Aesthetic Applications of Botulinum Toxin A in Asians: An International, Multidisciplinary, Pan-Asian Consensus

Abstract

Background: Botulinum toxin type A remains the most popular nonsurgical aesthetic treatment worldwide. Previous consensus statements have focused on Caucasians and on Koreans as generally representative of Asians. However, indications and dosages vary among different ethnic groups. This publication reports the results of a multidisciplinary, pan-Asian consensus focusing on incobotulinumtoxinA.

Methods: A consensus group of plastic surgeons and dermatologists from Asia, Europe, and the United States convened for a live meeting in Asia, followed by a questionnaire-based Delphi procedure. Treatment of Asians in both their native countries and countries of migration was discussed.

Results: For most items, the group achieved a majority consensus. A number of treatment indications, strategies, and dosages were identified in Asians, which are distinct to those previously described for Caucasians due to differences in facial morphotypes, anatomy, and cultural expectations. The group also formulated position statements for intradermal botulinum toxin type A ("mesotoxin"), body shaping with the calves as a paradigm, and reduction of parotid glands. While Asians have previously been considered a homogeneous group for the purposes of aesthetic treatment, this publication considers regional variations. A new classification of Asian facial morphotypes is proposed to aid treatment planning and implementation.

Conclusions: This is the first pan-Asian consensus for aesthetic use of botulinum toxin type A. Its unique objective is to optimize treatment safety and efficacy for patients of complete or part-Asian ancestry in all regions. The recommendations for incobotulinumtoxinA may be extended with care to other botulinum toxin formulations.

Fig. 1.

Suggested injection sites of the gastrocnemius muscles for calf shaping according to the position statement. A total of 15–25 IPs are commonly used with a dose of 4 U per injection point and a total dose of 60–100 U for the head of each gastrocnemius muscle. The injection level should be intramuscular. Reproduced with permission from Seo K, Botulinum Toxin for Asians; Jeju, South Korea: Jeju, Korea: Seoul Medical Publishing Ltd.; 2014.

Fig. 2.

Suggested parotid gland injection sites for gland reduction according to the position statement. A total of 4–6 IPs with a dose of 4–6 U per IP is suggested giving a total dose of approximately 30 U (20–40 U) depending on the volume of the parotid gland. The level of injection is intraglandular. IP, injection point. Reproduced with permission from Seo K, Botulinum Toxin for Asians; Jeju, Korea: Seoul Medical Publishing Ltd.; 2014.