Botulinum Toxin Treatment - Guideline

Indications

• eyelid blepharospasm/hemifacial spasm
• chemical denervation of the upper lid in severe keratitis
• cosmetic purposes (reduce frown lines, forehead lines, chemical brow lifting, crow's feet, bar code lines, DAO, platysma bands, etc.)

Differential diagnosis

• rhytides resulting from tissue laxity (not dynamic)
• dermatochalasis, palpebral ptosis
• eyebrow ptosis

Pretreatment

• diagnosis (including good quality frontal and side pictures, dynamic pictures)
• consent form: always mention risk of bruising, eyelid ptosis, asymmetry, touch-up
• align expectations with realistic results; identify patients with high expectations or dysmorphophobia
• +PLUS (additional self-pay treatments): consider offering adjuvant cosmetic therapies such as fillers, collagen stimulators, eyelid or brow surgery
• anticoagulation: no need to adjust

Required material

• treatment basin (disposable or not)
• 10x10cm gauze
• make-up remover (micellar water)
• Octenisept® disinfecting solution
• marking pen (white eyeliner)
• botulinum toxin (Vistabel®)
• saline solution (NaCl) for dilution
• 3ml syringe for dilution
• 1ml or 0.3ml insulin syringe for treatment
• 30G-34G needles depending on muscle

Procedure

• patient in sitting position
• dilution of toxin: usually 2.5ml NaCl for 100 units Vistabel®
• cleanse skin, remove make-up
• mark injection points according to indication
• disinfect skin with Octenisept® and gauze
• inject botulinum toxin with fine needle (30G-34G)
• press on skin in case of bruising
• cleanse skin and apply SPF 50

Post procedure

• elevate head, avoid sport and sauna on the same day
• touch-up if needed on day 12-14 after treatment