Ann Dermatol Vener
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Men are showing increasing interest in nonsurgical esthetic procedures even if women account for the vast majority of patients. Botulinum toxin A injections are particularly sought by men: this is the most frequently performed nonsurgical procedure, with 296,000 injections in the US in 2007 (Fig. 1). ⋯ However, they often require larger doses. In addition, men's facial morphology presents certain specificities that must be respected when choosing the injection points.
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This study wants to prouve that the resting tone is increasing with age. On the behalf of the Face Recurve concept, the deep fat is expelled superficially because of mimic muscle shortening. Botulinum toxin is proposed for a new indication: resting tone decrease in order to slow down muscle shortening and consequently structural aging. ⋯ Two classical uses, the maximum strength of contraction and the dermal injection, are associated to the action on the resting tone for more evolved cases. Finally, a new possibility for botulinum toxin injection is the blockage of muscular regeneration to stabilize the section of the age marker fascicules performed in the Face Recurve concept. This new indication is also useful in reconstructive surgery for treatment of the marginal mandibular lip deformity in patients with chronic unilateral facial palsies.
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Botulinum toxin could represent nowadays a new treatment modality especially for cutaneous conditions in course of which conventional treatments remain unsuccessful. Besides palmar and plantar hyperhidrosis, botulinum toxin has demonstrated efficacy in different conditions associated with hyperhidrosis, such as dyshidrosis, multiple eccrine hidrocystomas, hidradenitis suppurativa, Frey syndrome, but also in different conditions worsened by hyperhidrosis such as Hailey-Hailey disease, Darier disease, inversed psoriasis, aquagenic palmoplantar keratoderma, pachyonychia congenital. Moreover, different cutaneous conditions associated with sensitive disorders and/or neurological involvements could benefit from botulinum toxin, for example anal fissures, leg ulcers, lichen simplex, notalgia paresthetica, vestibulitis. Endly, a case of cutis laxa was described where the patient was improved by cutaneous injections of botulinum toxin.
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Long-term BoNT treatment administration has been assessed in various treatment settings (especially in neurology), with the level and duration of BoNT efficacy response being maintained with no major safety problems. Most side effects are local one and are transient. The incidence of antibody development is low and does not induce significant concerns in clinical practice.