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Special Topics |

Cosmetic Uses of Botulinum Neurotoxin Type A:  An Overview

Andrew Blitzer, MD,DDS; William J. Binder, MD
Arch Facial Plast Surg. 2002;4(4):214-220. doi:.
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Clostridium botulinum produces 7 serologically distinct toxins that are designated A, B, C, D, E, and F. They all have similar structure (a dichain with a disulfide bond) and a molecular weight of about 150 d. The light chain is a zinc-dependent metalloprotease, in which the substrate is one of the fusion proteins responsible for docking and ultimately exocytosis of the acetylcholine-containing vesicle. Each serotype light chain cleaves a specific residue of one of these proteins, thus preventing the formation of this docking complex and hence, preventing neurotransmitter exocytosis.1-2

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Figures

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Figure 1.

A, Diagram showing injection sites for glabellar lines. B, Patient with glabellar lines caused by significant corrugator muscle contraction; C, the same patient 2 weeks after botulinum neurotoxin type A (Botox) injection for glabellar lines.

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Figure 2.

A, A triangle is first drawn with apex at a central point between the medial brows. Two points are drawn at a midpupillary position, 1 cm above the superior orbital rim. Points are then drawn 1 to 1.5 cm apart to encompass all of the horizontal lines. B, Patient with significant horizontal forehead lines; C, the same patient 2 weeks after botulinum neurotoxin type A injection, showing marked improvement of lines.

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Figure 3.

A, Sites of injections for lateral orbital lines or crow's-feet. B, Patient with multiple lateral orbital lines or crow's-feet lines prior to botulinum neurotoxin type A (Botox) injection; C, the same patient 2 weeks after Botox injection for lateral orbital lines. D, Patient with noticeable lateral orbital lines or crow's-feet; E, the same patient 2 weeks after Botox injection for crow's-feet.

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Figure 4.

A, Sites of injection for lateral nasal or "bunny" scrunch lines; B, sites of injection for lateral oral or "marionette" lines; C, sites of injection for perioral or "lipstick" lines.

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Figure 5.

A, Sites of injection for mentalis muscle in patients with "peau d'orange" or "popply chin"; B, sites of injection for platysmal bands.

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