In Taiwan, botulinum toxin type A remains the most popular non-surgical aesthetic treatment. The use of injectable botulinum toxin for aesthetic purposes has evolved rapidly over the past 2 decades. As we mentioned before, there are currently three kinds of botulinum toxin on the market in Taiwan: onabotulinumtoxin A (Botox) from U.S.A., abobotulinumtoxin A (Dysport) from U.K., and incobotulinumtoxin A (Xeomin) from Germany. Since onabotulinumtoxin A is the first to be introduced into Taiwan, it holds the largest market share, followed by abobotulinumtoxin A. On the other hand, Incobotulinumtoxin A just got its approval from TFDA last year and was launched recently. Although used interchangeably, the dosage units and dose-response curves of different formulations are not directly comparable. There are also some distinct features regarding these three neurotoxins. Nevertheless, clinical equivalence has been suggested at a unit ratio of 1:1 for aesthetic use of incobotulinumtoxin A and onabotulinumtoxin A. Based on available data and clinical experience, a ratio of 1:2.5 is considered appropriate for extrapolating units of onabotulinumtoxin A to abobotulinumtoxin A.
The concept of beauty
Asians tend to have more developed masseter muscles than most Caucasians. A square or long female face is often considered to be masculine or unattractive. Traditionally, a round, full “moon-shaped” or “egg-shaped” face was the symbol of beauty, and many older individuals in Taiwan consider this as a sign of good fortune. Although a more slender face is favored by many young Taiwanese, a face that is perceived as too narrow is definitely undesirable.
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Asians have been described as developing fewer age-related wrinkles compared with the Caucasians. This has been attributed to a thicker dermis, increased fat above and deep to the superficial muscular aponeurotic system (SMAS), and dense fat and fibrous connections between the SMAS and deep fascia. Most of the wrinkles appeared at the age of 40’s. Women usually noticed their first skin line in the periorbital region. Along with these symptoms, the glabellar and forehead frown lines also appeared gradually. It is very common for people in Taiwan to ask for wrinkles correction of these three anatomical areas.
The Injection
Figure 1. The recommendations for treatment with botulinum toxin by facial area. Each point represents intramuscular or subcutaneous injection of 2-4 U onabotulinumtoxin A.
<Figure 1> shows the recommendations by facial area for treatment with botulinum toxin. In glabellar region, lower doses of botulinum toxin are more appropriate for the many Asians who have a lower muscle mass and less hyperdynamic activity than Caucasians. It should be noted that the muscle corrugators tend to be lower in Asians than in Caucasians. They also tend to be shorter, narrower, and less hyperdynamic. Therefore, it is suggested that 3-point injection pattern to the glabella is better than the traditional 5-point pattern.
-To be continued-
