Ethnic considerations for the facial aesthetic uses of botulinum toxin: an Asian perspective


Keywords | Summary | Correspondence | Literature




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There are several consensus guidelines, mostly based on the Caucasian experiences, for facial aesthetic uses of botulinum toxin type A. For Asians, only a few articles on the same subject have been published. This article is aimed to review the ethnic differences in facial anatomy which are relevant to botulinum toxin injection for facial aesthetics. Literature review of the anatomic diversities of the muscles of the forehead, glabellar, and periorbital areas is provided. Ethnic differences in the facial expression patterns are also discussed.


Es existieren mehrere Konsensusleitlinien zum ästhetischen Einsatz von Botulinumtoxin A im Gesicht, die überwiegend auf Kaukasier Bezug nehmen. Für Asiaten sind nur wenige Artikel zum Thema veröffentlicht worden. Dieser Beitrag zielt auf eine Betrachtung der ethnischen Unterschiede in der Gesichtsanatomie ab, die bei Botulinumtoxin- Injektionen im Gesichtsbereich von Bedeutung sind. In einer Literaturübersicht werden anatomische Unterschiede der Stirnmuskulatur, der Glabella sowie der periorbitalen Region dargestellt. Ebenso werden ethnische Unterschiede im Gesichtsausdruck besprochen.

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Nark-Kyoung Rho, MD
Leaders Aesthetic Laser & Cosmetic Surgery Center
Tower Palace E-4006
Dogok-dong, Kangnam-gu, Seoul 135-535


1. Carruthers J, Fagien S, Matarasso SL: Consensus recommendations on the use of botulinum toxin type A in facial aesthetics. Plast Reconstr Surg 2004, 114 (6 Suppl): 1S-22S.
2. Carruthers JD, Glogau RG, Blitzer A: Advances in facial rejuvenation: botulinum toxin type A, hyaluronic acid dermal fillers, and combination therapies—consensus recommendations. Plast Reconstr Surg 2008, 121 (5 Suppl): 5S-30S; quiz 31S-36S.
3. Kane M, Donofrio L, Ascher B, Hexsel D, Monheit G, Rzany B, Weiss R: Expanding the use of neurotoxins in facial aesthetics: a consensus panel’s assessment and recommendations. J Drugs Dermatol 2010, 9 (1 Suppl): s7-22.
4. Ascher B, Talarico S, Cassuto D, Escobar S, Hexsel D, Jaen P, Monheit GD, Rzany B, Viel M: International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit) – Part I: Upper facial wrinkles. J Eur Acad Dermatol Venereol 2010, 24 (11): 1278-1284.
5. Rho NK, Kim HS, Kim YS, Kim YJ, Kim CH, Min PK, Suh SB, Lee KS, Lee SJ, Lee WS: Botulinum toxin type A for facial wrinkles and benign masseter hypertrophy in Korean patients. Korean Journal of Dermatology 2010, 48 (10): 823-831.
6. Braz AV, Sakuma TH: Patterns of contraction of the frontalis muscle: a pilot study. Surg Cosmet Dermatol 2010, 2 (3): 191-194.
7. Spiegel JH, Goerig RC, Lufler RS, Hoagland TM: Frontalis midline dehiscence: an anatomical study and discussion of clinical relevance. J Plast Reconstr Aesthet Surg 2009, 62 (7): 950-954.
8. Tzou CHJ, Giovanoli P, Ploner M, Frey M: Are there ethnic differences of facial movements between Europeans and Asians? British Journal of Plastic Surgery 2005, 58 (2): 183-195.
9. Tsukahara K, Fujimura T, Yoshida Y, Kitahara T, Hotta M, Moriwaki S, Witt PS, Simion FA, Takema Y: Comparison of age-related changes in wrinkling and sagging of the skin in Caucasian females and in Japanese females. J Cosmet Sci 2004, 55 (4): 351-371.
10. Le TT, Farkas LG, Ngim RC, Levin LS, Forrest CR: Proportionality in Asian and North American Caucasian faces using neoclassical facial canons as criteria. Aesthetic Plast Surg 2002, 26 (1): 64-69.
11. Choe K, Sclafani A, Litner J, Yu G, Romo Tr: The Korean American woman’s face: anthropometric measurements and quantitative analysis of facial aesthetics. Arch Facial Plast Surg 2004, 6 (4): 244-252.
12. Ozsoy Z, Genc B, Gozu A: A new technique applying botulinum toxin in narrow and wide foreheads. Aesthetic Plast Surg 2005, 29 (5): 368-372.
13. Macdonald MR, Spiegel JH, Raven RB, Kabaker SS, Maas CS: An Anatomical approach to glabellar rhytids. Arch Otolaryngol Head Neck Surg 1998, 124 (12): 1315-1320.
14. Sato S: Statistical studies on the exceptional muscles of the Kyushu-Japanese. Part 1 – The muscles of the head (the facial muscles). Kurume Med J 1968, 15 (2): 69-82.
15. Wen J-h, Ji Z-l, Lu F: Clinical anatomical study of the corrugator and prcerus muscles. Chin J Practical Aesthetic Plast Surg 2001, 12 (1): 42-45.
16. de Almeida ART, da Costa Marques ERM, Kadunc BV: Glabellar wrinkles: a pilot study of contraction patterns. Surg Cosmet Dermatol 2010, 2 (1): 23-28.
17. Koh JS, Chae KS, Kim HO: Skin Characteristics of normal Korean subjects according to sex and site using non-invasive bioengineering methods. Korean Journal of Dermatology 1998, 36 (5): 855-864.
18. Tsukahara K, Sugata K, Osanai O, Ohuchi A, Miyauchi Y, Takizawa M, Hotta M, Kitahara T: Comparison of age-related changes in facial wrinkles and sagging in the skin of Japanese, Chinese and Thai women. J Dermatol Sci 2007, 47 (1): 19-28.
19. Freilinger G, Happak W, Burggasser G, Gruber H: Histochemical mapping and fiber size analysis of mimic muscles. Plast Reconstr Surg 1990, 86 (3): 422-428.
20. Ito J, Moriyama H, Shimada K: Morphological evaluation of the human facial muscles. Okajimas Folia Anat Jpn 2006, 83 (1): 7-14.
21. Lee Y, Hwang K: Skin thickness of Korean adults. Surg Radiol Anat 2002, 24 (3): 183-189.
22. Jung HJ, Kim DW, Chung SL, Kim TH: A study on the skin thickness of Koreans by ultrasound. Korean Journal of Dermatology 1990, 28 (2): 121-129.
23. Suh DH, Kwon TE, Kwon OS, Park KC, Cho KH, Eun HC: Measurement of skin elastic properities in normal Korean individuals. Korean Journal of Dermatology 1999, 37 (9): 1296-1304.