Evaluation of the Microbotox Technique: An Algorithmic Approach for Lower Face and Neck Rejuvenation and a Crossover Clinical Trial.

BACKGROUND: Microbotox consists of the injection of microdroplets of botulinum toxin into the dermis to improve the different lower face and neck aging components. No clinical trial has evaluated its effect on the different face and neck components and no study has compared it to the "Nefertiti lift" procedure. METHODS: In this crossover study, patients previously treated with the Nefertiti lift were injected using the microbotox technique. Using standardized preinjection and postinjection photographs, the jowls, marionette lines, oral commissures, neck volume, and platysmal bands at maximal contraction and at rest were assessed with validated photonumeric scales. In addition, the overall appearance of the lower face and neck was evaluated by the Investigators and Subjects Global Aesthetic Improvement Score. Pain and patient satisfaction rates were also evaluated. RESULTS: Twenty-five of the 30 patients previously treated with the Nefertiti technique were injected with a mean dose of 154 U using the microbotox technique. Platysmal bands with contraction, jowls, and neck volume reached a statistically significant improvement. The microbotox technique improved the jowls and the neck volume more than the Nefertiti technique, whereas the platysmal bands at rest and with contraction were more improved by the Nefertiti technique. One hundred percent of patients were satisfied with both techniques and rated themselves as improved. CONCLUSIONS: The microbotox technique is a useful, simple, and safe procedure for lower face and neck rejuvenation. It is mainly effective in treating neck and lower face soft-tissue ptosis, in contrast to the Nefertiti technique, which is more effective on platysmal bands. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The Impact of Botulinum Toxin on Brow Height and Morphology: A Randomized Controlled Trial.

BACKGROUND: Previous reports have objectively demonstrated the efficacy of botulinum toxin for brow elevation. No clinical trial has compared the variation of the eyebrow shape and height when the lateral eyebrow depressors are injected alone or in combination with the medial eyebrow depressors. METHODS: A prospective, randomized, controlled study was designed to evaluate and compare the effect of two different botulinum toxin injection techniques on brow shape and position. Patients were divided into two groups. AbobotulinumtoxinA was injected in the lateral eyebrow depressors alone (group 1) or in both the lateral and medial eyebrow depressors (group 2). Objective eyebrow measurements were performed using standardized preinjection and postinjection photographs. Patient satisfaction was also evaluated. RESULTS: Fifteen patients (30 eyebrows) were included in each group. The brow elevated by 0.6 to 2.1 mm at all positions in group 1. In group 2, the brow elevated from the medial limbus to the lateral edge of the brow (1 to 1.7 mm), with no changes at the level of the medial brow and canthus. When comparing the two injection techniques, the authors found a statistically significant difference in the change of eyebrow height at the level of the medial brow, medial canthus, and lateral brow edge. Ninety-seven percent of patients were satisfied with their results. CONCLUSION: Different eyebrow injection techniques yield different elevation patterns. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.