Six years of experience using an advanced algorithm for botulinum toxin application.

[BACKGROUND] Botulinum toxin (BTX) products continue to be widely used for facial rejuvenation. Variables to consider prior to BTX treatment include the anatomical area to be treated, gender, muscle mass, ethnicity, skin thickness, and the effects of aging.

[OBJECTIVE] To describe a treatment algorithm which has been developed for facial rejuvenation to help physicians to easily and systematically customize BTX treatment, and to describe its use in a large number of patients.

[METHODS AND MATERIALS] Prior to treatment, digital images of patients were obtained while relaxed and while forming different facial expressions. This information was used to plan the depth, dose, and location of BTX injections (onabotulinumtoxinA; Botox ; Allergan, Inc). Dilution was 100 U of BTX to 1 mL 0.9% preserved saline. Injections were performed with 30 U insulin syringes and 30 gauge needles.

[RESULTS] The treatment algorithm described here has been used by the author for facial rejuvenation for more than 5 years. It was originally based on published guidelines; however, by carefully noting treatment outcomes, the number and location of injection points and the dose of BTX used have been modified to create the current treatment system.

[CONCLUSION] Published guidelines for the use of BTX are an excellent starting point for clinicians with little experience; however, each practitioner is likely to develop their own algorithm for achieving good facial rejuvenation outcomes.