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Maytharakcheep S, Phokaewvarangkul O, Bhidayasiri R. Does needle size matter? Effects of micro-hypodermic needle injections of botulinum toxin type A in patients with hemifacial spasm. Parkinsonism Relat Disord 2024; 118:105950. [PMID: 38081119 DOI: 10.1016/j.parkreldis.2023.105950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Botulinum toxin type A (BoNT/A) injections are the first-line treatment for primary hemifacial spasms (HFS), but require frequent painful injections. Although micro-hypodermic needles are commonly used for aesthetic BoNT/A injections to lessen pain and bruising, their benefits in HFS remain unclear. OBJECTIVE To compare side effects of BoNT/A injection, specifically pain and bruising, between primary HFS patients who received injections using micro-hypodermic needles (34-G) and those using standard needles (30-G). METHODS This cross-over, double-blind, randomised controlled trial involved HFS patients who received BoNT/A injections using either a 34-G or 30-G needle at two visits 12 weeks apart. Primary outcomes, pain and bruising were assessed immediately after injection using the Visual Analogue Scale (VAS) and Short-form McGill Pain Questionnaire (Thai version, SF-MPQ). Bruise assessment was also conducted one week after each injection. Secondary outcomes involved comparing efficacy of BoNT/A between the two types of needles and assessing other complications beyond pain and bruising. RESULTS 65 HFS patients (47 women and 18 men; mean age 59.46 ± 11.48 years; mean disease duration 5.86 ± 4.16 years) were included in the study. Patients who received 34-G needle injections reported significantly reduced pain, as indicated by VAS, total SF-MPQ scores, and bruise scores, compared to those who received 30-G needle injections (p < 0.001, each). There were no differences in efficacy or occurrence of other complications associated with BoNT/A between the two needle types. CONCLUSION In HFS patients, BoNT/A injections using micro-hypodermic needles resulted in reduced pain and bruising, compared to standard needles, while maintaining similar BoNT/A benefits.
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Affiliation(s)
- Suppata Maytharakcheep
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand.
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Eftekhari MH, Aghaei H, Kangari H, Bahrami M, Eftekhari S, Tabatabaee SM, Shahraki K, Bahrami M, Broumand MG. Abobotulinum toxin A for periorbital facial rejuvenation: impact on ocular refractive parameters. Clin Exp Optom 2020; 104:115-118. [PMID: 32783216 DOI: 10.1111/cxo.13117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CLINICAL RELEVANCE Botulinum toxin is commonly used for cosmetic facial rejuvenation and can result in pain at the injected site, bruising and ecchymosis, erythema and oedema, headache, diplopia, blurred vision, focal facial weakness. This study evaluates the impact of botulinum toxin on refractive error and binocular vision. BACKGROUND Botulinum toxin (trade name: Dysport) is a neurotoxic protein which is made from a Gram-positive anaerobic bacterium known as Clostridium botulinum. In this study, we aimed to evaluate the impact of Dysport injection on refractive error, near point of accommodation and convergence, and palpebral fissure height. METHODS Twenty-eight subjects were treated for facial wrinkles, using Dysport. A 500-unit vial of Dysport was diluted with 2.5-ml preserved normal saline, and injected doses were 30-units for crow's feet, six units for lower eyelid wrinkles, 25 to 50-units for glabellar lines (five points), and 20 to 40 for forehead creases on four points. The refractive error, near point of accommodation and convergence and palpebral fissure heights were assessed before and two weeks after injection. RESULTS The participants comprised 23 women and five men at a mean age of 53.51 ± 14.1-years. The means of the equivalent sphere before and after injection were -0.07 ± 1.34 and -0.08 ± 1.35 (p = 0.36). The means of near point of accommodation monocularly before and after injection were 29.75 ± 6.16-cm and 26.75 ± 6.00, respectively. The means of near point of convergence before and after injection were 16.03 ± 5.27-cm and 15.55 ± 6.14, respectively (p = 0.30). The means of palpebral fissure height before and after injection were 10.33 ± 1.69-mm and 10.20 ± 1.46-mm, respectively. The changes in equivalent spherical refractive error, binocular near point of accommodation and convergence were not statistically significant. CONCLUSION Dysport injection for the correction of upper face animation lines, if performed at the appropriate sites and the appropriate concentration, has no significant impact on refractive error, near point of accommodation and convergence, and palpebral fissure height.
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Affiliation(s)
- Mohammad H Eftekhari
- Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Hossein Aghaei
- Eye Research Center, The Five Senses Institute, Rasoul Akram Hospital, Iran University of Medical Sciences , Tehran, Iran
| | - Haleh Kangari
- School of Rehabilitation, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Milad Bahrami
- School of Rehabilitation (Student Research Office), Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Shervin Eftekhari
- Tehran Medical Sciences Branch, Islamic Azad University , Tehran, Iran
| | - Seyed M Tabatabaee
- School of Rehabilitation, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Kourosh Shahraki
- Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mobin Bahrami
- School of Rehabilitation (Student Research Office), Mashhad University of Medical Sciences , Mashhad, Iran
| | - Mohammad G Broumand
- School of Rehabilitation, Shahid Beheshti University of Medical Sciences , Tehran, Iran
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Chagas TF, Almeida NVD, Lisboa CO, Ferreira DMTP, Mattos CT, Mucha JN. Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis. Braz Oral Res 2018; 32:e30. [PMID: 29742231 DOI: 10.1590/1807-3107bor-2018.vol32.0030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 03/08/2018] [Indexed: 11/21/2022] Open
Abstract
Botulinum toxin type A is effective in reducing excessive gingival display caused by hyperfunctional upper lip elevator muscles; however, this effect is transient. This study aimed to determine the duration of the effectiveness of botulinum toxin type A on a gummy smile. A systematic search was conducted using Medline (PubMed), Scopus, and Web of Science electronic databases, from 1970 to March 2017 with no language restriction; the search included studies evaluating adult patients with excessive gingival display who were treated with botulinum toxin and were followed-up for at least 3 months. OpenGrey and Clinical Trial Registry were also consulted. Quality assessment was applied to determine the level of evidence and bias, and a meta-analysis was performed. Of 2181 full texts, 71 were obtained, with 3 prospective studies meeting the selection criteria. The gingival display was significantly reduced to baseline with 2, 4, and 8 weeks of treatment. The gingival display considerably reduced at the baseline-2-week comparison (-4.44 mm using raw data and-4.05 mm using the standard difference) and increased throughout the weeks of follow-up. There is scant evidence to determine the duration of the effectiveness of toxin type A on a gummy smile. The effect tends to be stable until at least 8 weeks of follow-up, and the gingival exposure may not return to baseline within 12 weeks of follow-up. Well-designed randomized clinical trials with a minimum of 6 months of follow-up are necessary to strengthen the evidence.
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Affiliation(s)
| | | | | | | | | | - José Nelson Mucha
- Department of Orthodontics, Universidade Federal Fluminense - UFF, Niterói, RJ, Brazil
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Abstract
Botulinum toxin (BoNT) has been approved for aesthetic use since 2002. Since then, clinical studies and expert use have informed our understanding of how BoNT exerts its clinical effect and the practical use of this product across a number of aesthetic applications. This review discusses the clinical properties and characteristics of abobotulinumtoxinA, which patients are suitable for its use, and how it can be utilized to treat facial rhytides.
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Affiliation(s)
| | - Gary Monheit
- Dermatologist, Departments of Dermatology and Ophthalmology, University of Alabama at Birmingham, Birmingham, AL, USA
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Cohen JL, Scuderi N. Safety and Patient Satisfaction of AbobotulinumtoxinA for Aesthetic Use: A Systematic Review. Aesthet Surg J 2017; 37:S32-S44. [PMID: 28388721 PMCID: PMC5434490 DOI: 10.1093/asj/sjx010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A systematic review of the published literature (from January 2000 to January 2016) to ascertain the safety of, and patient satisfaction with, the aesthetic use of abobotulinumtoxinA was conducted. In addition to the licensed indications, other special populations were considered for discussion. The potential impact of neutralizing antibodies and systemic toxicity were also addressed. A total of 364 papers were screened and 86 were found to be relevant to the population, intervention(s), and outcomes stipulated in the protocol. The safety and patient satisfaction data from these publications are discussed in this review.
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Affiliation(s)
- Joel L Cohen
- Associate Clinical Professor, Department of Dermatology, University of Colorado, Boulder, CO, USA
- Assistant Clinical Professor, Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - Nicolo Scuderi
- Full Professor of Plastic and Reconstructive Surgery, Department of Surgery, Sapienza University of Rome, Rome, Italy
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Lorenc ZP, Kenkel JM, Fagien S, Hirmand H, Nestor MS, Sclafani AP, Sykes JM, Waldorf HA. Consensus panel's assessment and recommendations on the use of 3 botulinum toxin type A products in facial aesthetics. Aesthet Surg J 2013; 33:35S-40S. [PMID: 23515197 DOI: 10.1177/1090820x13480479] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this summary article, the authors discuss the characteristics of abobotulinumtoxinA, incobotulinumtoxinA, and onabotulinumtoxinA. With 3 neuromodulators available in the US market, comparisons between and among products will invariably be made, so arguments for the most effective facial aesthetic uses of each neuromodulator are presented. Topics addressed in this article include patient expectations, toxin reconstitution and preparation, patient positioning, differences among products, the role of complexing proteins, and dosing and injection strategies. Recommendations are also provided by treatment area.
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Lorenc ZP, Kenkel JM, Fagien S, Hirmand H, Nestor MS, Sclafani AP, Sykes JM, Waldorf HA. A review of onabotulinumtoxinA (Botox). Aesthet Surg J 2013; 33:9S-12S. [PMID: 23515199 DOI: 10.1177/1090820x12474629] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OnabotulinumtoxinA was introduced to the US market in 2002 as the first botulinum toxin type A (BoNTA) approved for facial aesthetics. This article provides an overview of onabotulinumtoxinA's uses and indications as well as safety and efficacy data. As with other BoNTA products, onabotulinumtoxinA is generally well tolerated. Consideration is also given to clinical applications of the product. Information on handling, storage, and dosing is provided.
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Al Hamdan EM, Algheryafi AM, Al-Ghareeb FJ, Ashri NY. Knowledge and attitude of dentists towards the use of botulinum toxin and dermal fillers in dentistry, Riyadh, Saudi Arabia. J COSMET LASER THER 2013; 15:46-54. [PMID: 23368690 DOI: 10.3109/14764172.2012.758377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Botulinum toxin (BTX) and dermal fillers (DFs) are considered as quick and effective non-surgical solutions for enhancing facial appearance. OBJECTIVE To evaluate dentists' knowledge and attitude towards using Botulinum toxin and DFs in dental treatment in Riyadh, Saudi Arabia. METHODS Five hundred questionnaires were distributed in Riyadh city to government and private sectors to determine awareness and attitude towards using Botulinum toxin and DFs in dental clinics for therapeutic and aesthetics uses. RESULTS Botulinum toxin: A total of 1.2% is practising it. Only 34.8% could recognise its composition. Use of Botulinum toxin in wrinkle reduction was the most reported (73.7%). A total of 81.1% believed that Botulinum toxin has side effects; allergic reaction was the most reported (57.5%). A total of 47.8% reported that higher doses are more toxic, and that males need higher doses than females (10.2%). Dermal fillers: A total of 0.9% is practising it. The most reported type (47.8%) was Fat transfer. Filling of wrinkles was the most reported use (57.8%). A total of 69% believed that DFs has side effects; allergic reaction was the most reported (53.4%). Attitude: A total of 37.8% would like to practise Botulinum toxin/DFs, mostly for aesthetic dental reason. However, 60.2% rejected the idea, mainly due to lack of knowledge and experience (44%). CONCLUSION Limited knowledge regarding Botulinum toxin and dermal fillers is found among dentists in Riyadh, Saudi Arabia.
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Affiliation(s)
- Eman M Al Hamdan
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
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Michaels BM, Csank GA, Ryb GE, Eko FN, Rubin A. Prospective randomized comparison of onabotulinumtoxinA (Botox) and abobotulinumtoxinA (Dysport) in the treatment of forehead, glabellar, and periorbital wrinkles. Aesthet Surg J 2012; 32:96-102. [PMID: 22231417 DOI: 10.1177/1090820x11430685] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There are several commercially available neurotoxins to improve facial aesthetics, but few prospective, randomized trials have been conducted without commercial support to compare these agents. OBJECTIVES The authors present the results of a study examining and comparing the effects of onabotulinumtoxinA (BoNT-ONA; Botox, Allergan, Inc., Irvine, California) and abobotulinumtoxinA (BoNT-ABO; Dysport, Ipsen Ltd, Slough, UK). METHODS The authors enrolled 53 patients in a prospective, randomized trial in which each patient received a dose of BoNT-ONA on one side of the upper face and BoNT-ABO on the other. The effects of each agent were monitored and recorded over 150 days according to each patient's ability to elevate the brow, wrinkle count (as measured by the Visia system; Canfield Imaging Systems, Fairfield, New Jersey), and assessment of Fitzpatrick wrinkle scale rankings by blinded graders. RESULTS Results showed no statistically significant differences between the two agents. Both agents yielded measurable improvements on wrinkles of the upper face at 150 days. CONCLUSIONS At the current pricing of the agents, BoNT-ABO offers a significant cost savings over BoNT-ONA, with a comparable efficacy. The effect of both drugs appears to be more prolonged than indicated in the current manufacturer guidelines.
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Affiliation(s)
- Basil M Michaels
- Clinical Surgery at the University of Massachusetts, Pittsfield, MA 01201, USA.
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Kiripolsky MG, Goldman MP. Safety and efficacy of administering abobotulinumtoxinA through a single injection point when treating lateral periocular rhytides. J Cosmet Dermatol 2011; 10:232-4. [PMID: 21896136 DOI: 10.1111/j.1473-2165.2011.00574.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A retrospective analysis was performed to assess efficacy and patient satisfaction associated with AbobotulinumtoxinA for the treatment of dynamic periocular rhytides. When keeping the total dose of ABA the same for each side of the face, one injection point yielded the same efficacy and safety as three separate injection points into the lateral periocular areas.
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