Different neuromodulator filler products offer varied outcomes

NEW YORK — The proper placement and volume of neuromodulator fillers depends on the product used and the aesthetic goal of the patient, according to an educational program presented at Facial Aesthetics New York.

“The way I would look at neuromodulators is, if you know what a neuromodulator is, if you’re able to see someone animate, carefully, then that's going to dictate where you're going to place product and the strength of that animation will dictate your dose,” Steve G. Yoelin, MD, said during his presentation.

Steve G. Yoelin

Yoelin advised that the dosage strength in “units” is not interchangeable from one product to another. As a general example from his practice, for every unit of Botox (onabotulinumtoxinA, Allergan), he is likely to use 3 units of Dysport (abobotulinumtoxinA, Galderma) or Xeomin (incobotulinumtoxinA, Merz).

Education about the products is important for both the physician as well as the patient. Learning about each product’s ingredients is useful to determine if any of the components could cause a hypersensitivity or allergic reaction. While profound adverse events, such as difficulty breathing or muscular weakness caused by the toxin spreading, occur rarely from the low doses used for cosmetic treatments, these possible complications should still be listed on all consent forms for the patient’s education.

Physicians should be particularly cautious when it comes to injecting patients with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junctional disorders (eg, myasthenia gravis or Lambert-Eaton syndrome).

Yoelin advised that physicians can be more liberal with high doses in the upper third of the face. Otherwise, in the lower half of the face, use smaller doses initially with extremely precise placement. Have the patient animate their face to help dictate the volume to inject.

Regarding the brow, Yoelin often injects in the frontalis. For every unit place in the frontalis, he will use 2.5 or more units in all the depressors around the brow. The goal is to have movement without lines, if possible, in the frontalis without dropping the brow.

Finally, be sure to consider the difference in male and female aesthetics: male brows tend to sit lower and flatter, while female brows are arched and higher. Also, consider the difference between natural lines that appear during animation compared to static lines that remain without animation. – by Talitha Bennett

Disclosure: Yoelin reports he receives consulting fees from, is on the speakers bureau for and has performed contracted research for Allergan, and has received consulting fees from Galderma.

Reference:

Yoelin SG. Toxins: Basic and Advanced Techniques. Presented at: Facial Aesthetics New York; Nov. 3, 2016; New York.