madman
Super Moderator
The realm of aesthetic medicine is broad, and there are now countless medications and topical agents used in the practice of aesthetic medicine. This chapter examines the most commonly used injectable and topical medications for aesthetic medicine.
BOTULINUM TOXINS
Since the 1990s botulinum toxins have been used in aesthetic medicine. Botulinum toxin is a neurotoxin produced by the bacteria Clostridium botulinum. Originally used for the medical purpose of treating blepharospasm, botulinum toxins are now approved by Food and Drug Administration (FDA) for a wide range of indications. The first use in aesthetic medicine was noted when treatment of blepharospasm resulted in the additional benefit of reducing crow’s feet lines produced by constriction of the vertical portion (lateral aspect) of the orbicularis oculi muscle. Interestingly, botulinum toxins were not approved to treat crow’s feet lines until 2013. In its first use as aesthetic medicine, botulinus toxins were used to treat vertical glabellar lines and horizontal forehead rhytids.
Mimetic lines are produced by the contraction of facial muscles. Mimetic lines are commonly seen in the forehead, glabella, and lateral orbicularis (crow’s feet areas) but can also be identified in other facial subunits such as the lower face and midface (Fig. 1). Mimetic lines are amenable to treatment with botulinum toxins because the mechanism of action of botulinum toxins is to paralyze or weaken muscles by inhibiting the release of acetylcholine from the neuromuscular junction (Fig. 2).
The botulinum toxin polypeptide chain has a heavy (H) chain and a light (L) chain linked by a disulfide bond. Intramuscular injection of botulinum toxins acts at the neuromuscular junction to cause muscle paralysis by inhibiting the release of acetylcholine from presynaptic motor neurons. The heavy (H) chain of the toxin is an irreversible binder to high-affinity receptors at the presynaptic surface of cholinergic neurons. The toxin-receptor complex is endocytosed into the cell, and the disulfide bond between the 2 chains is cleaved. The toxin is then released into the cytoplasm. The light (L) chain interacts with different proteins (SNAP 25, vesicle-associated membrane protein, and syntaxin) in the nerve terminals and prevents the fusion of acetylcholine vesicles with the cell membrane.1,2 The peak of the effect occurs approximately 7 days after injection. Doses of all commercially available botulinum toxins are expressed in terms of units of biological activity. One unit of botulinum toxin corresponds to the calculated median intraperitoneal lethal dose (LD50) in female Swiss-Webster mice.1 The affected nerve terminals do not degenerate, but the blockage of neurotransmitter release is irreversible. The function is recovered by the sprouting of nerve terminals and the formation of new synaptic contacts; this usually takes approximately 3 months.
Commercially Available Types of Neurotoxins for Aesthetic Use
There are now on the market several brands of neurotoxins using different formulations of botulinum toxin. Several are FDA approved for nonaesthetic uses (eg, Myobloc), whereas others (Botox, Dysport, Xeomin, Jeuveau) are FDA approved for use to treat mimetic rhytids.
-Botox (onabotulinum A)
-Dysport (abobotulinum A)
-Jeuveau (prabotulinum toxin A)
-Xeomin (incobotulinum toxin A)
*Current Practical Use of Neurotoxins
*Contraindications to Neurotoxin Use for Aesthetic Purposes
*Adverse Effect of Neurotoxin Treatment
HYALURONIC ACID FILLERS
-Technique for Injection
-Contraindications
-Adverse Reactions and Complications
NONHYALURONIC ACID FILLERS
-Calcium Hydroxylapatite—Radiesse
-Poly-L-Lactic-Acid Filler—Sculptra
-Polymethylmethacrylate Fillers—Bellafill, ArteFill
CHEMICAL PEELS
-Superficial Peeling Agents
-Medium Depth Agents
-Deep Peel Agents
TOPICAL AESTHETIC MEDICATIONS
-Tretinoin
-Hydroquinone
-Growth Factors
-Vitamin C
BOTULINUM TOXINS
Since the 1990s botulinum toxins have been used in aesthetic medicine. Botulinum toxin is a neurotoxin produced by the bacteria Clostridium botulinum. Originally used for the medical purpose of treating blepharospasm, botulinum toxins are now approved by Food and Drug Administration (FDA) for a wide range of indications. The first use in aesthetic medicine was noted when treatment of blepharospasm resulted in the additional benefit of reducing crow’s feet lines produced by constriction of the vertical portion (lateral aspect) of the orbicularis oculi muscle. Interestingly, botulinum toxins were not approved to treat crow’s feet lines until 2013. In its first use as aesthetic medicine, botulinus toxins were used to treat vertical glabellar lines and horizontal forehead rhytids.
Mimetic lines are produced by the contraction of facial muscles. Mimetic lines are commonly seen in the forehead, glabella, and lateral orbicularis (crow’s feet areas) but can also be identified in other facial subunits such as the lower face and midface (Fig. 1). Mimetic lines are amenable to treatment with botulinum toxins because the mechanism of action of botulinum toxins is to paralyze or weaken muscles by inhibiting the release of acetylcholine from the neuromuscular junction (Fig. 2).
The botulinum toxin polypeptide chain has a heavy (H) chain and a light (L) chain linked by a disulfide bond. Intramuscular injection of botulinum toxins acts at the neuromuscular junction to cause muscle paralysis by inhibiting the release of acetylcholine from presynaptic motor neurons. The heavy (H) chain of the toxin is an irreversible binder to high-affinity receptors at the presynaptic surface of cholinergic neurons. The toxin-receptor complex is endocytosed into the cell, and the disulfide bond between the 2 chains is cleaved. The toxin is then released into the cytoplasm. The light (L) chain interacts with different proteins (SNAP 25, vesicle-associated membrane protein, and syntaxin) in the nerve terminals and prevents the fusion of acetylcholine vesicles with the cell membrane.1,2 The peak of the effect occurs approximately 7 days after injection. Doses of all commercially available botulinum toxins are expressed in terms of units of biological activity. One unit of botulinum toxin corresponds to the calculated median intraperitoneal lethal dose (LD50) in female Swiss-Webster mice.1 The affected nerve terminals do not degenerate, but the blockage of neurotransmitter release is irreversible. The function is recovered by the sprouting of nerve terminals and the formation of new synaptic contacts; this usually takes approximately 3 months.
Commercially Available Types of Neurotoxins for Aesthetic Use
There are now on the market several brands of neurotoxins using different formulations of botulinum toxin. Several are FDA approved for nonaesthetic uses (eg, Myobloc), whereas others (Botox, Dysport, Xeomin, Jeuveau) are FDA approved for use to treat mimetic rhytids.
-Botox (onabotulinum A)
-Dysport (abobotulinum A)
-Jeuveau (prabotulinum toxin A)
-Xeomin (incobotulinum toxin A)
*Current Practical Use of Neurotoxins
*Contraindications to Neurotoxin Use for Aesthetic Purposes
*Adverse Effect of Neurotoxin Treatment
HYALURONIC ACID FILLERS
-Technique for Injection
-Contraindications
-Adverse Reactions and Complications
NONHYALURONIC ACID FILLERS
-Calcium Hydroxylapatite—Radiesse
-Poly-L-Lactic-Acid Filler—Sculptra
-Polymethylmethacrylate Fillers—Bellafill, ArteFill
CHEMICAL PEELS
-Superficial Peeling Agents
-Medium Depth Agents
-Deep Peel Agents
TOPICAL AESTHETIC MEDICATIONS
-Tretinoin
-Hydroquinone
-Growth Factors
-Vitamin C
