Botulinum toxin type A: history and current cosmetic use in the upper face

LncRNA-miRNA-mRNA regulatory networks in skin aging and therapeutic potentials

Skin aging is a complex process influenced by intrinsic and extrinsic factors. Although dermatology offers advanced interventions, molecular mechanisms in skin aging remain limited. Competing endogenous RNAs (ceRNAs), a subset of coding or non-coding RNAs, regulate gene expression through miRNA competition. Several ceRNA networks investigated up to now offer insights into skin aging and wound healing. In skin aging, RP11-670E13.6-miR-663a-CDK4/CD6 delays senescence induced by UVB radiation. Meg3-miR-93-5p-epiregulin contributes to UVB-induced inflammatory skin damage. Predicted ceRNA networks reveal UVA-induced photoaging mechanisms. SPRR2C sequesters miRNAs in epidermal aging-associated alteration of calcium gradient. H19-miR-296-5p-IGF2 regulates dermal fibroblast senescence. PVT1-miR-551b-3p-AQP3 influences skin photoaging. And bioinformatics analyses identify critical genes and compounds for skin aging interventions. In skin wound healing, MALAT1-miR-124 aids wound healing by activating the Wnt/β-catenin pathway. Hair follicle MSC-derived H19 promotes wound healing by inhibiting pyroptosis. And the SAN-miR-143-3p-ADD3 network rejuvenates adipose-derived mesenchymal stem cells in wound healing. Thus, ceRNA networks provide valuable insights into the molecular underpinnings of skin aging and wound healing, offering potential therapeutic strategies for further investigation. This comprehensive review serves as a foundational platform for future research endeavors in these crucial areas of dermatology.

Complementary Strategies to Promote Hair Regrowth in Post-COVID-19 Telogen Effluvium

Post-COVID-19 telogen effluvium has been largely reported as a sequela in the post-acute phase of COVID-19, causing major emotional distress among the affected patients. The affected individuals are further exposed to a vast amount of misinformation from the internet and social media and it is important for physicians to be familiar with the phenomenon and provide appropriate counselling to their patients regarding this condition. This article aims to review the evidence-based complementary strategies that can help enhance hair regrowth after post-COVID-19 hair loss, from psychological support and patient education to the importance of optimal nutrition and potential indications and benefits of oral nutritional supplementation, as well as the role of both topical and injectable hair growth stimulators.

Botulinum-A intramuscular injection in an orthopaedic paediatric patient cohort: service restructure analysis

Botulinum intramuscular injections are increasingly being used in the management of hypertonic musculature. Historically, injections were administered under general anaesthesia (GA), which has service and economic implications. Our delivery changed to outpatient conscious injections to improve service efficiency. A retrospective analysis of all patient injections from January 2010 to December 2015 analysed cost-benefit and efficiency of service remodelling. 472 patients were administered injections, 298 in theatre under GA and 174 without GA. In 2010, 97 of 102 cases were performed under GA (45 theatre-hours), decreasing to 18 of 68 cases in 2015 (8.4 theatre-hours). The mean hospital stay decreased from 410 to 135 min. The reduction in theatre use and the requirement for a postanaesthetic bed led to significant savings per case. Service remodelling showed successful cost saving and reduced in-hospital stay.

Are nurse injectors the new norm?

PURPOSE

As Botox(®)/filler use has increased in recent years, a growing number of nonaesthetic health professionals have emerged to perform these procedures. Since studies have shown that patients identify training as the most important factor in considering these procedures, this study seeks to summarize the perspective of plastic surgeons regarding these paradigm shifts.

METHODS

In the summer of 2013, an eight-question survey was sent to members of ISAPS, ASAPS, and ASPS (approximately 26,113 plastic surgeons globally). Two questions assessed practice location and membership affiliation and six questions assessed various healthcare practitioners' capability to administer Botox, fillers, and vaccines (control). Healthcare practitioners included plastic surgeons and dermatologists, gynecologists, dentists, nurses in plastic surgery and dermatology, or nurses in other fields.

RESULTS

On three e-mail notifications, 14,184 plastic surgeons opened the survey and 882 responded: 36.6 % from North America, 29.1 % from Europe, 12.9 % from South America, 10.1 % from Asia, 4.5 % from the Middle East, 3.4 % from Australia, 1.9 % from Africa, and 1.6 % from Central America. Seventy-seven percent believed nurses were not as capable as plastic surgeons in administering Botox; 81 % felt the same for fillers. Conversely, 84 % agreed that nurses were as capable as plastic surgeons in administering vaccines. Plastic surgeons ranked nurses in other fields (48 %) as most capable in administering vaccines, then plastic surgeons (42 %), nurses of plastic surgeons (9 %), gynecologists (1 %), and dentists (<1 %). When asked about Botox/fillers, responders ranked plastic surgeons (98 %) most capable, then nurses in plastic surgery (2 %), gynecologists (<1 %), dentists (<1 %), and nurses in other fields (<1 %). When asked to rank according to patient perception, the order remained the same.

CONCLUSION

Based on responses from over 880 plastic surgeons from around the world, plastic surgeons consider themselves and dermatologists the most capable injectors. However, they still believe nurses in other fields to be the most capable of administering vaccines. This dichotomy may define the role of various practitioners in an increasingly more competitive injectable environment to improve patient satisfaction and outcomes. Given that the majority of growth in cosmetic injectables is being driven by providers other than plastic surgeons and dermatologists, further clarification on training requirements and practice guidelines may be necessary to ensure a consistent, reproducible experience for the patient.

Balanced botox chemodenervation of the upper face: symmetry in motion

Cosmetic botulinum toxin type A (Botox, Allergan, Inc., Irvine, CA) has revolutionized minimally invasive treatment of the upper face. Increasingly sophisticated outcomes result in facial symmetry in motion. The face is a three-dimensional moving unit, not an isolated photograph. This is why the advanced injector must hone an astute ability to observe casual microexpressions. Consideration is then given to the patient's age, facial anatomy, facial asymmetry, and dynamic rhytids. The ratio of dosing to agonist and antagonist muscles that allows unopposed action is determined. Nuance in placement and dose combined with adjunct therapy results in natural and appropriate facial emotion and avoids unnatural or bizarre patterns of movement. Asymmetrical scenarios are presented to exemplify this process of analysis and treatment. Many authors have detailed the mechanism of action, history of Botox development, and specific muscle group treatment in the periorbital region. In this discussion, I leave behind rigorous academic analysis and wish to offer my approach, which has evolved through 15 years experience treating the aesthetic patient with Botox. The clinician can read about recommended patterns of injection, and the procedure is quite simple. It is only through skilled observation and understanding of expressive nuance and anatomy that the advanced injector will meet the goal of a natural communicative result with chemodenervation. Experience is accumulated through critical analysis of patient results over time. This discussion first directs attention to why it is important to learn how to look at the face in motion as well as at facial rhytids. A plan is developed for treatment including drug preparation, dosing decisions, precise three-dimensional delivery, and adjunct therapy. Perils may generally be avoided by choosing appropriate dosing and placement. The asymmetrical patient scenario is used to demonstrate nuance in evaluation and treatment.

[The corrugator supercilii muscle. A review]

Corrugator supercilii is a facial, forehead and supra-orbital muscle. The frown glabellar wrinkles are mainly formed by repeated contractions of this muscle. These wrinkles will produce the picture of premature ageing even in a young person. Many treatments reduce or abolish the action of this muscle, enhancing the appearance of the glabellar area. We propose to review the recent material related to the anatomical characteristics of this muscle in order to build the necessary knowledge to optimize the result of these different treatments.

Advances in minimally invasive facial rejuvenation

PURPOSE OF REVIEW

Current cosmetic surgical practice for facial rejuvenation has undergone a significant change due to the introduction of technologies to improve the age-associated changes of the face. The most widely adopted methods of minimally invasive facial rejuvenation include the use of neuromuscular blocking agents and injectable fillers. The topic of minimally invasive procedures might include a variety of subjects including nutritional and hormonal modulation, light-based and laser-based therapies, minimal incision surgical procedures, as well as the use of botulinum toxin and fillers. The focus of this study will be on the minimally invasive facial rejuvenation efforts achieved by injection techniques.

RECENT FINDINGS

Botulinum A neurotoxin has been shown to be effective in the reduction of hyperfunctional lines in the upper and lower face. Anatomic areas that have been found to benefit include the glabella, the forehead, the periorbital area, lips, and the platysma muscle. The more recently introduced hyaluronic acid and other injectable fillers are receiving increasing usage. These temporary fillers have been found to improve creases and wrinkles, augment deep nasolabial folds, augment thin lips, and improve hollowing in the periorbital and other depressions and deformities.

SUMMARY

There has been a significant paradigm shift in the field of rejuvenation surgery. Injectable minimally invasive methods have been offered to remedy age-related and other acquired deformities of the head and neck region. These methods have provided temporary correction of undesirable characteristic that were traditionally approached with more invasive surgically oriented modalities.

Botulinum neurotoxin type A in facial aesthetics

Injection of botulinum neurotoxin type A has rapidly become the most common non-surgical cosmetic procedure performed, due to its exceptional safety profile, as well as its ability to rejuvenate and enhance a number of facial areas. There are several marketed botulinum neurotoxin preparations, but products are not interchangeable as each possesses distinctive characteristics that are attributed to the unique toxin purification and manufacturing processes. These differences can emerge in the form of potency, duration of effect and the potential for migration outside targeted tissue, causing unwanted effects. However, although there are established preclinical pharmacologic and therapeutic differences between products, there are few well-controlled clinical comparisons in facial aesthetics. It is important for clinicians using these products to understand these differences as they relate to achieving desired outcomes for patients who seek improved facial aesthetics.

Use of botulinum toxins in cancer therapy

A recent study has demonstrated for the first time that botulinum neurotoxin (BoNT) briefly opens tumour vessels, allowing more effective destruction of cancer cells by radiotherapy and chemotherapy. This review discusses the implications of BoNTs in cancer treatment. After briefly reviewing the different BoNT serotypes, their pharmacological activities and their general use in medicine, the authors focus on their possible application in cancer and describe how BoNTs have been used so far to treat spasm related to tumour or to therapies. By dissecting the mechanisms of action leading to a potentiation of anticancer therapy, it can be seen that BoNTs act by an effect on the tumour microenvironment rather than by a direct cytotoxic effect on tumour cells.

Treatment of Depression with Botulinum Toxin A: A Case Series

BACKGROUND

Major depression is a common and serious disease that may be resistant to routine pharmacologic and psychotherapeutic treatment approaches.

OBJECTIVE

To evaluate the efficacy of botulinum toxin A treatment of glabellar frown lines in treating patients with major depression, using a small open pilot trial.

METHODS

Patients who met DSM-IV criteria for ongoing major depression in spite of pharmacologic or psychotherapeutic treatment were evaluated with the Beck Depression Inventory II (BDI-II) before receiving botulinum toxin A to their glabellar frown lines. Two months later, all patients were re-evaluated clinically and with the BDI-II.

RESULTS

Ten depressed patients were treated with botulinum toxin A, and 9 of 10 patients were no longer depressed 2 months after treatment. The tenth patient had an improvement in mood.

CONCLUSION

To our knowledge, these are the first reported cases of depression treated with botulinum toxin A.

Botulinum toxin-physiology and applications in head and neck disorders

This article is structured around a literature review that was carried out using Ovid and Medline with the key words "botulinum," "toxin," and "ENT." Botulinum toxin has been used safely in humans for more than 20 years. The effects are transient, such that treatments are required to be repeated at intervals. Its application to ENT provides a useful tool to treat dystonia, autonomic dysfunction, facial nerve paresis, and hyperfunctional lines. It may also be of benefit in laryngeal rebalancing and the treatment of headaches. Further research is being carried out and new indications for treatment with botulinum toxin may include sialorrhea and rhinorrhea.

Type A botulinum toxin in the upper aspect of the face

The use of botulinum toxin type A (BTX-A) for facial rejuvenation was first systematically developed by Carruthers and Carruthers on the upper aspect of the face. In the early 1990s, the first studies of the cosmetic use of BTX-A were published. BTX-A was only approved in 2002, however, by the U.S. Food and Drug Administration when extensive cosmetic studies were evaluated. The treatment of facial wrinkles with BTX-A has truly changed the concepts held by physicians regarding facial rejuvenation, mainly on the upper aspect of the face. It is one of the most common cosmetic procedures currently performed by physicians.

[Skin, wrinkles and botulinum toxin]

OBJECTIVE

To present an up-to-date analysis about the use of botulinum toxin for treating facial lines and wrinkles.Method. - A systematic search of the literature was conducted to select the most recent or relevant publications on this topic, through Medline.

RESULTS

Out of the 583 articles retrieved, 90 were finally selected for the study.

DISCUSSION

Validity of using botulinum toxin for cosmetic use is demonstrated, together with contra-indications and different methods to objectivate the results. The different available types of toxin are presented and compared. Modalities of preparation, conservation, and waste disposal are detailed. Anatomical bases of muscular facial balance are reviewed, with techniques of injection presented for each site, and also with adjunctive procedures. Complications and side effects are described and analysed. Most complications can be prevented through: perfect knowledge of local anatomy;use of small volumes;orientation of the needle bevel towards the muscle body, injection within the muscle body if thick, more superficial if thin;application of ice on the skin pre- and post-injecting. Adding epinephrin or diluting with xylocaïne and epinephrin is not commonly used.

CONCLUSION

Botulinum toxin has found its way as a major component of the therapeutic armamentarium. Its efficacy for facial rejuvenation has made it extremely popular, but its use does follow strict rules, and should be restricted to soundly trained practitioners.