin.
Limiting activity may reduce unwanted diffusion, but agreement has not been reached on this nor have controlled studies been conducted.
This may also reduce unwanted diffusion, but the same limitations apply as above.
Avoid exposure to heat for 2 hours after treatment.