Z. Paul Lorenc, MD, FACS
It was with great interest that I read the consensus article by Liu et al on the use of letibotulinumtoxinA for the aesthetic treatment of Asians.1 When it comes to the clinical application of newly approved toxins, these types of publications are invaluable for new injectors of a given product. Given that botulinum toxin type A (BoNTA) units of activity for different products are not interchangeable, the widespread adaptation of BoNTA products for use in off-label indications, and the fact that doses and injection patterns used in clinical trials are almost never the same as those used in clinical practice, early clinical experience is always welcome. In addition, although letibotulinumtoxinA is not FDA approved, the diversity of the patient population within the United States also makes articles like this one a valuable resource, as preserving patient features and expressivity while also carefully managing dynamic lines, resting expression, facial shape, and tissue positions and contours within the lower face should always be a central treatment goal. As the authors note for their patients in Asia, it is also uncommon for me to encounter a patient who is seeking a frozen or unnatural-looking outcome. Thus, dose must be carefully controlled using differing reconstitution or dilution volumes, and product carefully placed according to each individual patient’s anatomic patterns and muscle mass...
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