Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Jun 2007

Botulinum Toxin (Botox) to Enhance Facial Macroesthetics: A Literature Review

DMD,
DDS, MDS, and
DDS, MSD
Page Range: 164 – 171
DOI: 10.1563/0-835.1
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Abstract

Dental implants have emerged as a predictable treatment option for partial edentulism. Their ability to preserve bone and soft tissue yields highly esthetic results in the long term. Increasingly, patients are demanding not only enhancements to their dental (micro) esthetics but also to their overall facial (macro) esthetics. Dynamic wrinkles (caused by hyperfunctional muscles) in the perioral, glabellar, and forehead regions can cause a patient's expressions to be misinterpreted as angry, anxious, fearful, or fatigued. An emerging treatment option to address these issues is the use of a paralyzing material such as botulinum toxin A (Botox) to decrease the appearance of the wrinkles, which yields a more esthetic and youthful facial appearance. Botox is a deadly poison that is produced by the bacterium Clostridium botulinum and causes muscle paralysis by inhibiting acetylcholine release at the neuromuscular junction. When used in areas of hyperfunctional muscles, a transient partial paralysis occurs that diminishes the appearances of wrinkles, Therefore, wrinkles not attributable to hyperfunctional muscles (eg, wrinkles caused by aging, gravity, photodamage, trauma, and scarring) will not be amenable to treatment with the toxin. As a result, proper case selection is essential. A thorough understanding of the indications, techniques, dosages, and complications and their management is imperative to achieve a satisfactory result. This article will review the pathogenesis of facial wrinkles as well as the history, techniques, clinical controversies, and other important considerations for successful treatment of facial wrinkles with Botox.

Copyright: American Academy of Implant Dentistry
<sc>Figure</sc>
1.
Figure 1.

Cross section of human skin demonstrating the differences between a line, wrinkle, and fold.


Contributor Notes

Sarosh F. Dastoor, DMD, is a resident, Carl E. Misch, DDS, MDS, is a professor, and Hom-Lay Wang, DDS, MSD, is a professor and the director of graduate periodontics, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor. Address correspondence to Dr Wang at Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 N University Ave, Ann Arbor, MI 48109-1078 (homlay@umich.edu).

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