Advanced botulinum toxin techniques against wrinkles in the upper face.

The use of botulinum toxin type A for facial rejuvenation is one of the most common procedure in esthetic medicine. Overall clinical and study experience with botulinum toxin type A for facial enhancement has confirmed that it is effective and safe even in the long term. The different injection techniques, the starting doses, the sex, the dilution, and the storing of the product, nevertheless, may influence the final result of the treatment. In this article we propose some recommendations including general principles as well as information about its specific use. Perhaps one of the most important perspectives is that, based on a well-established knowledge of the technique, individualized esthetic planning is the key to success. This depends on a precise understanding of the underlying anatomy and physiology of the individual muscles and their interactions, as well as on individual patient's characteristics, including goals and expectations.