Current possibilities and limitations of aesthetic dermatology

Medical indications for the use of botulinum toxin A (BT-A) have been on the rise. It has been shown to be an effective additional method to smooth out dynamic facial wrinkles with a minimum of side effects. Presynaptic blocking of the neuromuscular end plate produces temporary paralysis of the skeletal musculature, structures innervated by parasympathetic nerves, and the sweat glands. Selective injection of BT-A into defined mimetic muscle groups eliminates mechanically associated formation of wrinkles. In addition to this aesthetic corrective application, BT-A is also employed as an effective alternative in cases of circumscribed, severely impairing forms of hyperhidrosis. The marks of extrinsic and intrinsic aging can be managed by careful combinations of therapy. Numerous possible methods are available for enduring treatment of actinic wrinkles, deep wrinkles, and facial furrows with a minimum of complications (ablative and nonablative laser, dermabrasion, chemical peeling, or soft tissue filling with autologous and nonautologous materials).