Adapting neurotoxin (NT) to individual patients is the key to natural results. Doing so requires careful evaluation of each patient's anatomy and the position of various key anatomic components, particularly the eyebrows, at rest and at various levels of muscle activity.

As discussed in their own separate chapters by Drs. Beddingfield, Sadick, and Rossi, there are many possible applications of NT on the face and neck.

In my practice, I find that NT is most practical for the upper face. I rarely, if ever, use BOTOX for the perioral area or the chin. I find that fillers are far more practical in these areas as they last much longer and have more predictable results. And for very fine and superficial perioral lines that do not do as well with fillers, resurfacing is a far better choice, especially with availability of the new fractional lasers, ranging from the near-infrared to erbium and CO2. I do occasionally use BOTOX on the neck. It is very helpful for stubborn platysmal bands postplatysmaplasty procedures and can delay recurrence of bands in patients with a strong platysma muscle combined with thin subcutaneous tissues, but the high cost makes it impractical for most patients. My results with primary treatment of the bands and jowls (Nefertiti neck method) have been variable and too often unimpressive for the cost and duration, and some patients complain of weakness in opening their mouth as a result of weakness of the platysma. Time will tell if prolonged use can improve results.