Advances in the use of botulinum neurotoxins in facial esthetics.

AIM:   To present the latest findings and future developments in the cosmetic use of botulinum neurotoxin.

METHODS:   Review of recent literature and new scientific developments.

RESULTS:   Botulinum neurotoxin type A preparations onabotulinumtoxinA (BOTOX(®) Cosmetic/Vistabel(®), Allergan Inc.) and abobotulinumtoxinA (Dysport(®) /Azzalure(®) /Reloxin(®) , Ipsen Pharma,) have been used for many years and are effective and well tolerated for facial esthetic procedures. However, advances are continually made in the esthetics field. New formulations that may exhibit reduced antigenicity are becoming available, such as incobotulinumtoxinA (Xeomin(®) /Xeomeen(®) /Bocouture(®); formerly known as NT 201, Merz Pharma), which is a botulinum neurotoxin type A free from complexing proteins. In addition, lower facial procedures using botulinum toxin combined with fillers are becoming increasingly popular. Injection techniques and patterns are also evolving, with the aim of creating a more natural result and avoiding a "frozen" appearance. Moreover, the diversity of individuals requesting esthetic procedures is increasing, with growing interest from men and patients with a variety of skin types and colors.

CONCLUSIONS:   The uses of botulinum toxins for facial esthetics procedures continue to expand, with new techniques and formulations. The availability of products such as incobotulinumtoxinA may reduce the risk of neutralizing antibody development while maintaining the good efficacy and safety of existing formulations.