Botulinum toxin A in the mid and lower face and neck

Although once considered a novel concept, the use of botulinum neurotoxins to smooth hyperkinetic lines in the upper face has become an accepted and successful procedure in facial rejuvenation. In the mid and lower face and neck, botulinum toxin injections can diminish rhytides and sculpt the face into more aesthetically pleasing lines. The doses used in the mid and lower face and neck differ greatly from those in the upper face, and only experienced clinicians with a detailed understanding of the underlying muscular anatomy and tissue relationships should inject in areas associated with more risk of potential complications. This article reviews current approaches to botulinum toxins as primary and adjunctive therapies in the mid and lower face and neck.