Italian Expert Consensus on the Efficacy and Safety of High Doses of Incobotulinum Toxin A (Bocouture®) in a Full-Face Approach Based on the Electromyographic Analysis

Incobotulinum toxin A (Bocouture^®) is a highly purified formulation of botulinum toxin A, devoid of complexing proteins. This characteristic minimises immunogenicity and promotes targeted action. Its high efficacy and safety make it particularly suitable for aesthetic applications, such as full-face and neck rejuvenation. Nonetheless, there exists a lack of standardised dosing protocols for applications in a comprehensive full-face treatment. The present study aims to establish an expert consensus regarding the appropriate dosing and specific injection techniques for incobotulinum toxin A in holistic full-face and neck aesthetic treatments. A multidisciplinary panel comprising six Italian experts in dermatology, plastic surgery, and neurology comprehensively reviewed existing literature (PubMed) on the aesthetic applications of incobotulinum toxin A, supplemented by their clinical experiences. Incobotulinum toxin A was administered to patients with the assistance of a portable electromyography (EMG) device to ensure precise targeting of the muscles. The primary focus was to define optimal injection sites and dosages for various facial and neck muscles, aiming to maximise aesthetic outcomes while minimising toxin diffusion. The unique characteristics of incobotulinum toxin A, including its high purity and low immunogenicity, facilitate its safe utilisation in a full-face approach with a decreased risk of adverse events. The implementation of EMG-guided injections significantly enhanced accuracy, thereby improving treatment outcomes by mitigating unwanted toxin dispersal and achieving muscle-specific effects. The consensus reached underscored the validity of a full-face approach, highlighting the necessity of a thorough understanding of muscle anatomy and the application of precise injection techniques. An overwhelming consensus (83.3-100.0%) was attained for most of the proposed strategies, indicating that the full-face treatment regimen employing incobotulinum toxin A yields effective and enduring results.