Abstract
BACKGROUND: Irrespective of botulinum toxin type A (BoNT-A) product used, differences in duration between the frontalis and glabella can be a challenge. Since the approval of daxibotulinumtoxinA for injection (DAXI, DAXXIFY; Revance, Nashville, TN), injectors have been eager not only to reproduce the durable results observed in the glabella but also to achieve an extended duration in the frontalis. OBJECTIVES: To describe how the author has successfully modified their injection technique to achieve extended DAXI duration in the frontalis. METHODS: In this study, the author presents an approach to obtaining longevity in the forehead with DAXI based on clinical experience performing more than 400 treatments on more than 250 patients with DAXI since product approval. RESULTS: DAXI has a limited diffusion profile. If patients are not injected in the mid-to-low frontalis directly, compensatory motion of the lower frontalis leads to premature return of movement, which can result in suboptimal DAXI injection and shortened patient-reported duration. With previous generations of BoNT-A products, some degree of migration from the upper frontalis injection sites and/or the glabella injection sites into the mid and low frontalis is sufficient to prevent this effect, but the precision of DAXI demands that these fibers be more deliberately addressed with a larger number of individual injections. CONCLUSIONS: Through the use of more injection points, a wider area of treatment, and customization to fit patient needs, duration similar to that observed in clinical studies (20.9 weeks) can be achieved using between 20% and 33% fewer units of DAXI.