Introduction: Muscle activity at the glabella causes wrinkles that are perpendicular to muscle contraction. Such wrinkles are currently treated with botulinum toxin. However, interpersonal local contraction variations are revealed during facial animation. Although a great number of articles on this topic have been published, the patterns of glabellar contraction have not yet been adequately studied and classified. Objective: To identify and classify the glabellar contraction patterns found in the population undergoing cosmetic treatment with botulinum toxin. Methods: Retrospective photographic analysis of 30 patients receiving botulinum toxin for the treatment of glabellar wrinkles.The contraction patterns were identified and classified based on the prevalence of lowering, approximation, or lifting movements at the glabella. Results: Five patterns were identified: 1) "U," 2) "V," 3) "Omega," 4) "Converging Arrows,” and 5) "Inverted Omega." The classification method allowed indentifying the most important muscles in each contraction pattern. Conclusion: There are interpersonal variations in facial animation. The classification of glabellar wrinkles enables a more accurate, individualized treatment with botulinum toxin. The most heavily used muscles receive higher doses or are injected into a larger number of sites. Those less solicited muscles are left untreated or receive lower doses, allowing for more effective and natural results.

Keywords: CLASSIFICATION, BOTULINUM TOXINS, REJUVENATION

Introduction: Hyperhidrosis is a condition characterized by an excessive and uncontrolled production of sweat; the most current treatment is botulinum toxin. Objective: Botulinum toxin type A acts through a transient block of acetylcholine release in the cholinergic autonomic fibers to reduce sweating. Its use is increasing as patients learn about its efficacy. Methods: Patients (n = 7) were treated with botulinum toxin with a total dose of 100 U.We analyzed patient and physician assessments and digital photography images using Image-Pro, a digital imaging system®. Results: Patients presented an average clinical improvement of hyperhidrosis of 73%, which was photographically documented. Conclusions: There is no need to use higher doses of botulinum toxin to obtain good results.

Keywords: BOTULINUM TOXINS, HYPERHIDROSIS, HYPERHIDROSIS/THERAPY

Introduction: Patients (n = 56) received incobotulinumtoxinA for the treatment of dynamic facial wrinkles.
Objective: To test the efficacy of incobotulinumtoxinA in correcting facial wrinkles.
Methods: The toxin was applied in in the usual doses and regions.
Results: Only 38 patients returned for evaluation after treatment. Of those, 19 complained about the low efficacy, short duration or absence of effects of the toxin. The total dose applied in patients who expressed satisfaction with the outcome (19 patients) was 872 units, while in the dissatisfied group (19 patients) it was 748 units – which was later increased by an additional 30.62% (229 units) of the initial dose.
Conclusion: Although some clinical studies demonstrate that this botulinum toxin has an efficacy similar to others available, this study has not succeeded in reproducing that fact.

Keywords: BOTULINUM TOXINS, FACE, THERAPEUTICS

In dermatology, botulinum toxin stands out in the treatment of wrinkles and expression lines, mainly being used for aesthetic purposes. However, in recent years the use of botulinum toxin in the treatment of dermatological diseases has grown and shown good results. The present review is aimed at reporting the use of botulinum toxin in clinical conditions that may be treated by dermatologists, exploring its mechanism of action and long-term results, thus gathering practical information for specialist physicians.

Keywords: BOTULINUM TOXINS; DISEASE; DERMATOLOGY; SKIN.

Ultrasonography is a diagnostic imaging method, which is painless and non-radioactive, and based on the reflection of sound waves through the tissue. The recent development of high frequency and better resolution equipment has enabled the observation of superficial structures and the identification of the different layers, structures, and appendages of the skin, considerably increasing its use in various dermatological conditions - particularly in skin cancer. The authors present two cases in which the association of dermoscopic and ultrasound examinations allowed the careful in vivo analysis of tumor morphology, contents, size, thickness and vascularization, allowing the differentiation between basal cell carcinoma and hidrocystoma, and thus contributing to better pre-operative assessment.

Keywords: CARCINOMA, BASAL CELL; HIDROCYSTOMA; NEOPLASMS; ULTRASONICS

The width of the lower third of the face is mainly determined by the size and shape of the jawbone, the thickness of the masseter muscle and the volume of adjacent subcutaneous tissue. The ideal, culturally recognized pattern for a male face corresponds to a wider lower third and a mandibular angle tending to 90º, while a female face should have a more oval appearance or the shape of a heart, and the middle third wider than the lower third. In order to achieve these aesthetically ideal proportions, botulinum toxin type A (BoNTA) has been successfully applied in the masseter muscle, which is one of the determinates of the lower face's width. Te present article reviews the current literature on the use of botulinum toxin for this purpose, offering the experience of the authors in this practice, aiming at achieving a more harmonious facial contour.

Keywords: BOTULINUM TOXINS, TYPE A; MASSETER MUSCLE; HYPERTROPHY

Introduction: The use of botulinum toxin in the periorbital muscles is aimed at reducing expression lines in that site, correcting the eyebrows' height and treating blepharospasm. However, the application of botulinum toxin in this area can lead to undesirable side effects, such as ptosis, edema in the lower eyelids, artificial appearance of the demarcation area between the orbicularis muscle's treated area and the malar region, ectropion and hematomas.
Objective: To treat the dynamic wrinkles in the lower portion of the orbicularis oculi muscle through injections of microdoses of botulinum toxin.
Methods: A prospective monocentric study with the analytical longitudinal observation of 300 patients undergoing treatment with botulinum toxin microdoses in the lower eyelids' rhytids was carried out. Sociodemographic data, patient satisfaction, dose quantification and complications were analyzed.
Results: Sixty-six percent of the patients showed a total improvement of the wrinkles after the first session. The other required an additional session. Eighty-six percent preferred the treatment with this therapeutic modality.
Conclusions: Despite the great benefit offered by the classic injection points for the treatment of periorbital rhytids types I to III, the authors observed the need to treat rhytids type B (presence of wrinkles on the lower eyelid). Due to the high rate of complications in this region, microdoses of botulinum toxin were proven to be effective and safe.

Keywords: BOTULINUM TOXINS, TYPE A; ESTHETICS; DERMATOLOGY

Introduction: The application of botulinum toxin in the perioral region is a minimally invasive procedure that leads to substantial improvement in the signs of aging in addition to increasing the volume of the lips. However literature on this procedure is still scarce.
Objective: To evaluate changes in shape and volume of the lips, as well as the patients' satisfaction after the application of botulinum toxin in perioral lines.
Methods: Nineteen patients underwent evaluation, photographic record and measurements following the application of botulinum toxin in the perioral region, being subsequently assessed for changes in the lips and satisfaction.
Results: Most of the patients rated their lips as moderately or significantly more attractive after the application of botulinum toxin (p = 0.039). Fifteen women deemed the changes in the lips as a major factor in the overall improvement of their faces.
Conclusions: The use of botulinum toxin in the perioral region leads to the elevation of the upper lip, causing the shortening of the philtrum and the extension of the vermilion. The application of botulinum toxin in the vermilion's border leads to the relaxation of the orbicularis muscle, favoring a more intense tonus effect arising from the upper lip lifting muscles. The patients' satisfaction with the appearance of their lips was evaluated by four additional questions (linked to the lip's shape, volume, attraction and beauty), receiving positive answers. Side effects were minimal.

Keywords: LIP; BOTULINUM TOXINS, TYPE A; BOTULINUM TOXINS

Rosacea is a common chronic skin disease that has several clinical manifestations, with erythema and inflammation being predominant characteristics. Its presence is associated with psychosocial impact on patients' lives. Although there are several options for topical and systemic treatments, it is known that only the inflammation is treated and that the erythema persists in most cases. More recently, there have been some publications describing the treatment of rosacea with botulinum toxin associated with good results. In this manner, the authors sought to evaluate the action of botulinum toxin in the treatment of rosacea that is persistent and refractory to various clinical treatments.

Keywords: Rosacea; Botulinum Toxins; Therapeutics

INTRODUCTION: Hidrocystomas are skin-colored or translucent cysts, single or multiple, appearing on the face. They originate in the eccrine or apocrine sweat gland and are sometimes disfiguring. They can be excised by surgery, electrodissection, or by caustics, but are usually recurrent and the treatments can leave scars or dyschromia. Botulinum toxin A (BoNT-A) has been suggested as therapy in few cases in the literature.
OBJECTIVE: To analyze the effects of BoNT-A in cases of facial hidrocystomas.
METHODS: Retrospective observational study of case series. Patients with facial hidrocystomas treated with BoNT-A at the Cosmiatry Outpatient Dermatology Clinic of the Hospital do Servidor Público Municipal de São Paulo, were evaluated.
RESULTS: Of the 13 patients evaluated, 5 were included, the largest case series described so far. Of these, all lesions treated showed clinical improvement during the period evaluated. Four patients showed partial regression and one, total regression of the lesions.
CONCLUSION: In this series of cases, BoNT-A showed positive and long-lasting results in the treatment of facial hidrocytsomas, with no adverse effects.

Keywords: Botulinum toxins; Hidrocystoma; Therapeutics

INTRODUCTION: Raynaud's phenomenon (RP) is an exaggerated physiological response of the extremity vessels, mainly to cold and stress. Patients refractory to clinical treatment or intolerant to its adverse events may be treated with local injection of botulinum toxin (BTX).
OBJECTIVE: To describe the experience of botulinum toxin use in severe cases of RP.
METHODS: Observational, descriptive, retrospective, and unicenter study of case series of severe RP treated with BTX-A, from 2011 to 2015. Parameters of pain, numbness, color, and stiffness were scored by visual analogical scale (VAS) and tabulated and compared before and after the treatment.
RESULTS: Total pain improvement in 71.4% of cases and partial improvement in 28.6%. Numbness disappeared in 57.1% of cases and improvement in 42.9%. There was a total regression of stiffness in 57.1% of cases and partial improvement in 28.6%. The color was completely reversed in 57.1% of the patients. There was ulceration healing in the only case in with they were present. Ischemic attacks were reduced in 85,7% of cases. No complications occurred.
CONCLUSIONS: This study suggests that the use of BTX-A in patients with severe RP is a promising therapeutic option.

Keywords: Raynaud disease; Botulinum toxins; Botulinum toxins, type A

INTRODUCTION: Patients often request anti-aging treatments of the perioral and periorbital regions. Most of the time, it is necessary to use a combination of procedures, so the result meets the patient’s expectations.
OBJECTIVE: This is a prospective, single-center, and comparative study assessing the rejuvenation of the perioral and periorbital regions after treatment with medium depth chemical peel using phenol 88% with or without the previous application of botulinum toxin.
METHODS: Sixteen patients underwent regional peel with phenol 88%; eight received botulinum toxin application two weeks before. The assessment was conducted using standard photographs and evaluation scales by doctors and patients.
RESULTS: The overall evaluation by doctors and patients on the 45th day was considered excellent or good for all patients, with little advantage for combined treatment in the periorbital region.
CONCLUSION: Combining these two relatively low-cost procedures, often overlooked by dermatologists, resulted in a significant improvement in the changes related to aging in these areas.

Keywords: Botulinum toxins type A; Chemexfoliation; Phenol; Rejuvenation

INTRODUCTION: Hidradenitis suppurativa (HS) is an inflamatory, chronic, recurrent, and debilitating condition. There is a lack of consensus about its treatment.
OBJECTIVE: We conducted a review of the national and international literature, searching for articles that addressed the use of botulinum toxin in HS, in addition to describing the doses and techniques used.
METHODS: A bibliographic search was performed in LILACS, Medline, and SciELO.
RESULTS: Botulinum toxin can be an effective therapy in patients with HS, especially in cases of concomitant hyperhidrosis and traditional therapies fail. It offers the possibility of conducting treatment with minimal adverse events, reproducible over time without loss of effectiveness, in addition to reducing pain.
CONCLUSIONS: Patients will likely need more than one treatment over time, as the lesions tend to recur after 6 to 10 months. The technique used has been the standard for hyperhidrosis. Further research is needed to understand its role in the management of HS, including the ideal dosage and frequency of administration.

Keywords: Hidradenitis suppurativa; Hidradenitis; Botulinum toxins; Botulinum toxins, type A

INTRODUCTION: Rosacea is a chronic inflammatory skin disease. The intradermal application of botulinum toxin (BT) has been studied as a therapeutic option for patients who struggle to manage flushing and/or persistent facial erythema. There is no standard protocol for TB application in rosacea.
OBJECTIVE: To evaluate the effectiveness of botulinum toxin application on erythematotelangiectatic rosacea.
METHODS: Pilot study with case series. We applied intradermal TB in 10 patients with a diagnosis of rosacea and symptoms of persistent erythema and/or facial flushing. Patients received 10 to 15 injections per hemiface (1 unit of onabotulinum TB per injection) and 0 to 5 injections in the nasal region, totaling 25 to 35 units per patient.
RESULTS: Seventy-five percent of the patients presented a reduction in flush and erythema intensity. The follow-up time was three months, and no serious adverse events were observed.
CONCLUSIONS: The therapeutic arsenal to control erythema and facial flushing of rosacea, especially refractory to the usual treatment, should consider the intradermal application of TB type A.

Keywords: Erythema; Rosacea; Flushing; Botulinum toxins

Frontal fibrous alopecia is a primary lymphocytic scarring alopecia that is difficult to control, with a perifollicular lichenoid infiltrate marking its histology. Since its description in 1994 by Kossard, there has been an increase in cases reported worldwide. This article reports two cases that underwent incisional biopsies with longitudinal and transverse sections in areas presenting higher disease activity and reviews some aspects of this dermatosis. It also addresses the suspicion of a possible relationship with the application of botulinum toxin – a question already raised by other authors but with no established confirmation.

Keywords: Alopecia; Botulinum toxins; Botulinum toxins type A