New indications for botulinum toxin type A in treating facial wrinkles of the mouth and neck.

Botulinum toxin type A (BTX-A) is commonly used to smooth hyperkinetic lines in the periocular and forehead areas of the upper face, but has been used less frequently for indications in the lower face and neck. This study was designed to determine whether botulinum toxin treatment of the mouth and neck areas is as clinically successful as treatment of the upper face. This was a retrospective study of patients who were treated with botulinum toxin type A (BOTOX, Allergan, Inc) to soften hyperkinetic facial wrinkles. Of 100 patients randomly selected from a single clinical practice, 91 met the inclusion criteria and were divided into two groups for analysis: the 56 patients in Group 1 did not receive treatment in the mouth and neck areas, while the 35 patients in Group 2 were treated at least once in the mouth and neck areas. Patients were surveyed for periods ranging from seven to 49 months. Most patients in each group had a single BTX-A procedure during this period. Both groups of patients had comparable improvement of wrinkles both at the evaluation immediately after the neuromuscular blockade and during followup. In comparison with patients whose treatment was confined to the upper face, patients who received global treatment with BTX-A, including BTX-A injections in the mouth and neck areas, were injected in more sites per procedure and had more procedures in combination with other therapies. Patient satisfaction with botulinum toxin treatment and outcomes was high in both groups. BTX-A is an important tool within the therapeutic spectrum for the treatment of hyperkinetic facial wrinkles, including those in the areas of the mouth and neck.