Pearls and Pitfalls of Botulinum Toxin and Filler Substances in the Upper Third of the Face



Botulinum toxin is currently the most popular aesthetic procedure for men and women. The upper third of the face is frequently treated. The risks and complications of treating three areas above the zygomatic arch are discussed. Combining fillers with toxin in these areas often provides the most successful results. Precautions about treatment and methods to avoid complications are addressed.


Botulinum toxin Dermal fillers Upper third of face Glabella Crow’s feet Forehead Combination therapy Complications Precautions and risks 


  1. Carruthers J, Carruthers A. A prospective, randomized, parallel group study analyzing the effect of BTX-A (Botox) and nonanimal sourced hyaluronic acid (NASHA, Restylane) in combination compared with NASHA (Restylane) alone in severe glabellar/rhytides in adult female subjects: Treatment of severe glabellar rhytides with a hyaluronic acid derivative compared with the derivative and BTX-A. Dermatol Surg. 2003;29:802.PubMedGoogle Scholar
  2. Carruthers J, Fagien S, Matarasso SL, and the Botox Consensus Group. Consensus recommendations on the use of botulinum toxin type A in facial aesthetics. Plast Reconstr Surg Suppl. 2004;114(6):1S.CrossRefGoogle Scholar
  3. Kablik J, Monheit GD, Yu L, Chang G, et al. Comparative physical properties of hyaluronic acid dermal fillers. Dermatol Surg. 2009;35(Suppl):302–12.PubMedCrossRefGoogle Scholar
  4. Matarasso SL, Matarasso A. Treatment guidelines for botulinum toxin type A for the periocular region and a report on partial upper lip ptosis following injections to the lateral canthal rhytids. Plast Reconstr Surg. 2001;108:208–14.PubMedCrossRefGoogle Scholar
  5. Matarasso SL, Sadick NS. Soft tissue augmentation. In: Bolognia J, Jorrizzo JL, Rapini RV, Horn T, editors. Dermatology. London: Mosby/Harcourt Health Sciences; 2003. p. 2439–49.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of DermatologyUniversity of California School of MedicineSan FranciscoUSA

Personalised recommendations