CME/CE: ABOUT FACE: Navigating Neuromodulators and Injection Techniques for Optimal Results

April 2020 | Volume 19 | Issue 4 | Supplement Individual Articles | 300 | Copyright © April 2020

Published online March 31, 2020

Steve G. Yoelin , Shino Bay Aguilera , Joel L. Cohen , Michael H. Gold , Joely Kaufman , Corey S. Maas

aSteve Yoelin, MD, Medical Associates, Newport Beach, CA
bShino Bay Cosmetic Dermatology and Laser Institute, Fort Lauderdale, FL
cAboutSkin Dermatology and DermSurgery, AboutSkin Research, Greenwood Village and Lone Tree, CO; University of California, Irvine, Irvine, CA
dGold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN
eSkin Associates of South Florida; University of Miami Miller School of Medicine, Coral Gables, FL
fThe Maas Clinic Facial Plastic and Aesthetic Surgery, San Francisco and Lake Tahoe, CA; University of California, San Francisco, San Francisco, CA


Four BTXA products are commercially available for cosmetic use
  • Their potency units are not interchangeable and cannot be directly compared
  • All are good products, but some patients respond differently to different BTXA products
There is no universally accepted conversion ratio among BTXA products
  • Several reviews and experts suggest the ratio for aboBTXA:onaBTXA is between 2:1 and 3:1
  • Several reviews suggest the ratio for incoBTXA:onaBTXA is 1:1, but some experts believe it is higher (between 1.2:1 and 1.5:1)

Practitioners who are new to BTXA use should consider gaining expertise with one product before adopting another.

Practitioners might vary the diluent volume used to reconstitute BTXA products, depending on site of injection, treatment goals, patient-specific characteristics, and mathematical ease of dose conversion among products.

An individualized approach to BTXA injection is important for achieving the best results.
  • Dose selection and placement of BTXA injections should consider muscle size, strength, and recruitment along with facial asymmetry and sex differences in anatomy and facial aesthetics
  • Optimal rejuvenation of the aging face may require multimodal treatment 
Proper injection technique and knowledge of facial anatomy are necessary for minimizing the risk of complications with BTXA treatments.
  • Interventions can be offered to patients bothered by posttreatment bruising, eyelid ptosis, and lid edema


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