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Harnchoowong S, Vachiramon V, Jurairattanaporn N. Cosmetic Considerations in Dark-Skinned Patients. Clin Cosmet Investig Dermatol 2024; 17:259-277. [PMID: 38321987 PMCID: PMC10844008 DOI: 10.2147/ccid.s450081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
For dermatologists, diversities of human races result in an opportunity to encounter patients with various skin types. Cosmetic procedures have gained more popularity and become more accessible over the past decades. Thus, the selection of appropriate treatment protocol for each patient becomes inevitable. This review will focus on basic knowledge and key points in performing safe cosmetic-related procedures in patients with dark-complexioned skin. In terms of structure and function of the skin, people of color have equal epidermal thickness, corneocyte size and melanocyte number. However, they have more stratum corneum compaction, melanosome dispersion and melanocyte activity than fair skin individuals. Data regarding drug penetration and cutaneous irritation showed conflicting results. Superficial chemical peels and microdermabrasion can be done safely in dark-skinned patients. Medium-depth peel should be used with extreme caution. While deep-depth peel should be avoided at all times due to pigmentary and textural complications. Prolonged treatment interval, use of priming agents and sun protection are recommended. Injectable materials including botulinum toxin and soft tissue augmentation by hyaluronic acid filler can be done harmlessly in dark-skinned patients. Lasers and energy-based devices should be done with caution. Higher melanin dispersion and melanocyte activity acts as competitive chromophore. Pigmentary or textural changes can occur after aggressive treatment protocol. High energy setting, pulse stacking, short wavelength lasers and short treatment interval should be avoided in dark-skinned patients.
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Affiliation(s)
- Sarawin Harnchoowong
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natthachat Jurairattanaporn
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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An JM, Shahriar SMS, Lee DY, Hwang SR, Lee YK. Pore Size-Dependent Stereoscopic Hydrogels Enhance the Therapeutic Efficiency of Botulinum Toxin for the Treatment of Nerve-Related Diseases. ACS Appl Mater Interfaces 2022; 14:19139-19153. [PMID: 35452222 DOI: 10.1021/acsami.2c01738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Botulinum toxin (BoNT) is a major neurotherapeutic protein that has been used at low doses for diverse pharmacological applications. However, the pleiotropic effect of BoNT depends on multiple periodic injections owing to its rapid elimination profile, short-term therapeutic effect, and high mortality rate when administered at high doses. In addition to low patient compliance, these drawbacks represent the significant challenges that limit the further clinical use of BoNT. This study developed a new hydrogel-based single dosage form of BoNT by employing a one-step cross-linking chemistry. Its controlled porous structures and composition facilitated uniform drug distribution inside the hydrogel and controllable release of BoNT mediated by slow diffusion. A single dose remained stable for at least 2.5 months and showed sustained effect for at least 20 weeks, meeting the requirements for a single-dose form of BoNT. Additionally, this dosage form was evaluated as safe from all aspects of toxicology. This delivery system resulted in a 100% survival rate after administering a BoNT dose of 30 units, while a dose of more than 5 units of naked BoNT caused a 100% mortality rate within a few days. Overall, this strategy could provide patients with the first single-dose treatment option of BoNT and improve their quality of life.
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Affiliation(s)
- Jeong Man An
- Department of Bioengineering, College of Engineering, Hanyang University, Seoul 04763, Republic of Korea
- Department of Chemical and Biological Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
- KB Biomed Inc., Chungju 27469, Republic of Korea
| | - S M Shatil Shahriar
- Department of Chemical and Biological Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
- KB Biomed Inc., Chungju 27469, Republic of Korea
- Department of Surgery-Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198-5940, United States
| | - Dong Yun Lee
- Department of Bioengineering, College of Engineering, and BK FOUR Biopharmaceutical Innovation Leader for Education and Research Group, Hanyang University, Seoul 04763, Republic of Korea
- Institute of Nano Science and Technology (INST), Hanyang University, Seoul 04763, Republic of Korea
| | - Seung Rim Hwang
- College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea
| | - Yong-Kyu Lee
- Department of Chemical and Biological Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
- KB Biomed Inc., Chungju 27469, Republic of Korea
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Park MY, Ahn KY. Scientific review of the aesthetic uses of botulinum toxin type A. Arch Craniofac Surg 2021; 22:1-10. [PMID: 33714246 PMCID: PMC7968983 DOI: 10.7181/acfs.2021.00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 01/02/2023] Open
Abstract
Botulinum toxin type A (BoNT-A), onabotulinumtoxinA (Botox) was approved by the United States Food and Drug Administration for temporary improvement of glabellar lines in patients 65 years and younger in 2002, and has also been used widely for aesthetic purposes such as hyperhidrosis, body shape contouring, and other noninvasive facial procedures. BoNT-A inhibits presynaptic exocytosis of acetylcholine (ACh)-containing vesicles into the neuromuscular junction at cholinergic nerve endings of the peripheral nervous system, thereby paralyzing skeletal muscles. ACh is the most broadly used neurotransmitter in the somatic nervous system, preganglionic and postganglionic fibers of parasympathetic nerves, and preganglionic fibers or postganglionic sudomotor nerves of sympathetic nerves. The scientific basis for using BoNT-A in various cosmetic procedures is that its function goes beyond the dual role of muscle paralysis and neuromodulation by inhibiting the secretion of ACh. Although the major target organs for aesthetic procedures are facial expression muscles, skeletal body muscles, salivary glands, and sweat glands, which are innervated by the somatic or autonomic nerves of the peripheral cholinergic nerve system, few studies have attempted to directly explain the anatomy of the areas targeted for injection by addressing the neural physiology and rationale for specific aesthetic applications of BoNT-A therapy. In this article, we classify the various cosmetic uses of BoNT-A according to the relevant component of the peripheral nervous system, and describe scientific theories regarding the anatomy and physiology of the cholinergic nervous system. We also review critical physiological factors and conditions influencing the efficacy of BoNT-A for the rational aesthetic use of BoNT-A. We hope that this comprehensive review helps promote management policies to support long-term, safe, successful practice. Furthermore, based on this, we look forward to developing and expanding new advanced indications for the aesthetic use of BoNT-A in the future.
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Affiliation(s)
- Mee Young Park
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea
| | - Ki Young Ahn
- Dr. Ahn’s Aesthetic and Plastic Surgical Clinic and Botulinum Center, Daegu, Korea
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Chan IL, Cohen S, da Cunha MG, Maluf LC. Characteristics and management of Asian skin. Int J Dermatol 2018; 58:131-143. [DOI: 10.1111/ijd.14153] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- I. Lym Chan
- Faculdade de Medicina do ABC; Santo André São Paulo Brazil
| | - Simão Cohen
- Faculdade de Medicina do ABC; Santo André São Paulo Brazil
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Chang BL, Wilson AJ, Taglienti AJ, Chang CS, Folsom N, Percec I. Patient Perceived Benefit in Facial Aesthetic Procedures: FACE-Q as a Tool to Study Botulinum Toxin Injection Outcomes. Aesthet Surg J 2016; 36:810-20. [PMID: 26780945 DOI: 10.1093/asj/sjv244] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are numerous methods of assessing patient satisfaction with botulinum toxin type A neuromodulation of the glabellar rhytids. As the use of aesthetic neuromodulation increases both in breadth and number of procedures, there is a need for more comprehensive tools to evaluate patient-reported outcomes. The FACE-Q is a recently validated patient-reported outcome instrument that can be used to measure patient perceptions of botulinum toxin type A neuromodulation. OBJECTIVES This study used the FACE-Q to assess patient satisfaction following botulinum toxin type A neuromodulation of the glabellar rhytids. METHODS 57 female patients completed the FACE-Q, a survey that evaluates patients' satisfaction with their facial appearance. After this baseline survey, the patients received injections of one of onabotulinumtoxinA (Botox, Allergan, Dublin, Ireland), abobotulinumtoxinA (Dysport, Galderma, Lausanne, Switzerland), or incobotulinumtoxinA (Xeomin, Merz Pharmaceuticals, Frankfurt am Main, Germany) in the glabella. Two weeks post-injection, the patients completed the FACE-Q again. The percentage changes in patient responses were tabulated to determine how neuromodulation affects patient satisfaction with their facial appearance. The percentage changes for each of the neurotoxin groups were compared to determine if patient satisfaction with neuromodulation varies with the type of neurotoxin. RESULTS Patient satisfaction with their overall facial appearance increased by 28% following neuromodulation. Patients stated that they believe they look an average of 5.6 years younger post-neuromodulation. There were no significant differences among the treatment groups. CONCLUSIONS The FACE-Q demonstrates that patients are more satisfied by their overall facial appearance and age appearance following neuromodulation of their glabellar rhytids. Patients are equally satisfied with the improvement of their facial appearance regardless of which neurotoxin they received. LEVEL OF EVIDENCE 2: Therapeutic.
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Affiliation(s)
- Brian L Chang
- From the Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Anthony J Wilson
- From the Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Anthony J Taglienti
- From the Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Catherine S Chang
- From the Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Nancy Folsom
- From the Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Ivona Percec
- From the Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
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Palmer FR 3rd, Hsu M, Narurkar V, Munyon T, Day D, Karnik J, Tatsutani K. Safety and effectiveness of focused cold therapy for the treatment of hyperdynamic forehead wrinkles. Dermatol Surg 2015; 41:232-41. [PMID: 25654195 DOI: 10.1097/DSS.0000000000000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 25% of patients exploring treatments for wrinkle reduction, have reservations about toxins. Therefore, a nonsurgical, minimally invasive, and toxin-free approach to eliminate facial hyperdynamic lines is desirable. OBJECTIVE To assess the clinical safety and effectiveness of focused cold therapy (FCT) for the reduction of hyperdynamic forehead wrinkles. METHODS Forty-one subjects received FCT to temporal branches of the facial nerve. Hyperdynamic forehead wrinkles were assessed by the investigator and subject before treatment, immediately after procedure, and at 7, 30, 60, 90, and 120 days after treatment. A validated 5-point wrinkle scale and a 9-point global improvement scale were used to measure line severity. RESULTS Five subjects received a lower treatment dose and were therefore excluded from analysis. In the remaining 36 subjects, 91% had at least a 1-point improvement in forehead line severity at 30 days after treatment and 70% had at least a 2-point improvement. There were no serious adverse events. CONCLUSION Subjects treated for forehead wrinkles showed significant clinical improvement with high subject satisfaction and no serious adverse events. Focused cold therapy seems to be an effective, safe nontoxic alternative to popular wrinkle-reducing treatments.
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Affiliation(s)
- Jae Jung Lee
- Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hye Shin Jeon
- Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hee Young Choi
- Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Park MY, Ahn KY. Effect of the refrigerator storage time on the potency of botox for human extensor digitorum brevis muscle paralysis. J Clin Neurol 2013; 9:157-64. [PMID: 23894239 PMCID: PMC3722467 DOI: 10.3988/jcn.2013.9.3.157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/26/2013] [Accepted: 03/26/2013] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose It is recommended that Botox be used within 5 hours of reconstitution, which results in substantial quantities being discarded. This is not only uneconomic, but also inconvenient for treating patients. The aim of this study was to determine the potencies of Botox used within 2 hours of reconstitution with unpreserved saline, the same Botox refrigerated (at +4℃) 72 hours after reconstitution, and during the next 4 consecutive weeks (weeks 1, 2, 3, and 4). This comparison was used to determine the length of refrigeration time during which reconstituted Botox will maintain the same efficacy as freshly reconstituted toxin. Methods Individual paralysis rates in the extensor digitorum brevis (EDB) compound muscle action potential (CMAP) amplitude and area were measured 1 week after injecting fresh reconstituted 2.5 MU of Botox on one side of the foot, and when the same quantity of Botox that had been refrigerated for a designated time (i.e., 72 h, or 1, 2, 3, or 4 weeks) into the other side of the foot. The EDB CMAP amplitude and area at 12 and 16 weeks postinjection were also measured to compare the efficacy durations in all five comparative groups. Results Ninety-four volunteers were divided into five groups according to the refrigerator storage time of the second Botox injection. The paralysis of the EDBs was significant for each injection of Botox, both fresh and refrigerated, with no statistically significant differences between them, regardless of the refrigeration time. There was a tendency toward increased CMAP amplitude and area at 12 or 16 weeks postinjection (p<0.0001). The duration of effective muscle paralysis did not differ significantly throughout the 16-week follow-up period between all five groups. Conclusions The potency of reconstituted Botox is not degraded by subsequent refrigeration for 4 weeks. However, there are definite concerns regarding its sterility, and hence its safety, since multiple withdrawals from the same vial over long periods can introduce bacterial contamination.
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Affiliation(s)
- Mee Young Park
- Department of Neurology, College of Medicine, Yeungnam University, Daegu, Korea
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Chauhan DS, Cariappa KM, Guruprasad Y. Botulinum toxin type a for the treatment of hyperkinetic lines of the face. J Maxillofac Oral Surg 2012; 12:173-83. [PMID: 24431836 DOI: 10.1007/s12663-012-0407-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/28/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study sought to determine the efficacy of Botulinum toxin A (BTA) for the treatment of hyperkinetic lines of the face. Twenty three patients who were concerned for facial wrinkles and desiring correction are presented. METHODS This clinical study evaluated the postoperative results of 23 patients who underwent treatment for facial wrinkles with BTA. Among the patients included in the study, 20 were males and remaining 3 were females. The age of the patients ranged from 27 to 46 years (mean 34.69 years) and the treatment was done in three different sessions and divided into 3 treatment subgroups of forehead, crow's feet, and glabellar wrinkles. RESULTS All the patients were followed up for a period of at least 6 months and graded for the response to treatment with BTA by the operator, observer and the patient independently using the facial wrinkle scale. The patient's satisfaction to the treatment was also noted on all the follow-up visits on the satisfaction scale and the results were subjected to statistical analysis using Kappa analysis, Chi-square test and T test. The results showed that the treatment of facial hyperkinetic lines with BTA is associated with few adverse events like pain on injection, transient headache, and mild change in facial appearance in subjects with high hair line which are not serious and thus safe. CONCLUSION The findings of this study support the use of BTA for the treatment of hyperkinetic lines of the face although further studies with more sample size are required.
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Affiliation(s)
- Dinesh Singh Chauhan
- Department of Oral & Maxillofacial Surgery, AME'S Dental College Hospital & Research Centre, Raichur, 584103 Karnataka India
| | - K M Cariappa
- Department of Oral & Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, 576104 Karnataka India
| | - Yadavalli Guruprasad
- Department of Oral & Maxillofacial Surgery, AME'S Dental College Hospital & Research Centre, Raichur, 584103 Karnataka India
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Abstract
BACKGROUND Botulinum toxin is a well-established treatment for dynamic glabellar lines. A previous study evaluated the existence of glabellar contraction "patterns," according to the predominance of eyebrow approximation, depression, or elevation movements, namely "U," "V," "convergent arrows," "omega," and "inverted omega." OBJECTIVES To confirm contraction patterns in the adult population for a better treatment approach and to verify whether changes occur after repeated treatment. METHODS Pairs of photographs-at rest and under contraction-from two groups were retrospectively analyzed: 334 adult volunteers with a predominance of specific movements, being verified and 36 previously treated individuals when they returned for re-injections. RESULTS The five glabellar contraction patterns were confirmed. Each individual's initial pattern reappeared upon waning of the toxin effect. CONCLUSION Interpersonal differences in facial animation are observed. Classifying glabellar wrinkles allows accurate treatment with botulinum toxin, injecting the most commonly recruited muscles with higher doses or into more sites. Muscles not so recruited are spared or injected with lower doses for more-effective and -natural results. Although botulinum toxin blockade causes recruitment of adjacent muscles, the initial muscle contraction pattern is resumed when the effect wanes.
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Berry MG, Stanek JJ. Botulinum neurotoxin A: a review. J Plast Reconstr Aesthet Surg 2012; 65:1283-91. [PMID: 22552262 DOI: 10.1016/j.bjps.2012.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 01/27/2012] [Accepted: 04/09/2012] [Indexed: 11/24/2022]
Abstract
Despite its ubiquity in cosmetic circles and broad general awareness, a literature search of botulinum neurotoxin in JPRAS and BJPS yielded a mere 4 articles germane to cosmesis. A pair each detailing its application in masseteric hypertrophy(1,2) and the use of cryoanalgesia.(3,4) Given that botulinum neurotoxin A is the most commonly used cosmetic treatment, with American figures being most accurate,(5) a review of the background, development and scientific evidence would be perhaps useful, if not overdue, as Plastic Surgeons increasingly incorporate non-surgical interventions into their practices as part of a comprehensive facial rejuvenation strategy.
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Abstract
Patient satisfaction with botulinum toxin treatment is a key success factor in aesthetic procedures and is governed by the interaction of numerous variables. Duration of effect is important because it influences retreatment intervals as well as affecting cost and convenience to the patient. In order to review the evidence on the duration of benefit associated with various commercial formulations of botulinum toxin, MEDLINE was searched using the following terms: 'botulinum' and 'duration'/'retreatment' (limits: 'clinical trials,' 'meta-analyses,' 'English'). I also searched my existing reference files, reference lists of identified articles, and meeting/conference abstracts to ensure completeness. The focus was on clinical medicine and aesthetic trials. To be eligible for the analysis, studies had to include efficacy assessments at multiple timepoints. To estimate duration of benefit, the following outcomes were examined and summarized: responder rates, mean wrinkle severity scores at various timepoints (with or without changes from baseline), and relapse rates. Duration at both repose and maximum attempted muscle contraction was considered when provided. Where possible, duration was assessed by formulation and dose. The initial search yielded 164 articles. Of these, 35 included an adequate measure of duration in aesthetic indications. The majority of these (22) were on the glabellar area. Study designs and endpoints were highly heterogeneous, and duration of effect varied between studies. Several studies with the BOTOX Cosmetic (onabotulinumtoxinA; Allergan, Inc., Irvine, CA, USA) formulation of botulinum toxin type A (BoNTA) included relapse rates, defined conservatively as return to baseline levels of line severity for two consecutive visits approximately 30 days apart (at repose and maximum contraction). In these studies, duration of effect ranged from 3 to 5 months in female patients and from 4 to 6 months in male patients. Individual patients had longer durations of response. Across all studies providing relapse rates, most patients relapsed by 6 months. In studies assessing patient satisfaction, satisfaction remained high throughout the duration of the studies ( approximately 4 months). With the Dysport formulation (abobotulinumtoxinA, clostridium botulinum type A toxin-hemagglutinin complex; Ipsen Biopharm Ltd, Wrexham, England), retreatment intervals were estimated at a mean of 3.9 months (median = 3.3 months). These results were consistent with responder rates from another Dysport study in which the active treatment differed from placebo at 3 but not 4 months. A single comparative study demonstrated that the proportion of patients relapsing at week 16 was 23% (95% CI 11.5, 41.6) in the BOTOX Cosmetic group as compared with 40% (95% CI 25.2, 60.1) in the Dysport group. Myobloc (rimabotulinumtoxinB, botulinum toxin type B; Solstice Neurosciences, Inc., South San Francisco, CA, USA) was associated with shorter durations of action (2-3 months). Data from facial areas other than the glabella, although more limited, supported a duration of at least 3-4 months. The addition of BoNTA to dermal fillers or light/laser therapy appeared to increase the degree of effect. Repeated BoNTA treatments may prolong duration of effect or potentiate the effect. In conclusion, patients can expect treatments to last > or =3 months but often as many as 4-5 months depending on the facial area, dose, and formulation. Additional research should help clarify the impact of age, baseline rhytid severity, patient sex, repeated treatments, and combination treatment on longevity of effect.
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Rauso R, Santagata M, Colella G, Nesi N, Gherardini G, Tartaro G. Can occlusal devices prolong the effect of botulinum toxin type A in the contouring of the lower face? Eur J Plast Surg 2010. [DOI: 10.1007/s00238-009-0375-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The Asian patient with Fitzpatrick skin types III-V is rarely highlighted in publications on cutaneous disorders or cutaneous laser surgery. However, with changing demographics, Asians will become an increasingly important group in this context. Although high melanin content confers better photoprotection, photodamage in the form of pigmentary disorders is common. Melasma, freckles, and lentigines are the epidermal disorders commonly seen, whilst nevus of Ota and acquired bilateral nevus of Ota-like macules are common dermal pigmentary disorders. Post-inflammatory hyperpigmentation (PIH) occurring after cutaneous injury remains a hallmark of skin of color. With increasing use of lasers and light sources in Asians, prevention and management of PIH is of great research interest. Bleaching agents, chemical peels, intense pulsed light (IPL) treatments, and fractional skin resurfacing have all been used with some success for the management of melasma. Q-switched (QS) lasers are effective for the management of epidermal pigmentation but are associated with a high risk of PIH. Long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers and IPL sources pose less of a PIH risk but require a greater number of treatment sessions. Dermal pigmentary disorders are better targeted by QS ruby, QS alexandrite, and QS 1064-nm Nd:YAG lasers, but hyper- and hypopigmentation may occur. Non-ablative skin rejuvenation using a combination approach with different lasers and light sources in conjunction with cooling devices allows different skin chromophores to be targeted and optimal results to be achieved, even in skin of color. Deep-tissue heating using radiofrequency and infra-red light sources affects the deep dermis and achieves enhanced skin tightening, resulting in eyebrow elevation, rhytide reduction, and contouring of the lower face and jawline. For management of severe degrees of photoaging, fractional resurfacing is useful for wrinkle and pigment reduction, as well as acne scarring. Acne, which is common in Asians, can be treated with topical and oral antibacterials, hormonal treatments, and isotretinoin. Infra-red diode lasers used with a low-fluence, multiple-pass approach have also been shown to be effective with few complications. Fractional skin resurfacing is very useful for improving the appearance of acne scarring. Hypertrophic and keloid scarring, another common condition seen in Asians, can be treated with the combined used of intralesional triamcinolone and fluorouracil, followed by pulsed-dye laser. Esthetic enhancement procedures such as botulinum toxin type A and fillers are becoming increasingly popular. These are effective for rhytide improvement and facial or body contouring. We highlight the differences between Asian skin and other skin types and review conditions common in skin of color together with treatment strategies.
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Affiliation(s)
- Stephanie G Y Ho
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Fagien S, Carruthers JD. A Comprehensive Review of Patient-Reported Satisfaction with Botulinum Toxin Type A for Aesthetic Procedures: . Plast Reconstr Surg 2008; 122:1915-25. [DOI: 10.1097/prs.0b013e31818dbfe3] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carruthers JDA, Glogau RG, Blitzer A. Advances in Facial Rejuvenation: Botulinum Toxin Type A, Hyaluronic Acid Dermal Fillers, and Combination Therapies???-Consensus Recommendations: . Plast Reconstr Surg 2008; 121:5S-30S. [DOI: 10.1097/prs.0b013e31816de8d0] [Citation(s) in RCA: 260] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ahn KY, Kim ST. The Change of Maximum Bite Force after Botulinum Toxin Type A Injection for Treating Masseteric Hypertrophy: . Plast Reconstr Surg 2007; 120:1662-6. [DOI: 10.1097/01.prs.0000282309.94147.22] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Asian skin exhibits increased dermal thickness, collagen, and melanin content when compared with Caucasian skin. As a result of these features, the stigmata of aging skin in Asians is characterized more by pigmentation changes rather than fine, facial wrinkles, and it has an increased tendency toward pigmentary dyschromia after treatment. All facial skin rejuvenation techniques may not be applicable toward this selected population. This article highlights the various skin rejuvenation techniques that balance safety and efficacy and are most suitable toward treating the aging Asian face.
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Affiliation(s)
- Michael M Kim
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, 6th Floor Johns Hopkins Outpatient Center, 601 North Caroline Street, Baltimore, MD 21287, USA
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Abstract
The botulinum toxin A (BTX-A) role on elimination of hyperkinetic wrinkles is consolidated, although relying on subjective methods of assessment. A prospective open-label study was performed on 10 patients to objectively analyze superficial skin texture changes caused by BTX-A in the glabellar area. Skin areas were reproduced by silicon replica technique at baseline, 1 month, and 6 months after treatment. Takahashi's parameters (roughness, anisotropy, microsulcus number, and width) were obtained from scanning electron microscopy (SEM) analysis and compared using the Wilcoxon signed rank test. SEM images showed skin texture changes, and software analysis gave parameters for statistical analysis, allowing an objective evaluation. Statistically significant parameter modifications were evidenced. BTX-A effectiveness in wrinkle treatment was confirmed, and no differences in skin texture parameters from baseline to toxin action end were noted.
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Affiliation(s)
- Luca Andrea Dessy
- Department of Dermatology and Plastic Surgery, University "La Sapienza," Rome, Italy.
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21
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Campos JH, Oliveira LB, Queiroz TO, Santos KP, Freitas FM. Comparison between intramuscular and perimuscular injections of botulinum toxin type A. Aesthetic Plast Surg 2006; 30:700-3; discussion 704. [PMID: 16977369 DOI: 10.1007/s00266-005-0221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Botulinum toxin type A (BTX-A) must be injected in the intramuscular area to exert its paralytic effect. The durability of the BTX-A effect varies in different patients, and this fact can result from different locations of the drug injection, for example, the muscle peripheral area (perimuscular). This study aimed to evaluate whether a difference exists in the effect duration of the muscle paralysis between intramuscular and perimuscular injections of BTX-A. METHODS This study used 18 male New Zealand rabbits divided into two groups (A and B) based on the location of the BTX-A injection. The group A animals received 10 units of BTX-A diluted with 0.1 ml of normal saline injected perimuscularly. The group B animals received the same dosage injected in the intramuscular area of the left masseter muscle. An electroneurophysiologic study was performed 1 week before the experiment for all the animals, then repeated 1, 4, and 8 weeks after the toxin injection. RESULTS The amplitude values recorded in the masseter muscle were significantly lower in both groups throughout the study than the physiologic amplitude. The comparison between groups A and B did not show any statistically significant amplitude variations throughout the 8 weeks. CONCLUSION No significant difference in the neuromuscular blockade induced by botulinum toxin type A was observed between injections into the muscle peripheral area and intramuscular injections.
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Affiliation(s)
- José H Campos
- Fundação Bahiana para Desenvolvimento das Ciências, Técnica Operatória e Cirurgia Experimental 1, Av. Dom João VI, 274-Brotas-Salvador, Bahia, Brazil
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22
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Abstract
The use of botulinum toxin type A for facial enhancement is the most common cosmetic procedure currently undertaken in the United States. Overall clinical and study experience with botulinum toxin type A treatment for facial enhancement has confirmed that it is effective and safe in both the short and long term. Nevertheless, consistent guidelines representing the consensus of experts for aesthetic treatments of areas other than glabellar lines have not been published. Therefore, a panel of experts on the aesthetic uses of Botox Cosmetic (botulinum toxin type A; Allergan, Inc., Irvine, Calif.) was convened to develop consensus guidelines. This publication comprises the recommendations of this panel and provides guidelines on general issues, such as the importance of the aesthetic evaluation and individualization of treatment, reconstitution and handling of the botulinum toxin type A, procedural considerations, dosing and injection-site variables, and patient selection and counseling. In addition, specific considerations and recommendations are provided by treatment area, including glabellar lines, horizontal forehead lines, "crow's feet," "bunny lines" (downward radiating lines on the sides of nose), the perioral area, the dimpled chin, and platysmal bands. The review of each area encompasses the relevant anatomy, specifics on injection locations and techniques, starting doses (total and per injection point), the influence of other variables, such as gender, and assessment and retreatment issues. Factors unique to each area are presented, and the discussion of each treatment area concludes with a review of key elements that can increase the likelihood of a successful outcome. Summary tables are provided throughout.
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Affiliation(s)
- Jean Carruthers
- Vancouver, Canada; Boca Raton, Fla.; and San Francisco, Calif. From the Department of Ophthalmology, University of British Columbia; private practice; and the Department of Dermatology, University of California School of Medicine, San Francisco
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23
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Spósito MMM. Nuevas indicaciones en el tratamiento mediante la toxina botulínica tipo A en cosmética: Boca y cuello. Plast Reconstr Surg 2004; 114:88S-100S. [DOI: 10.1097/01.prs.0000124409.17493.b7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Matarasso A, Deva AK. Informe sobre seguridad y eficacia: La Toxina Botulínica. Plast Reconstr Surg 2004; 114:65S-72S. [DOI: 10.1097/01.prs.0000124405.17493.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Abstract
Botulinim toxin A (BTX-A) is available commercially in two formulations: Botox (Allergan, Inc. Irvine, California) and Dysport (Ipsen Limited, Berkshire, United Kingdom). To use BTX-A successfully for cosmetic purposes, it is important to understand the basic principles of BTX-A therapy and the specific guidelines for its use, including dilution and storage. Injection using electromyographic guidance is helpful in achieving correct placement of BTX-A by locating the muscle responsible for a particular facial line.
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Abstract
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.
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Affiliation(s)
- Dóris Hexsel
- Department of Dermatology, School of Medicine, Universidade de Passo Fundo, Plinio Brasil Milano 476, 90520-000 Porto Alegre, RS, Brazil.
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27
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Sp??sito MMM. New Indications for Botulinum Toxin Type A in Cosmetics: Mouth and Neck. Plast Reconstr Surg 2003; 112:75S-85S. [DOI: 10.1097/00006534-200310001-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Abstract
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.
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Affiliation(s)
- P J Nicolau
- Service de chirurgie plastique, reconstructrice et esthétique et des brûlés, hôpital Rothschild, 33, boulevard de Picpus, 75571 Paris cedex 12, France.
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30
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Park MY, Ahn KY, Jung DS. Botulinum Toxin Type A Treatment for Contouring of the Lower Face. Dermatol Surg 2003; 29:477-483. [DOI: 10.1097/00042728-200305000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Flynn TC, Clark RE. Botulinum toxin type B (MYOBLOC) versus botulinum toxin type A (BOTOX) frontalis study: rate of onset and radius of diffusion. Dermatol Surg 2003; 29:519-22; discussion 522. [PMID: 12752521 DOI: 10.1046/j.1524-4725.2003.29124.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Botulinum toxin types A and B can improve the appearance of facial wrinkles. Differences in the time until onset and the degree of diffusion have been observed anecdotally, but no direct comparative studies have been done. OBJECTIVE To compare the rate of onset and the radius of diffusion of botulinum toxin types A and B in the rhytides of the forehead. METHODS Adults with symmetrical moderate to severe forehead wrinkles at full contracture received botulinum toxin type A (BOTOX; 5 U) on one side of the forehead and type B (MYOBLOC; 500 U) on the other side. Photographs taken at rest and full frontalis contracture were analyzed by computer, and a time-lapse motion picture was created. Radius of diffusion and time until full effect were measured. RESULTS Botulinum toxin type B had a slightly faster onset of action than type A. All patients responded to type B quickly, whereas some had a delayed response to type A. A greater radius of diffusion was consistently observed with botulinum toxin type B, as measured by the greater area of wrinkle reduction at the doses used. CONCLUSIONS In this comparative study of patients with symmetrical forehead wrinkles, botulinum toxin type B produced a greater area of diffusion and a more rapid onset of action than type A.
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Flynn TC, Clark RE. Botulinum Toxin Type B (MYOBLOC) Versus Botulinum Toxin Type A (BOTOX) Frontalis Study. Dermatol Surg 2003; 29:519-522. [DOI: 10.1097/00042728-200305000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Since type A botulinum toxin was first reported for the treatment of masseter muscle hypertrophy in 1994, there have been few reports about cosmetic indications for contouring procedures of the lower face with injection of botulinum toxin type A, and this procedure remains unpredictable. OBJECTIVES This study attempted a quantitative prospective analysis of reduction of masseter muscle hypertrophy after Botox injection, using ultrasound and computerized tomography (CT) scans to analyze the possible use of botulinum toxin type A as a contouring procedure for the lower face. METHODS Forty-five patients consented to the study and received a contouring procedure of the lower face from November 2001 to April 2002. Twenty five to 30 U of Botox per side was injected at five to six points into the prominent portions of the mandibular angle. Serial measurements were made of the thickness of the masseter muscle by ultrasound and CT before the injections and at 1 and 3 months thereafter. A quantitative analysis for the masseter thickness changes was performed on just one patient who underwent all ultrasound and CT scans. Statistical analysis of the masseter thickness change was by two-way and multiple comparison analysis. To evaluate clinical long-term effects, the patient's satisfaction with the procedure and any side effects after injections were monitored during 4 to 10 months of follow-up. RESULTS Among the total of 45 patients, 15 underwent the three ultrasound measurements, and 14 had the three CT measurements. With regard to quantitative analysis of the thickness change to the masseter on both sides of the face according to time points, this was gradually reduced by both the ultrasound and CT measurements during the first 3 months. By ultrasound, the maximum reduction in masseter thickness was seen 1 month after the injections, with a slight increase being observed at 3 months after injection. A continued reduction of masseteric muscle thickness was seen on the CT up to 3 months after injection. In terms of patient satisfaction for up to 10 months of follow-up, the results were as follows: very satisfied, 1; satisfied, 36; slight improvement, 3; no change or dissatisfied, 5. Main local side effects included masticatory difficulties, muscle aching at injection sites, and speech disturbance. However, these side effects were transitory, usually lasting from 1 to 4 weeks after the injections. CONCLUSIONS Preliminary results from this study suggest that an injection of Botox resulted in relatively satisfactory clinical effects, although there was only a short-term follow-up. It is suggested that the use of botulinum toxin type A for contouring of the lower face can be established as a simple, predictable, alternative facial contouring procedure without a prolonged recovery time.
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Affiliation(s)
- Mee Young Park
- Department of Neurology, Yeungnam University Medical Center, Korea
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34
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Abstract
Botulinum toxin type A is frequently used to smooth hyperkinetic lines in the periocular and forehead areas of the upper face, but it has been used less frequently for indications in the lower face and neck. This study was designed to determine whether botulinum toxin treatment of the mouth and neck areas is as clinically successful as the treatment of the upper face. This was a retrospective study of patients who were treated with botulinum toxin type A (Botox) to soften hyperkinetic facial wrinkles. Of 100 patients randomly selected from a single clinical practice, 91 met the inclusion criteria and were divided into two groups for analysis. The 56 patients in group 1 did not receive treatment in the mouth and neck areas, whereas the 35 patients in group 2 were treated at least once in the mouth and neck areas. Patients were surveyed for periods ranging from 7 to 49 months. Most patients in each group had a single botulinum procedure during this period. Both groups of patients had comparable improvement of wrinkles both at the evaluation immediately after the neuromuscular blockade and during follow-up. In comparison with patients whose treatment was confined to the upper face, patients who received global treatment with botulinum toxin type A, including injections in the mouth and neck areas, were injected in more sites per procedure and had more procedures in combination with other therapies. Patient satisfaction with botulinum toxin treatment and outcomes was high in both groups. Botulinum toxin type A is an important tool within the therapeutic spectrum for the treatment of hyperkinetic facial wrinkles, including those in the areas of the mouth and neck.
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Affiliation(s)
- M Matilde M Spósito
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
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35
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Abstract
This article reviews the cosmetic use of botulinum toxin in upper face from both the historic and clinical viewpoints. The published literature and our current experience are outlined. Botulinum toxin type A in the upper face has become an extremely popular cosmetic procedure and is outstandingly safe.
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36
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Affiliation(s)
- Alan Matarasso
- Department of Plastic Surgery, Manhattan Eye, Ear and Throat Hospital, New York, NY 10028, USA
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37
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Abstract
BACKGROUND Botulinum toxin type A (BT-A) is increasingly being used by dermatologists for correction of frown lines. Because objective measurements of clinical results appear to be difficult, several different treatment protocols have been issued purely empirically or on the basis of subjective ratings. OBJECTIVE Our purpose was to establish objective parameters to measure the efficacy of BT-A for correction of hyperkinetic facial lines. METHODS Thirty consecutive patients received BT-A injections for correction of facial expression lines. For each patient a full range of facial expressions was recorded by means of a digital imaging system that allowed identical positioning and illumination before and after treatment. Computer-assisted measurements of brow mobility were used to measure muscular paralysis. RESULTS Reproducibility of serial photographs by means of a digital overlay technique was confirmed by 4 independent observers. Upward mobility of brows was decreased to 35% at 2 weeks and 71% at 12 weeks after treatment. In contrast, inward mobility (frowning) was decreased to 7% at 2 weeks and 57% at 12 weeks. Brow-to-brow distance in repose increased with treatment by 13% and displayed a negative correlation with age. CONCLUSION The effects of BT-A on upper face muscular activity can reproducibly be measured by digital image analysis; this is a valuable tool for clinical documentation and evaluation of treatment efficacy. Onset and offset of the effects of BT-A display a longer time course than previously assumed. Tissue qualities such as elasticity contribute measurably to smoothing facial expression lines after BT-A treatment and correlate inversely with age.
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Affiliation(s)
- M Heckmann
- Department of Dermatology, Ludwig-Maximilians-Universität, Munich, Germany.
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38
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Abstract
This article reviews the cosmetic use of botulinum toxin in upper face from both the historic and clinical viewpoints. The published literature and our current experience are outlined. Botulinum toxin type A in the upper face has become an extremely poplular cosmetic procedure and is outstandingly safe.
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Affiliation(s)
- A Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, Canada.
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