Nonsurgical cosmetic procedures, including injection procedures, are among the fastest growing medical procedures. In 2018, botulinum toxin and hyaluronic acid injections were the two most common nonsurgical cosmetic procedures performed in the United States. Botulinum toxin is a neuromodulator with seven serotypes, but only serotypes A and B are in clinical use. The facial areas in which botulinum toxin is used most commonly include the forehead, glabella, and lateral canthal lines (ie, crow’s feet). Adverse effects are transient. Several types of injectable dermal fillers are available. Hyaluronic acid is the most commonly used filler and is hypoallergenic. Others include calcium hydroxylapatite, poly L-lactic acid, and polymethylmethacrylate. The characteristics of fillers, including their elasticity and viscosity, are used to determine which should be used for specific applications. Potential serious complications include vascular occlusion leading to tissue necrosis or blindness. Immediate recognition and management of complications are needed to prevent long-term sequelae. With appropriate training, physicians and other clinicians can perform these injections safely in the office setting.
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