Guide Botulinum Toxin for Asians

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botulinum toxins and other noninvasive cosmetic treatment modalities. He is is titled Botulinum Toxin for Asians and in the preface Dr. Seo writes “In this.
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The first group received 96 U of botulinum toxin across the 48 injection sites, using the scattering method, with 2 U of botulinum toxin at each point. The second group received 72 U of botulinum toxin across the 48 injection sites, using the scattering method, with 1. The third group received 96 U of botulinum toxin administered across ten injection sites on the medial and lateral sides of the gastrocnemius muscle, with 9.


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The fourth group also used the local point method with 72 U of botulinum toxin, with 7. The injections were administered under sterile conditions using gauge needles with 1 inch depth in the prone position. The patients were asked to contract the muscle while the injection was performed to ensure appropriate localization of the muscle area. In the point injection group, topical lidocaine was applied prior to injection to reduce pain. Six months after the follow up, patient satisfaction and experiences were evaluated using a survey to determine the efficacy of the methods Appendix A, available as Supplementary Material online at www.

All subjects were females aged between 18 and 35 years mean, The before and after 2D photography and MRI examinations were imageologically compared.

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Based on the 2D pictograph and volumetric analysis, we concluded that the extent of volumetric reduction of the gastrocnemius muscle and leg circumference was different depending on the injection methods and dose. The maximum effect was recorded using the scattering method with 96 U of botulinum toxin Figure 5. At one month after the injection, the lower leg circumference was reduced by about 1. The MRI results showed a decrease in volume of about 80, to , mm 3 before and after treatment.

Careful analysis of the 2D photography demonstrated that the gastrocnemius muscle almost disappeared or was slightly visible in the tiptoe position contracted muscle as in the standing position relaxed muscle. The second group, which used the scattering method with 72 U of botulinum toxin Figure 6 , also displayed significant outcome during the follow up.

However, the extent of volumetric decrease was not as significant as that in the subjects administered 96 U of botulinum toxin. The lower leg circumference of this group decreased by about 1. Two-dimensional photography also showed a reduction in the volume of the gastrocnemius muscle during the tiptoe position contracted muscle. The subjects from the third group Figure 7 , using the point injection method of 96 U of botulinum toxin with five points in each medial and lateral side of the gastrocnemius muscle, showed a decrease in the lower leg circumference of approximately 0.

Botulinum Toxin for Asians

The gastrocnemius muscle on both medial and lateral sides exhibited reduction in volume as demonstrated in the 2D photographs. Six months after injection, the muscle volume enlarged by about 10, to 20, mm 3. However, the 2D photographs showed minimal significant change in the volume of the gastrocnemius muscle: it was either unchanged or slightly enlarged.

In the fourth group Figure 8 , whereby the point injection method of 72 U of botulinum toxin was used with five points in each medial and lateral side of the gastrocnemius muscle, the leg circumference of the subjects decreased by about 0. The 2D photography showed slight or insignificant reduction in the gastrocnemius muscle in the tiptoe position contracted muscle.

Six months after injection, the muscle volume became enlarged, almost nearing or completely returning to the original size, while the 2D photography in the tiptoe position showed similar gastrocnemius muscle shape to that before the injection Table 2. Two-dimensional photography with scattering method of injection with 96 U of botulinum toxin on a year-old woman.

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A Preinjection. B At one month postinjection, the lower leg circumference was reduced by about 1. Two-dimensional photography with scattering method of injection with 72 U of botulinum toxin on a year-old woman. Two-dimensional photography with point injection method of 96 U of botulinum toxin on a year-old woman. B At one month postinjection, the lower leg circumference decreased by approximately 0.

C At 6 months postinjection, the muscle volume enlarged by about 10, to 20, mm 3. Two-dimensional photography with point injection method of 72 U of Botulinum toxin on a year-old woman. C At 6 months postinjection, the muscle volume became enlarged almost nearing or completely returning to the original size. In the analysis of gastrocnemius muscle volume measurements of both legs, data obtained before injection were assigned to the control group; and those obtained one month and 6 months after injection were assigned to the first and second experimental groups, respectively.

The statistical analysis of both sides of gastrocnemius muscle volume measurement is shown in Figures 9 and 10 , which reflect the volume reduction at one month after injection and the slight increase at 6 months after injection. Statistical graphic analysis of gastrocnemius muscle volume measurements of the right leg.

The y-axis indicates the changing of muscle volume mm 3 , and the x-axis indicates different injection methods and dosages. Statistical graphic analysis of gastrocnemius muscle volume measurements of the left leg. The subjects were asked to fill out a survey form during the last follow up to obtain feedback about the significance of the effect of the injection. Most subjects showed a high satisfaction rating because their expectations were met Appendix B, available as Supplementary Material online at www.

Eight of 10 subjects in the point injection group and 4 of eight subjects in the point injection group experienced adverse effects, such as cramps in both legs, which worsened during walking.

Consensus recommendations on the aesthetic usage of botulinum toxin type A in Asians.

However, the cramps did not affect daily activities or require special treatment. The cramps only lasted for one to 2 months postinjection. No serious complications, such as edema, seroma, or gait disturbance, were observed. The injection did not harm the subjects and exhibited low risk of complication. It has been considered the safest procedure to correct hypertrophied gastrocnemius muscle. Over the years, several studies in the field of plastic surgery have been conducted worldwide to help Asian women attain their ideal perfect body with a pair of perfectly shaped legs.

Tsai et al 3 attempted to categorize and standardize the criteria for the concept of an ideal female leg in Asians. In the present clinical study, 16 out of the 18 subjects had a maximal circumference of about Therefore, the subjects initially presented with the main complaint of having relatively hypertrophic gastrocnemius muscles, with the desire to undergo treatment to correct their shortcomings.

Currently, the invasive methods available to correct lower contour problem of the lower legs in clinical practice include liposuction, selective neurotomy, and gastrocnemius muscle resection.

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Liposuction has a strict requirement indication for patients who are overweight and with excess fat deposition in the lower leg. The common complications for this procedure include postsurgical edema, prolonged healing time, and asymmetry of both legs. To correct the contour asymmetry of the legs, selective neurotomy was introduced. It can effectively reduce calf circumference, thereby improving the contour of the legs with a relatively longer retaining duration.

The surgery technique involves cutting the nerve supply of the medial gastrocnemius muscle and the medial nerve branch of the soleus muscle. The complications of this method include mild postsurgical edema and severe complications, such as bending of the lower extremities to the lateral side, recurrence of hypertrophic calves, and injury of the nerve of the soleus muscle, in cases handled by inexperienced surgeons. This method was later studied and modified by Lee et al 11 by using subtotal resection of the gastrocnemius muscle for hypertrophic muscular calves in Asians.

The related complications of this procedure include seroma, hollow deformity of the popliteal fossa, late hematoma, and injury of the nerve of the soleus muscle. Most women cannot accept such scars because they hinder the aesthetic appearance of the lower leg. Botulinum toxin is widely used in clinical practice to treat hypertrophic muscle disorders. In our outpatient clinic, botulinum toxin is frequently used to correct masseter muscle hypertrophy since most Asian women aspire to have a heart-shaped face.

Botulinum toxin can be used to treat noncosmetic problems, like hyperhidrosis, by decreasing cholinergic stimulation of eccrine glands responsible for sweat reduction. Anatomically, the gastrocnemius muscle possesses lateral and medial heads in the posterior leg. Literature on calf recontouring is limited, with proposed doses initiated by either anecdotal evidence or small case series.

Suggested doses range from 32 to units of botulinum toxin type A per calf. Thus, this study aimed to observe and determine the most effective method to correct the contour of the lower leg calf, as well as determine the dose that can produce the maximum effect to meet the demands of the physician and patient.

The overall results of this study demonstrated that injection of large doses in many points allowed maximum delivery and efficient result. Injection with minimum doses in multiple points also showed effective and satisfactory results.


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    6. Lower facial shape can be improved even in individuals who start with a normal muscle thickness of 0. When targeting the masseters, both the onset and peak of effect become apparent significantly later than with other muscles.

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    A decrease in masseteric volume typically starts to become apparent 2 weeks post injection, and the effect continues to develop over the ensuing 1—3 months. Muscle volume is usually restored to some extent at 6 months 36 and may approach its pretreatment state by 10—12 months after injection. There are reports of results lasting for more than 1 or 2 years, even after only 1 session of botulinum toxin type A treatment.

    In a proportion of subjects, mild temporary muscular weakness following treatment may manifest as difficulty in chewing; this generally passes and chewing returns to normal force within 3 months. Treatment should be performed with caution in Asian patients with a congenitally long philtrum and protruding upper lip, as it may lead to further elongation of the philtrum. The Pan-Asian Aesthetics Toxin Consensus Group formulated position statements for the following emerging treatment indications, with the caveat that further data must be accrued to fully assess safety and efficacy from an evidence-based perspective.

    Injection of botulinum toxin type A in the dermal-subdermal layer 40 has been reported anecdotally to produce improvement in skin texture and turgor, and reduction in sebum production and pore prominence. The consensus group discussed the possibility that needle insertion into the skin, rather than botulinum toxin itself, might be sufficient to produce at least some of the beneficial effects. From an evidence-based perspective, large, placebo-controlled trials would be required to evaluate the efficacy of intradermal botulinum toxin injection.

    Because toxin spreads in a 3-dimensional manner from its point of injection, effects on the musculature or the skin cannot be considered in isolation. Intracutaneous injection of botulinum toxin type A has been described as a strategy to preferentially target the superficial portions of the underlying muscles, and hence to achieve efficacy without impairment of function. Although the popularity of body shaping with botulinum toxin type A is reportedly increasing in Asian subjects, it is still dwarfed by facial use. The most commonly described treatment is injection of the calves.

    The aim of injecting botulinum toxin type A into the calves is to produce atrophy. Suggested injection sites of the gastrocnemius muscles for calf shaping according to the position statement.

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    The injection level should be intramuscular. As with treatment of the masseters, onset of atrophy becomes apparent 1—2 weeks post injection and reaches maximum effect by 2—3 months. The muscle returns to approximately half its original volume after 5—6 months and approaches its previous state approximately 10—12 months after injection. If the subject avoids active exercise of the treated muscle, a return to pretreatment muscle volume can be prevented. Clinical experience indicates that repeated injections over several years can also result in chronic muscular atrophy. The consensus group added the caveat that it does not consider functional impairment to be an acceptable result of cosmetic treatment with botulinum toxin.

    Enlarged parotid glands can contribute to a square-shaped lower face. The most protruding part of the parotid gland around the mandibular angle is the preferred injection site. Injection of botulinum toxin in very thin subjects with an obvious submandibular salivary gland can improve lines on the neck. Suggested parotid gland injection sites for gland reduction according to the position statement. The level of injection is intraglandular.