Author:
David E. Bank, MD, FAAD, Director, The Center for Dermatology, Cosmetic & Laser Surgery, Mount Kisco, New York

Introduction

The 2007 American Society for Dermatologic Surgery (ASDS) Annual Meeting was held October 10 – 14 at the Sheraton in Chicago, IL. During the course of the meeting, neurotoxins were discussed in a number of different sessions, focusing both on current and newer applications, as well as additional neurotoxins that may be coming to the U.S. market.,

All About Botulinum Toxins

Dr. Mitchell P. Goldman, MD, discussed his use of Botox treatment for platysmal bands¹. He recommended grasping the edge of the muscle firmly and injecting five units into the platysma every 2 cm, but not to exceed 50 units total. Dr. Goldman also discussed the benefit of Botox in combination with other treatment modalities such as with: intense pulsed light (IPL);² laser resurfacing;³ topical treatments (growth factors, vitamin-containing creams and anti-oxidant creams, etc.); and dermal fillers.

Dr. Jean Carruthers, MD, addressed the question of whether we should attempt to treat individual muscles with Botox or whole muscle groups, and concluded that treating muscle groups achieved superior results to treating individual muscles.⁴

Dr. Michael Kaminer, MD, addressed the issue of the "dissatisfied Botox patient".⁵ According to Dr. Kaminer, brow ptosis is the number one complaint. One way to try to avoid this is to not treat the frontalis without also treating the brow depressor muscles. Bruising is also another common complaint, and this can be minimized by having the patient avoid nonsteroidal anti-inflammatory drugs and acetylsalicylic acid seven days prior to treatment. Another "complaint" from patients is persistence of wrinkles. Some patients may need fillers in addition to Botox to achieve optimal correction, and it is best to tell them prior to Botox treatment, so that they are prepared.

Dr. Timothy Flynn presented using Botox to minimize post-surgical scars by reducing muscle tension on healing wounds.

Dr. Frederick Brandt summarized the current state of Botulinum toxins available in different countries in different stages of development.⁶ This is summarized in the tables that follow: