The mid- and lower face

Even for experienced physicians the mid-and lower face is a challenge, because the gap between a perfect and a disastrous result over the treatment period is quite small. However, with adequate knowledge of the anatomy and careful dosing it is possible to obtain good results in most patients. This chapter follows a practical approach. Each

indication is characterized by the mimic muscles to be treated, the injection points, and the dosages. The chapter refers to the book of Marc Heckmann and myself.1 The recommendations for the injection points are based on two German consensus papers on the usage of botulinum toxin A (BTX-A) in esthetic medicine.2,3 Both consensus papers refer to the use of Dysport. The BOTOX consensus paper was only partially helpful, as not all areas discussed in this chapter were covered.4 In dermatologic practice, 3U of Dysport are generally accepted as being equal to 1 U of BOTOX. This ratio has recently been confirmed for dystonia by a Cochrane systematic review.5 Therefore, when no recommendations from the BOTOX consensus paper are available this ratio might be useful.