ARTicle | InjeCTIon TeCHnIque |


The unpleasant consequences of the intradermal


procedure are related to the injection technique. Too deep an injection causes an unfavourable outcome similar to the intramuscular technique. The toxin diffuses to the non-targeted muscles and may induce asymmetrical animation, which resolves over time (usually in 2–4 weeks). Intradermal rejuvenation may not last as long as the


conventional intramuscular injection because it inhibits only the superficial part of the muscle. one study by Chang et al20


soothing effect on the lower facial treatment using the intradermal technique, which lasted at least 8 weeks without prominent side-effects. The clinical improvement of wrinkles was greatest at 2 months after injection and gradually faded after 3 months20


concerns1–3 showed a moderate but significant wrinkle


Figure 6 Different injection techniques produce different outcomes. Before treatment (A). Intradermal injection technique applied to the frontalis and platysma restores some muscle function and tone to rejuvenate and reshape the facial contour with oblong configuration (B), while injecting to relax both the muscles brings about fuller appearance (C)


injection to relax the muscles and smooth out wrinkles, whereas intradermal injection is to keep some function and tone. This cleverly calculated combination creates facial rejuvenation with a balanced, harmonious, and natural feel, and a pleasant facial appearance.


Conclusions The intradermal injection technique is an alternative procedure, which can be performed panfacially to refresh appearance and rejuvenate the face with an oblong configuration. The technique can be harmoniously applied as a complementary procedure to the intramuscular technique to create a feel of natural attractiveness.


. However, patients


usually return for another treatment every 12–14 weeks. Intradermal facial rejuvenation addresses the patients’ : looking rested, relaxed, and natural as opposed


to having had treatments or procedures performed. The procedure can be applied in combination with conventional intramuscular techniques; intramuscular


References


1. Carruthers A, Cohen JL, Cox SE et al. Facial aesthetics: achieving the natural, relaxed look. J Cosmet Laser Ther 2007; 9 (Suppl 1): 6–10


2. Carruthers J, Carruthers A. Botulinum toxin type A treatment of multiple upper facial sites: patient-reported outcomes. Dermatol Surg 2007; 33(1 Spec No.): S10–7


3. Fagien S, Cox SE, Finn JC, Werschler WP, Kowalski JW. Patient-reported outcomes with botulinum toxin type A treatment of glabellar rhytids: a double-blind, randomized, placebo-controlled study. Dermatol Surg 2007; 33(1 Spec No.): S2–9


4. Fagien S, Raspaldo H. Facial rejuvenation with botulinum neurotoxin: an anatomical and experiential perspective. J Cosmet Laser Ther 2007; 9(Suppl 1): 23–31


5. Carruthers J, Fagien S, Matarasso SL; Botox Consensus Group. Consensus recommendations on the use of botulinum toxin type a in facial aesthetics. Plast Reconstr Surg 2004; 114(6 Suppl): 1S–22S


6. Levy PM. The ‘Nefertiti lift’: a new technique 28 ❚


for specific re-contouring of the jawline. J Cosmet Laser Ther 2007; 9(4): 249–52


7. Feily A, Fallahi H, Zandian D, Kalantar H. A succinct review of botulinum toxin in dermatology; update of cosmetic and noncosmetic use. J Cosmet Dermatol 2011; 10(1): 58–67


8. Fagien S. Botulinum toxin type A for facial aesthetic enhancement: role in facial shaping. Plast Reconstr Surg 2003; 112(5 Suppl): 6–18S


9. Piérard GE, Lapière CM. The microanatomical basis of facial frown lines. Arch Dermatol 1989; 125(8): 1090–2


10. Lehrer MS, Benedetto AV. Botulinum toxin


— an update on its use in facial rejuvenation. J Cosmet Dermatol 2005; 4(4): 285–97


11. Carruthers JD, Glogau RG, Blitzer A; facial Aesthetics Consensus Group Faculty. Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies—consensus recommendations. Plast Reconstr Surg 2008; 121(5 Suppl): 5S–30S


12. De Boulle K, Fagien S, Sommer B, Glogau R.


Treating glabellar lines with botulinum toxin type A-hemagglutinin complex: A review of the science, the clinical data, and patient satisfaction. Clin Interv Aging 2010; 5: 101–18


13. Ascher B, Talarico S, Cassuto D et al. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit) — Part I: Upper facial wrinkles. J Eur Acad Dermatol Venereol 2010; 24(11): 1278–84


14. Ascher B, Talarico S, Cassuto D et al. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit) — part II: Wrinkles on the middle and lower face, neck and chest. J Eur Acad Dermatol Venereol 2010; 24(11): 1285–95


15. Carruthers JD, Carruthers A. Botulinum


toxin A in the mid and lower face and neck. Dermatol Clin 2004; 22: 151-158


16. Petchngaovilai C. Midface lifting with


botulinum toxin: intradermal technique. Journal of Cosmetic Dermatology 2009; 8: 312-316


17. Carruthers J, Carruthers A. Botulinum toxin


in facial rejuvenation: an update. Dermatol Clin 2009; 27(4): 417–25


18. Carruthers A, Carruthers J. Eyebrow height after botulinum toxin type A to the glabella. Dermatol Surg 2007; 33(1 Spec No.): S26–31


19. Wu WT. Botox facial slimming/facial


sculpting: the role of botulinum toxin-A in the treatment of hypertrophic Masseteric muscle and parotid enlargement to narrow the lower facial width. Facial Plast Surg Clin North Am 2010; 18(1): 133–40


20.Chang SP, Tsai HH, Chen WY, Lee WR, Chen


PL, Tsai TH. The wrinkles soothing effect on the middle and lower face by intradermal injection of botulinum toxin type A. Int J Dermatol 2008; 47(12): 1287–94


21. Benedetto AV. ed, Botulinum Toxins in Aesthetic Clinical Practice. Informa Healthcare: London and New York, 2011


Declaration of interest The contribution represents original work, has not been previously published or simultaneously submitted for publication elsewhere. The author does not have financial or other relationships of a declarable nature.


October 2011 | prime-journal.com


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