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Aesthetic Dermatology
Botulinum Toxin in Aesthetic Indications – Technique Follows Function
Oliver P Kreyden
President, Swiss Group of Aesthetic Dermatology and Skincare (SGEDS)
Abstract
A symmetrical body stands for health. Symmetry is thought to be the major prerequisite for an attractive face, but many faces are not
symmetrical yet are still regarded as beautiful. However, in our judgement of overall appearance, the condition of the skin, the hair and the
nails plays another important role. Also, the landmarks of beauty underlie fashion. Nowadays, in our rapidly growing society, due to active
and aggressive media and the Internet, ‘survival of the prettiest’ is more suitable than ‘survival of the fittest’, which prevailed 50 years ago.
On the other hand, increasing demand for non-surgical aesthetic treatments has prompted many physicians with little knowledge of
aesthetic dermatology to offer various non-surgical treatments, with the danger that aesthetic dermatology stands to lose its scientific
relevance. Therefore, before treating patients with botulinum toxin for aesthetic indications, it is vital to know every detail of the mechanism
of action of the drug, the exact anatomy of the treated area and the treatment clues before, during and after treatment. This knowledge is
available in the literature as well as at specific workshops and/or congresses. Every beginner should adhere strictly to the suggested
protocols in the literature. As the aesthetic problem differs from patient to patient, the expert needs to individualise the injection plan to
each case: technique follows function. Every physician should be able to adapt his or her skills to achieve results that satisfy both the
patient and the therapist. To become such an expert, the physician should start with simple cases following a set injection plan; only as his
or her skills improve should the physician start to deal with increasingly challenging cases. The dose has to be adapted and precise and
standardised information on the procedure, side effects, complications and alternative therapies should be given to the patient before the
treatment. A follow-up consultation two weeks after treatment and photographic documentation before and after treatment leaves the
impression that the patient is in good hands and has an attentive doctor. These points will help aesthetic dermatology remain what it should
be: a highly scientific field within dermatology.
Keywords
Botulinum toxin, beauty, technique, clinic, aesthetic, indication, skill, patient management
Disclosure: The author has no conflicts of interest to declare.
Received: 5 March 2009 Accepted: 20 April 2009
Correspondence: Oliver P Kreyden, President, Swiss Group of Aesthetic Dermatology and Skincare (SGEDS), Dermatology and Venerology FMH, Aesthetic Dermatology,
praxis@kreyden.ch
What Is Beauty? a beautiful person, leaving us with feelings such as pleasure or
The definition of beauty is not easy. Beauty is a characteristic of satisfaction. Symmetry is thought to be a major prerequisite for an
a person, place, object or idea that provides a perceptual attractive face. Many faces are not symmetrical, yet are still
experience of pleasure, meaning or satisfaction. Epichram (530 AD) regarded as beautiful. What role, then, does asymmetry play in the
had another very simple definition: “For the donkey, the donkey-girl perception of beauty? The assessment of computer-manipulated
is the most beautiful.” We follow five principles of beauty in images by independent judges was studied. Nevi located at
aesthetic dermatology: different positions and standardised changes of the orbital region
were estimated in 250 individuals. The results showed that slight
• symmetry; lateral orbital and facial asymmetry does not impair attractiveness
• ordinary; at all, and that asymmetries close to the midline are significantly
• motion; less attractive than those affecting the lateral aspect of the face.
• body odour; and
• skin and hair condition. A single nevus that is located laterally on the face is significantly more
attractive than a nevus close to the midline. Most intersestingly, faces
A symmetrical body stands for health: the more ordinary a person with a completely symmetrical bilateral pair of nevi in the same lateral
seems, the more handsome he or she appears. The rhythm of positions (perceived as attractive when alone) received the worst
motion and smell – the most sensitive sense – plays a very ratings. The study concluded that symmetry is a characteristic of an
important role in our judgement of overall appearence. The attractive face, but there are exceptions to the rule. Under certain
condition of the skin, the hair and the nails completes the image of conditions symmetry can be completely unattractive. The visual
© TOUCH BRIEFINGS 2009 43
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