Author:
Joshua A Zeichner, MD, Department of Dermatology, Mount Sinai School of Medicine, New York, NY

Introduction

The fourth annual Winter Clinical Dermatology Meeting was held on March 14-18, 2008 at the Ritz Carlton Hotel in Kapalua, Maui, Hawaii.  Meeting directors Dr. Mark Lebwohl, Dr. Darrell Rigel, and Dr. James Del Rosso organized a well-balanced program covering updates and innovations in both medical and cosmetic dermatology.  Additionally, Dr. Clay Cockerell offered a workshop on dermatopathology during the first day of the meeting.  The highlights of this meeting are described below.,

What's New In Botulinum Toxin

Dr. Seth Matarasso provided an update on the use of botulinum toxin in facial and other rejuvenation procedures.¹ The only aesthetic procedure that botulinum toxin is approved for by the US Food and Drug Administration (FDA) is injection in the glabellar complex, and all other aesthetic uses are currently considered off-label.  Dr. Matarasso explained that after treating one muscle set, often adjacent, untreated muscles are recruited.  For example, after treating the glabella, you may also need to treat the nasalis muscle to eliminate "bunny lines" that may become more apparent.  When injecting the nasalis, one must be careful not to hit the levator labii superioris, because a patient could potentially develop a lip droop if this occurred.  While botulinum toxin has traditionally been used in the upper face, there are more potential uses in the region of the zygomatic arch.  For example, development of the nasolabial fold is partially muscular in etiology, and one could potentially treat it with a unit of botulinum toxin on either side.  While the fold may be reduced, patients will also have a droop and flattening of cupid's bow.  When treating the orbicularis oris muscle for perioral rhytides, Dr. Matarasso recommends superficial injections at the vermillion border.  This can result in pseudo eversion and poofing of lip.  Too much toxin may alter phonation, however.  The mentalis muscle can be treated at the apex of the chin to improve dimpling.  Also, the depressor anguli oris can be relaxed to lift the oral commissures.  To find this very small, triangular muscle, one should trace the nasolabial fold down to the mandible and inject just posterior.  Alternatively, the muscle is located anterior to the masseter, best palpated when the patient clenches down.  The platysma can be treated to improve the appearance of neck banding, but over treatment can leave patients with difficulty swallowing.  Finally, injection of botulinum toxin in the upper chest may give subtle results to improve wrinkling in the cleavage of female patients.