To report the method and results of 18-point Botulinum Toxin A (BTA, Dysport®) upper face rejuvenation on 845 subjects by an eye plastic surgeon.

In a retrospective chart review, all subjects (the first cycle of injection) with BTA upper face rejuvenation from 2003 to 2009 were included. Excluded were subjects with associated facial spastic disorders, injection after upper face lifting, and aberrant regeneration of facial nerves. Upper face rejuvenation included 18 points of injection at forehead creases (4), frown lines (5), bunny line (1), crow’s feet (4 on both sides), and lower eyelid crease (4 on both sides). They were re-visited in 10-14 days for assessment of the effects and possible touch up injection. Demographics, year of injection, topical anesthetic usage, touch up injection, and adverse effects (AE) were recorded.

There were 845 subjects (85.8% females) whose age was below 40 in 49.3%. Touch up injection was performed in 8% of subjects (68/845) mainly for eyebrow asymmetry. AE (22/845, 2.6%) were bruise (15/845, 1.8%), blepharoptosis (3/845, 0.3%), remained eyebrow asymmetry after touch up injection (2/845, 0.2%), and headache (2/845, 0.2%). They were significantly more in subjects with touch up injection, younger than 40 years, and in the first and second year of experience (especially for the bruise).

18-point BTA upper face rejuvenation has a low rate of AE in which majority is the bruise at lateral canthal area. They were significantly more in the first years of experience, subjects younger than 40, and who needed touch up injections.