International Consensus Recommendations on the Aesthetic Usage of Ready-to-Use AbobotulinumtoxinA (Alluzience)

Abstract

Alluzience (abobotulinumtoxinA RTU; Ipsen, Paris, France and Galderma SA, Lausanne, Switzerland) is the first ready-to-use (RTU) botulinum toxin type A liquid solution approved for the treatment of glabellar lines in Europe. In this article, the authors provide consensus recommendations on the aesthetic usage of abobotulinumtoxinA RTU. Members of the International Board on Alluzience convened to develop consensus on the treatment of glabellar lines as well as other facial wrinkles based on their own extensive experience. Consensus recommendations were developed to provide practical guidelines for injection of abobotulinumtoxinA RTU. General guidance on proper assessment, treatment planning, and patient education is provided, as well as specific injection guidelines per indication. Indications covered include glabellar lines, crow's feet, horizontal forehead lines, lateral eyebrow lift, lower eyelid wrinkles, bunny lines, drooping nasal tip, perioral wrinkles, drooping mouth corners, masseter hypertrophy, hollow cheek lines, dimpled chin, and platysmal bands. These guidelines provide a practical framework to support routine injection of facial muscles with Alluzience.

Figure 1.

Treatment of (A) glabellar lines, (B) crow’s feet, (C) horizontal forehead lines, and (D) lateral brow lift. For the treatment of glabellar lines, a 5-point injection is recommended for most patients, with 1 point in the procerus and 2 points in each corrugator. For the treatment of crow's feet, an injection pattern of 3 points per side (ie, 6 points in total) surrounding the canthal region is recommended for most patients. For the treatment of horizontal forehead lines, the International Board on Alluzience recommended 4 to 8 points for the total frontalis depending on patient presentation (gigure shows 8 points). For the lateral brow lift, 1 injection point should be placed at each eyebrow tail into the pars orbicularis, 1 cm above the orbital rim. An additional injection point should be placed at the external part of the frontalis, at a minimum of 4.5 cm up from the eyebrow (depending on hairline) and 4 to 5 cm from the midline. Created by and published with permission from Virginie Denis.

Figure 2.

Treatment of (A) lower eyelid wrinkles and (B) bunny lines. For the treatment of lower eyelid wrinkles, board members recommended 1 to 3 injections about 2 to 3 mm below the lash line. For the treatment of bunny lines, 1 to 3 injection points in the nasalis pars transversa are recommended (figure shows 2 points per side). Created by and published with permission from Virginie Denis.

Figure 3.

Treatment of (A) perioral wrinkles and (B) drooping mouth corners. For the treatment of perioral wrinkles, 4 to 6 injection points are recommended, with 4 symmetric points just above the vermilion border and, if necessary, 2 points on the lower lip. For the treatment of drooping mouth corners, a 1- to 2-point injection into the depressor anguli oris is recommended. The major injection points should be 1 cm lateral to the commissure and 1 cm down. If additional hyperkinetic wrinkles appear lateral to the lip corner, the International Board on Alluzience recommended also injecting the fascial platysma (inferior point). Created by and published with permission from Virginie Denis.

Figure 4.

Treatment of masseter hypertrophy. For masseter hypertrophy, a pyramid of 3 to 5 injection points per side is recommended (figure shows 3 points per side). Created by and published with permission from Virginie Denis.

Figure 5.

Treatment of (A) hollow cheek lines, (B) dimpled chin, and (C) platysmal bands. For the treatment of hollow cheek lines, the International Board on Alluzience recommended injecting 1 to 2 points per side, at least 1 cm behind the modiolus. Injections should be intradermal and have a posterior flow following the wrinkle. To treat the dimpled chin, a 1- to 3-point injection at the bony jawline close to the central midline is recommended. For platysmal bands, it is recommended to start the first point at the jawline and go down every 2 cm to the middle of the bands. Created by and published with permission from Virginie Denis.