• botulinum toxin type A;
  • cosmetic techniques;
  • face;
  • onabotulinumtoxin A;
  • rejuvenation


Background  Onabotulinumtoxin A (onabotulinum) has been used for 7 years in the treatment of the aging face. A survey was conducted to identify current practices in France.

Objective  To develop consensual practice recommendations for treating the aging upper- and mid-face with onabotulinum.

Methods and Materials  Fifty-seven participants reviewed practices and techniques for each identified upper- and mid-face treatment indication. From data gathered during six regional conferences and from a questionnaire, consensual recommendations were developed.

Results  General considerations, key treatment rules, injection specifics (dose, site, and techniques), associated procedures/treatments, and follow-up were defined for each indication, i.e., glabellar, horizontal forehead, crow’s feet and bunny lines, lower eyelid rhytides, and eyebrow repositioning and reshaping. For the consensus participants, current onabotulinum use is a global, both preventive and corrective treatment. In France, judicious lowest effective dose, treatment of multiple sites and adjunctive treatment modalities, such as fillers and peels, lead to satisfactory results for clinicians and patients with a youthful, harmonious, animated and natural looking face.

Conclusions  Years of experience using onabotulinum result in sophisticated treatment approaches, more specific targeted injections, and a better understanding of facial aging, leading to satisfying therapeutic results for both patients and clinicians.