Botulinum toxin tips for avoiding complications and off label use
Complications with botulinum toxin type A are more likely in the lower face compared to the upper face and more irritating to the patient. But there is a way to avoid those complications, according to New York City-based plastic surgeon Michael A. C. Kane, M.D., who presented a course on fillers and neurotoxins Monday, April 30 at The Aesthetic Meeting 2018 in New York City.
“I think the most common complication is asymmetry,” Dr. Kane writes in an email to The Aesthetic Channel. “Most of the new patients I see who have had a bad experience in the lower face talk about the loss of symmetry after their injection. Most of the musculature in the lower face is a bit asymmetric. If you inject all of your patients symmetrically, you can increase this apparent asymmetry.”
The key to avoiding this is recognizing asymmetry where it exists and adjusting the dosage, properly, according to Dr. Kane.
“I think using the lowest effective dose and injecting it where it belongs is the key to minimizing complications,” he writes.
During the course, Dr. Kane also talked about off-label use of botulinum toxin type A, including Botox (Allergan) and Dysport (Galderma) and Xeomin (Merz), in non-glabellar areas.
“I will use a neuromodulator in non-glabellar areas whenever a wrinkle or untoward shape is being at least partially caused by muscular action,” he writes. “The antiquated idea of static versus dynamic lines never made much sense to me. Nearly all lines have some component of each.”
Dr. Kane has been treating patients with facial nerve disorders, including every muscle in the face, since 1991. And since then, he has been cosmetically injecting the glabella, forehead, crow’s feet, masseter, orbicularis oris, depressor anguli oris, depressor labii inferioris and mentalis. He writes that he started to inject the levator labii superioris alaeque nasi and platysma, cosmetically, in 1992.
“My easiest and best tip is to start small when it comes to dosing,” he writes. “A natural look is better than a frozen look, and your incidence of complications should be less, as well. Also, pay attention to how patients move. No two patients are the same. Standardized injections are only good for standardized people – and there aren’t any.”