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Gronbeck C, Beltrami EJ, Jain N, Hargis G, Sloan B, Cook BL, Grant-Kels JM, Feng H. Surface anatomy in dermatology: Part II-Impact on perioperative management, procedural technique, and cosmesis. J Am Acad Dermatol 2024; 91:223-240. [PMID: 37429437 DOI: 10.1016/j.jaad.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
This CME series reviews updated Delphi consensus surface anatomy terminology through the lens of common medical and procedural dermatology scenarios, helping to underscore high-yield points that can be readily integrated into clinical practice to support patient care. Part I of the series reviewed the current state of standardized surface anatomy, provided an illustrative review of consensus terminology, highlighted prominent landmarks that can aid in critical diagnoses, and related the importance of precise terminology to principles of medical management. Part II will utilize consensus terminology to heighten recognition of key landmarks in procedural dermatology to support optimal functional and aesthetic outcomes.
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Affiliation(s)
- Christian Gronbeck
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Eric J Beltrami
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Neelesh Jain
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Geneva Hargis
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Brett Sloan
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Bernard L Cook
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Dermatology, the University of Florida College of Medicine, Gainesville, Florida
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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2
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Guignardat JF, Raoul G, Ferri J, Sciote JJ, Nicot R. Systematic review of the histological and functional effects of botulinum toxin A on masticatory muscles: Consideration in dentofacial orthopedics and orthognathic surgery. Ann Anat 2024; 256:152302. [PMID: 39038690 DOI: 10.1016/j.aanat.2024.152302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/31/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Botulinum toxin type A causes muscle paralysis and is widely used in the masticatory muscle for stomatognathic diseases, such as temporomandibular disorder, bruxism, or masseteric hypertrophy. Nonetheless, its muscular effect remains unclear. Better understanding could aid improved use and perhaps new indications, particularly in dentofacial orthopaedics and orthognathic surgery. METHODS This systematic review explored the histologic and functional effects of botulinum toxin in animal and human masticatory muscles and was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The MEDLINE, Web of Science, and Cochrane Library electronic databases were searched for relevant articles. The inclusion criteria were human or animal masticatory muscle analysis after botulinum toxin injection(s) AND histological structural/ultrastructural analysis by optical or electronic microscopy OR functional effect analysis by bite force evaluation (occlusal force analyzer) and muscle activity (electromyography). RESULTS Of an initial 1578 articles, 44 studies were eventually included. Botulinum toxin injection in the masticatory muscle altered its histological structure and functional properties. The human and animal studies revealed ultrastructural change, atrophy, and fiber type modifications of the masticatory muscles after one injection. Botulinum toxin decreased bite force and muscle activity, but recovery was uncertain. CONCLUSIONS Muscle forces applied on the skeleton is a key feature of facial growth. Masticatory muscle paralysis changes mechanical stress on bones, which rebalances the force applied on facial bones. This new balance could benefit dental deformity or surgical relapse. Therefore, botulinum toxin could limit the orthognathic effect of the masticatory muscles in such patients. Given the uncertain recovery, multiple injections should be avoided, and usage should not deviate from established consensus.
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Affiliation(s)
| | - Gwénaël Raoul
- Univ. Lille, Inserm, CHU Lille, U1008 - Advanced Drug Delivery Systems, Department of Oral and Maxillofacial Surgery, F-59000 Lille, France
| | - Joël Ferri
- Univ. Lille, Inserm, CHU Lille, U1008 - Advanced Drug Delivery Systems, Department of Oral and Maxillofacial Surgery, F-59000 Lille, France
| | - James J Sciote
- Department of Orthodontics, Temple University, Philadelphia, Pennsylvania, USA
| | - Romain Nicot
- Univ. Lille, Inserm, CHU Lille, U1008 - Advanced Drug Delivery Systems, Department of Oral and Maxillofacial Surgery, F-59000 Lille, France.
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3
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Gonzalez C, Rengifo J, Macias-Arias P, Duque-Clavijo V, Noreña-Rengifo BD. High-Resolution Ultrasound for Complications of Botulinum Toxin Use: A Case Series and Literature Review. Cureus 2024; 16:e63232. [PMID: 39070521 PMCID: PMC11281804 DOI: 10.7759/cureus.63232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Botulinum toxin (BTX) has revolutionized both aesthetic and therapeutic medicine by selectively inhibiting acetylcholine release at the neuromuscular junction, inducing localized muscle relaxation. However, its use can be associated with various complications. As a diagnostic modality, high-resolution ultrasound can better characterize these complications. Here, we present four clinical cases of complications associated with the application of BTX, along with their corresponding ultrasonographic findings. In this study, cases were selected randomly, irrespective of the timing of BTX injections, to illustrate a spectrum of complications observed in clinical practice. Despite its benefits, BTX can have adverse effects ranging from mild to severe, including aesthetic and functional complications, such as hematoma, ptosis, facial asymmetry, nodules, or pseudoaneurysm. High-resolution ultrasound emerges as a crucial tool in the multidisciplinary management of these complications, allowing for accurate evaluation and effective therapeutic guidance.
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Affiliation(s)
| | - Jaime Rengifo
- Dermatology, Pontifical Bolivarian University, Medellín, COL
| | - Paola Macias-Arias
- Dermatology, Federico Lleras Acosta ESE University Hospital Dermatological Center, Bogota, COL
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Kandari A, Devaprasad BATP, Hernandez-Rivera P, Hernandez IA, Friesen R. Botulinum toxin-A as a treatment option for refractory idiopathic trigeminal neuralgia of the ophthalmic branch: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:e73-e82. [PMID: 38575452 DOI: 10.1016/j.oooo.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 04/06/2024]
Abstract
Trigeminal neuralgia is one of the most common neurological pains affecting the head and neck and is associated with severe, lancinating, electrical pain episodes. The maxillary and mandibular branches are usually affected. The ophthalmic branch is rarely involved and, when present, it requires a comprehensive workup to rule out major conditions. Pharmacotherapy and surgery are the most common treatment options for this condition. Systemic medications may pose a wide range of side effects and effectiveness may decrease over time while surgery has inherent complications. Injectable onabotulinum toxins have been utilized for various applications in medicine and dentistry. There is, however, limited data on their use for the management of refractory trigeminal neuralgia of the ophthalmic branch. We present the case of a 58-year-old male diagnosed with refractory idiopathic trigeminal neuralgia affecting the ophthalmic branch, which was unresponsive to standard care and successfully managed with onabotulinum toxin type A. This treatment should be considered in cases of refractory trigeminal neuralgia prior to surgery. We reviewed the relevant literature concerning the application of Onabotulinum toxin A for managing trigeminal neuralgia of the ophthalmic branch. This case report and review aim to enlighten the application of Onabotulinum toxin A for managing refractory trigeminal neuralgia of the ophthalmic branch. Our case report and review show that Onabotulinum toxin A could be used for managing TN of the ophthalmic branch.
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Affiliation(s)
- Ahammad Kandari
- Department of Oral Medicine and Pathology, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Beena A T Pravin Devaprasad
- Private Practice, The Chennai smiles, Department of Oral and Maxillofacial Surgery, Coonoor 643102, Tamil Nadu, India
| | - Patricia Hernandez-Rivera
- Department of Oral Medicine and Pathology, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ivonne A Hernandez
- Department of Oral Medicine and Pathology, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Reid Friesen
- Department of Oral Medicine and Pathology, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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5
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Li Y, Zheng Q, Lin J, Su X, Zhuang J, Wei Q, Hu J. Mild Allergic Reactions after Botulinum Toxin Injection: A Case Series and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5845. [PMID: 38798928 PMCID: PMC11124596 DOI: 10.1097/gox.0000000000005845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 05/29/2024]
Abstract
Background Botulinum toxin type A (BTA) is becoming more and more prevalent as an injection agent in cosmetic surgery. However, there is an increasing amount of cases reporting unexpected adverse reactions related to BTA injection. BTA can invoke many kinds of hypersensitive reactions, some of which can be delayed-type or even fatal; hence, it is of crucial importance to pay close attention to atypical and early symptoms that may indicate the presence of BTA allergy in patients. Methods In this study, we reported three cases of mild and unexpected BTA-related hypersensitive reaction with a symptom of nonpruritic erythema on the chest that happened after BTA treatment of upper facial wrinkles and proposed several suggestions based on our practical experience and literature review. Results Two patients' symptoms were alleviated spontaneously, and one patient's were alleviated after taking oral corticosteroid. According to our literature review, we believe that these incidences indicate a kind of unreported allergic reaction relevant to botulinum toxin. Conclusions We suggest clinicians consider warily patients' subsequent BTA injection schedule if any suspicious reaction occurs after treatment. We suggest that patients who experience nonpruritic erythema after botulinum toxin injection should suspend subsequent injection plans for at least 3 months to prevent more severe consequences.
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Affiliation(s)
- Yingzi Li
- From the Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Qiaoyuan Zheng
- College of Clinical Medicine, Fudan University, Shanghai, People’s Republic of China
| | - Jinhao Lin
- Xinjiang Second Medical Collage, Karamay, People’s Republic of China
| | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jun Zhuang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qingqian Wei
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jintian Hu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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6
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Musharbash IJ, Chakra RJ. Treatment of Full Eyelid Ptosis Following Botox Injection: A Case Report. Cureus 2024; 16:e55970. [PMID: 38476507 PMCID: PMC10928411 DOI: 10.7759/cureus.55970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/14/2024] Open
Abstract
We report the case of a 24-year-old woman who was referred to one of the authors' clinics after six days of botulinum toxin type A injection to treat dynamic lines on her forehead, glabella complex, and crow's feet area. Her first esthetic injection was done by another colleague elsewhere in a different clinic. Her main complaint was full eyelid ptosis, which started four days after her treatment and continued to aggravate until the time she sought our help. We treated it with another dose of botulinum toxins. The patient started to notice a gradual improvement in her eyelid five days after our injection, so on day 14th, her eyelid was very closely back to normal opening; complete recovery was achieved. Ptosis due to botulinum toxin injection was surprisingly and successfully reversed in our article by a second dose of botulinum toxins. This suggests that this management successfully treats such cases and can deliver a beneficial reversal option for practitioners and their patients. The case report concludes that ptosis should be promptly evaluated and treated through a multimodal approach.
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Affiliation(s)
- Isam J Musharbash
- Dentistry, Dr. Isam Musharbash Clinic, Amman, JOR
- Dentistry, Dr. Rosalie Chakra Clinic, Irbid, JOR
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7
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Quach B, Clevens RA. Complications of Injectables. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:57-63. [PMID: 38307636 DOI: 10.1016/j.cxom.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
The field of non-surgical esthetic procedures has witnessed a significant surge in demand in recent years, with neuromodulators, skin treatments, and dermal fillers contributing significantly to the industry's growth. These procedures have become increasingly popular, reflecting the broader acceptance of esthetic enhancements in society. Neuromodulators play a pivotal role in facial rejuvenation, but they require precise knowledge of facial anatomy to optimize results and prevent complications. They include rare hypersensitivity reactions, local injection reactions, and brow and eyelid ptosis. Dermal fillers, both non-permanent and permanent, are widely used to restore volume and improve facial contours. However, they also carry risks, including bruising, temporary edema, and lumps. Permanent fillers present higher complication rates, and their use should be approached with caution. Vascular occlusion is a rare but severe complication associated with dermal fillers. To mitigate these risks, practitioners must have a comprehensive understanding of their compositions and potential complications. Overall, while non-surgical esthetic procedures offer remarkable results with minimal downtime, the importance of training, anatomic knowledge, and effective complication management cannot be overstated in ensuring patient safety and satisfaction in this evolving field of medicine.
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Affiliation(s)
- Bang Quach
- Facial Plastic & Reconstructive Surgery, 707 West Eau Gallie Boulevard, Melbourne, FL 32935, USA.
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8
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Hedayat K, Ehsani AH. A Phase III Clinical Study of the Efficacy and Safety of Botulinum Toxin Type A (MASPORT) with DYSPORT for the Treatment of Glabellar Lines. Aesthetic Plast Surg 2024; 48:324-332. [PMID: 38233684 DOI: 10.1007/s00266-023-03766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/17/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Botulinum toxin type A is a widely used treatment of facial wrinkles. The objective of this study was to compare the efficacy and safety of a new botulinum toxin type A (Masport [abobotulinum toxin A], MasoonDarou Co) with DYSPORT® for the treatment of glabellar lines. METHODS 262 subjects with moderate-to-severe glabellar lines received either a fixed dose of 50 units of MASPORT® or DYSPORT® (Ipsen Company, England). Subjects were followed up at 14, 30, 60, 90 and 120 days after injection. Efficacy was assessed by investigator at maximum frown and rest and also by Subject Global Assessment of Change (SGA). The responders were defined as persons with +2 grade improvement from baseline for both investigator and patient assessment. The occurrence and duration of adverse effects were recorded up throughout the study. RESULTS According to the investigator evaluations, the responder rate at maximum frown were 94.5% for MASPORT and 95.6% for DYSPORT group on day 30 and at rest were 85.45% and 85.68% for MASPORT and DYSPORT group, respectively. According to the subject self-assessment, the proportion of responders in MASPORT group at day 30 was 95.28% versus 97.04% for DYSPORT group. No serious drug related adverse effect was recorded in either study groups, and the rates of adverse effects were similar for both groups. CONCLUSION Abobotulinum toxin A [MASPORT] is equally safe and effective as commercial product [DYSPORT] for the treatment of glabellar lines with the dose of 50 units, up to 120 days. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Amir H Ehsani
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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9
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Punga AR, Alimohammadi M, Liik M. Keeping up appearances: Don't frown upon the effects of botulinum toxin injections in facial muscles. Clin Neurophysiol Pract 2023; 8:169-173. [PMID: 37681120 PMCID: PMC10480586 DOI: 10.1016/j.cnp.2023.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/04/2023] [Accepted: 05/18/2023] [Indexed: 09/09/2023] Open
Abstract
Aesthetic use of low doses of Botulinum toxin (BoNT) injections into the facial muscles has become a leading non-surgical aesthetic treatment worldwide to reduce facial wrinkles, including glabellar lines, forehead lines, and periorbital wrinkles. Within these aesthetic applications, BoNT injections intend to reduce and prevent wrinkles, and the recommended usage of 2 years is often exceeded, which may result in atrophy of the injected muscles. The long-term effects of BoNT injections in the facial muscles and the evidence of diffusion of BoNT to surrounding muscles are obvious pitfalls and challenges for clinical neurophysiologists in differential diagnosing neuromuscular transmission failures. Also, this is further complicated by the risk of developing side effects upon permanent chemical denervation of facial muscles, with less possibility for reinnervation. This review summarizes the known long-term effects of BoNT over time in different facial muscles and the use of objective electrophysiological measures to evaluate these. A better understanding of the long-term effects of BoNT is essential to avoid misdiagnosing other neuromuscular disorders.
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Affiliation(s)
- Anna Rostedt Punga
- Department of Medical Sciences, Clinical Neurophysiology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Mohammad Alimohammadi
- Department of Medical Sciences, Dermatology and Venerology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Maarika Liik
- Department of Medical Sciences, Clinical Neurophysiology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
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10
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Rahman E, Mosahebi A, Carruthers JDA, Carruthers A. The Efficacy and Duration of Onabotulinum Toxin A in Improving Upper Facial Expression Lines With 64-Unit Dose Optimization: A Systematic Review and Meta-Analysis With Trial Sequential Analysis of the Randomized Controlled Trials. Aesthet Surg J 2023; 43:215-229. [PMID: 36099476 DOI: 10.1093/asj/sjac253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Onabotulinumtoxin A (Onabot A) was the first treatment to be approved for aesthetic indications, namely glabellar lines (GLs), crow's feet lines (CFLs), and forehead lines (FHLs), with a cumulative dose of 64 U. OBJECTIVES The aim of this study was to conduct a meta-analysis to combine the available data for approved doses for GLs, CFLs, and FHLs to explore the effect and duration of simultaneous treatment with Onabot A. METHODS PubMed/MEDLINE, Embase, and other national clinical trial registries were searched for randomized controlled trials from January 2010 to July 2022. The meta-analysis, trial sequential analysis, and investigator-assessed time to return to nonresponder status in GLs, CFLs, and FHLs following Onabot A were plotted to elicit a cumulative dose-adjusted response curve based on Kaplan-Meier analysis with a log-rank test. RESULTS Fourteen randomized controlled trials were eligible for quantitative analysis. A total of 8369 subjects were recruited across the trials. The meta-analysis results show that Onabot A is very effective in reducing moderate to severe GLs, CFLs, and FHLs. The cumulative Z-curve for GLs, CFLs, and FHLs also exceeds the required information size (RIS). Kaplan-Meier analysis with a log-rank test demonstrated that simultaneous treatment of GLs, CFLs, and FHLs requires 182 days (95% CI = 179, 215 days) (P < 0.00002) to return to nonresponder status. CONCLUSIONS Treatment of the upper facial expression lines with Onabot A is effective, and the approved cumulative dose of 64 U gives longer-lasting effects. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Eqram Rahman
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK and an evidence-based medicine editor of Aesthetic Surgery Journal
| | - Afshin Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK and a research section editor of Aesthetic Surgery Journal
| | - Jean D A Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - Alastair Carruthers
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
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11
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Hong SO. Cosmetic Treatment Using Botulinum Toxin in the Oral and Maxillofacial Area: A Narrative Review of Esthetic Techniques. Toxins (Basel) 2023; 15:toxins15020082. [PMID: 36828397 PMCID: PMC9964918 DOI: 10.3390/toxins15020082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
Botulinum toxin (BoNT) is an anaerobic rod-shaped-neurotoxin produced by Clostridium botulinum, that has both therapeutic and lethal applications. BoNT injection is the most popular cosmetic procedure worldwide with various applications. Patients with dynamic wrinkles in areas such as the glabella, forehead, peri-orbital lines, nasal rhytides, and perioral rhytides are indicated. Excessive contraction of muscles or hyperactivity of specific muscles such as bulky masseters, cobble stone chins, gummy smiles, asymmetric smiles, and depressed mouth corners can achieve esthetic results by targeting the precise muscles. Patients with hypertrophic submandibular glands and parotid glands can also benefit esthetically. There are several FDA-approved BoNTs (obabotuli-numtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, letibotulinumtoxinA, prabotulinumtox-inA, daxibotulinumtoxinA, rimbotulinumtoxinB) and novel BoNTs on the market. This paper is a narrative review of the consensus statements of expert practitioners and various literature on the injection points and techniques, highlighting both the Asian and Caucasian population separately. This paper can serve as a practical illustrative guide and reference for optimal, safe injection areas and effective doses for application of BoNT in the face and oral and maxillofacial area. The history of BoNT indications, contraindications, and complications, and the merits of ultrasonography (US)-assisted injections are also discussed.
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Affiliation(s)
- Sung Ok Hong
- Department of Oral and Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
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12
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Bonińska K. Ophthalmic Complications after Needle-Based Medical Aesthetic Procedures: A Narrative Review. J Clin Med 2022; 12:jcm12010313. [PMID: 36615113 PMCID: PMC9821034 DOI: 10.3390/jcm12010313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/11/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This study aimed to discuss common complications of medical aesthetic treatments, which require ophthalmological intervention. METHODS This literature study evaluated published journal articles (clinical trials or scientific reviews) that were extracted from electronic databases (MEDLINE and PubMed) and reference lists of related articles. Only articles available in English were considered for this review. RESULTS Unskillful interference in the eye area can cause severe, irreversible complications, including blindness. This is a constant risk because of anatomical deviations, and retrograde blood flow. CONCLUSIONS Accurate knowledge of anatomy, especially the vascular anatomy of high-risk sites, and the understanding of the depth and plane of injection, and various injection techniques minimize the risk of these complications.
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Affiliation(s)
- Karolina Bonińska
- Miejskie Centrum Medyczne Jonscher, ul. Milionowa 14, 93-113 Łódź, Poland
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13
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Abstract
Drooping of the upper eyelid margin, aka blepharoptosis or "ptosis", is common. Whether the ptosis is severe or mild, congenital or acquired, aponeurotic or neuropathic or myopathic, proper management always begins with a detailed history and evaluation of the patient. The information gathered will direct the surgeon in choosing the technique most likely to give the best result. This article will briefly review common causes of ptosis, the evaluation of the ptosis patient as well as the two most common types of surgical intervention.
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Affiliation(s)
- Ron Pelton
- Surgery, Penrose-St Francis Health Services, Colorado Springs, United States
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14
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PrabotulinumtoxinA for Treatment of Millennials With Moderate to Severe Glabellar Lines: Post Hoc Analyses of the Phase III Clinical Study Data. Dermatol Surg 2022; 48:664-669. [PMID: 35616616 PMCID: PMC9154296 DOI: 10.1097/dss.0000000000003456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Supplemental Digital Content is Available in the Text. The use of esthetic products by millennials is increasing, yet published clinical trial data in this population are limited.
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Zargaran D, Zoller F, Zargaran A, Rahman E, Woollard A, Weyrich T, Mosahebi A. Complications of Cosmetic Botulinum Toxin A Injections to the Upper Face: A Systematic Review and Meta-Analysis. Aesthet Surg J 2022; 42:NP327-NP336. [PMID: 35178552 PMCID: PMC9005453 DOI: 10.1093/asj/sjac036] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Botulinum toxin A (BoNT-A) injections are a popular non-surgical procedure for facial rejuvenation. Its increase in popularity and utilization is met with limited regulations, potentially posing a significant risk to patient safety and public health. Objectives The authors sought to assess the safety profile of cosmetic glabellar and forehead BoNT-A injections and evaluate BoNT-A type on complication rate. Methods A systematic search of MEDLINE and EMBASE was performed for studies reporting complications after cosmetic BoNT-A in the glabellar or in the forehead region in the glabellar or in the forehead region. A random effects meta-analysis was carried out to assess complication rate. Where there were sufficient randomized-controlled trials, a network meta-analysis was performed. Results Of 556 identified articles, 24 were included in the final quantitative analysis, with 4268 BoNT-A injection sessions and 1234 placebos. Frequently observed treatment-related complications in the BoNT-A intervention group included headache, local skin reactions, and facial neuromuscular symptoms. The overall BoNT-A complication rate was 16%. The odds ratio of developing complications from abobotulinum toxin injections compared with placebo was 1.62 (1.15, 2.27; P > 0.05) and that from onabotulinum toxin injections compared with placebo was 1.34 (0.52, 3.48; P > 0.05). In 30% of the studies, the injectors were doctors, whereas the training status of the practitioner was not reported in the remaining 70%. Conclusions Cosmetic BoNT-A injections in the glabellar and forehead region appear to be safe, and most complications are mild and transient. Nevertheless, the literature demonstrates heterogeneous reporting of complications and a lack of consistency of the definition of treatment-related complications. Level of Evidence: 2
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Affiliation(s)
- David Zargaran
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
| | - Florence Zoller
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
| | - Alexander Zargaran
- Department of Plastic Surgery, Chelsea and Westminster Hospital, London, UK
| | - Eqram Rahman
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
| | - Alexander Woollard
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
| | - Tim Weyrich
- Department of Computer Science, University College London, UK
| | - Afshin Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
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Cavallini M, Papagni M, Lazzari R, Santorelli A. Botulinum Toxin Type A: Adverse Events and Management. Facial Plast Surg 2022; 38:111-115. [PMID: 35130564 DOI: 10.1055/s-0041-1741531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Aesthetic medicine is witnessing an increasing exploitation of all the procedures. The demand has never been higher than it is today. The number of practitioners is also increasing year by year. Consequently complications and other kinds of related troubles and procedures are also rising. Never like today is fundamental, in case of troubles, how to properly manage with the most frequent issues. In aesthetic medicine field, botulinum toxin procedures are the safest. Lot of patients are worried about botulinum toxin despite the available scientific literature. Rare short-term complications are observed. In the most of cases, nothing severe occurs if the international recommendations and the most recent guidelines are closely followed, the majority of them are injection related. This study is a review of rare or common problems that can occur and how to manage or solve the situations.
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Affiliation(s)
- Maurizio Cavallini
- Operative Unit of Dermatology and Dermato-Surgery, Centro Diagnostico Italiano Hospital, Milan, Italy
| | - Marco Papagni
- Italian Scientific Society of Aesthetic Medicine, Milan, Italy
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Borba A, Matayoshi S, Rodrigues M. Avoiding Complications on the Upper Face Treatment With Botulinum Toxin: A Practical Guide. Aesthetic Plast Surg 2022; 46:385-394. [PMID: 34341857 PMCID: PMC8328485 DOI: 10.1007/s00266-021-02483-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Currently, botulinum toxin (BoNT) injections are the most commonly performed non-invasive procedure for rejuvenation on the upper face. The therapeutic use of botulinum toxin has generally been safe and well tolerated. Adverse effects are considered mild, transient, and self-limited. However, as with all other injectable procedures, this one is also susceptible to adverse events and complications. When the safety zones are respected, the chance of any of these complications is practically null. Thus, this review aims to describe the main complications of treatment with BoNT on the upper face and to present a practical guide based on current evidence on how to avoid them. METHODS The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. RESULTS The main complications secondary to BoNT injections on the upper face are: ptosis of eyelid or eyebrow, eyebrow asymmetry, diplopia, Lakeophthalmos, Palpebral ectropion, and prominence of the palpebral bags. To avoid such complications, it is necessary to have knowledge of the anatomy of this region and adequate and individualized planning based on the existing patterns of the frontalis muscle, glabella, and crow's feet. This review presents the specificities of each of these regions and practical suggestions to obtain satisfactory results, avoiding complications. CONCLUSION Particularly on the upper face treatment with BoNT offers predictable results, has few adverse effects, and is associated with high patient satisfaction. However, it is suggested that the commented parameters and safety areas be incorporated into daily practice so that the possibilities of complications are minimized as much as possible. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- André Borba
- Department of Ophthalmology, Division of Oculoplastic, University of São Paulo Medical School, 255 Eneas Aguiar Street Office 4079, São Paulo, Zipcode 05403000 Brazil
| | - Suzana Matayoshi
- Department of Ophthalmology, Division of Oculoplastic, University of São Paulo Medical School, 255 Eneas Aguiar Street Office 4079, São Paulo, Zipcode 05403000 Brazil
| | - Matheus Rodrigues
- Department of Medicine, Division of Dermatology, Mato Grosso State University, Tancredo Neves Avenue 1095, Cáceres, Mato Grosso 78200000 Brazil
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18
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Li SL, Wang YQ, Song T, Hu JT. Microdrop Botox Technique for Dynamic Wrinkles in the Upper Face. Aesthetic Plast Surg 2022; 46:2625-2626. [PMID: 35089387 DOI: 10.1007/s00266-022-02789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/01/2022]
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19
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Mullaaziz D, Kaptanoğlu A. Is botulinum toxin a cause or a cure for headaches? J Cosmet Dermatol 2021; 21:595-599. [PMID: 34897957 DOI: 10.1111/jocd.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/22/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Botulinum toxin is used in the treatment of headache as well as cosmetic indications. In recent years, headache cases have been encountered after botulinum toxin injections for cosmetic purposes. However, no clinical studies have been conducted on this seemingly paradoxical issue. OBJECTIVE In our study, the aim was to evaluate the frequency of occurrence of headache and its clinical features in patients who had undergone botulinum toxin application for cosmetic purposes. METHODS A total of 186 patients who were treated with onabotulinum toxin A for cosmetic purposes in our clinic between January 2019 and January 2021 were retrospectively screened, and the clinical and demographic characteristics of the patients who reported headache complaints were examined. RESULTS Headache was reported in 19 (10.2%) of the 186 patients included in the study. Of the 19 patients who reported headaches, 17 (89.4%) had the onset of the complaint within the first 24 h, the complaint was resolved within the first 3 days in 16 (84.2%), and 12 (63.1%) reported spontaneous regression without the need for painkillers. The rate of development of headache complaints after the procedure was found to be statistically significantly higher in patients diagnosed with hypertension (p = 0.000) and patients treated for bunny line (p = 0.016). Ten patients (52.6%) described constant, 17 patients (89.5%) had diffuse, and 11 patients (57.9%) had throbbing-type headaches. CONCLUSION Botulinum toxin application causes diffuse, constant, throbbing-type headaches that start in the early period and ends within a short time without the need for treatment.
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Affiliation(s)
- Didem Mullaaziz
- Department of Dermatology and Venereology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Aslı Kaptanoğlu
- Department of Dermatology and Venereology, Marmara University Faculty of Medicine, İstanbul, Turkey
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20
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Neurocosmetics in Skincare—The Fascinating World of Skin–Brain Connection: A Review to Explore Ingredients, Commercial Products for Skin Aging, and Cosmetic Regulation. COSMETICS 2021. [DOI: 10.3390/cosmetics8030066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The “modern” cosmetology industry is focusing on research devoted to discovering novel neurocosmetic functional ingredients that could improve the interactions between the skin and the nervous system. Many cosmetic companies have started to formulate neurocosmetic products that exhibit their activity on the cutaneous nervous system by affecting the skin’s neuromediators through different mechanisms of action. This review aims to clarify the definition of neurocosmetics, and to describe the features of some functional ingredients and products available on the market, with a look at the regulatory aspect. The attention is devoted to neurocosmetic ingredients for combating skin stress, explaining the stress pathways, which are also correlated with skin aging. “Neuro-relaxing” anti-aging ingredients derived from plant extracts and neurocosmetic strategies to combat inflammatory responses related to skin stress are presented. Afterwards, the molecular basis of sensitive skin and the suitable neurocosmetic ingredients to improve this problem are discussed. With the aim of presenting the major application of Botox-like ingredients as the first neurocosmetics on the market, skin aging is also introduced, and its theory is presented. To confirm the efficacy of the cosmetic products on the market, the concept of cosmetic claims is discussed.
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21
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Zargaran D, Zoller FE, Zargaran A, Mosahebi A. Complications of facial cosmetic botulinum toxin A injection: analysis of the UK Medicines & Healthcare Products Regulatory Agency registry and literature review. J Plast Reconstr Aesthet Surg 2021; 75:392-401. [PMID: 34456155 DOI: 10.1016/j.bjps.2021.05.074] [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] [Received: 02/11/2021] [Accepted: 05/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Botulinum toxin A (BoNT-A) injection is one of the most frequently undertaken procedures in aesthetic medicine. The Medicines & Healthcare products Regulatory Agency (MHRA) is the government body in the United Kingdom (UK) mandated to ensure that the provision and administration of medicines is safe. We analyzed adverse events of facial cosmetic BoNT-A injections reported to the MHRA and assessed whether the incidence of reported adverse events in this government registry is comparable to published retrospective and prospective studies. METHODS A freedom of information (FOI) request was submitted to the MHRA to obtain recorded complications of BoNT- A. Complications reported to the MHRA between 1991 and 2020 were analyzed. Only cases with BoNT-A where the indication was specified as for facial cosmetics were included in the analysis. Additionally, the literature was reviewed on adverse events of facial cosmetic BoNT- A injections, and a statistical meta-analysis of complication rates was carried out. RESULTS A total of 188 adverse events of aesthetic BoNT-A injections were reported to the MHRA. The literature search resulted in 30 studies and a total of 17,352 injection sessions, where the complication rate was 16% (95% CI = 8% to 25%). Frequent adverse events included localized skin reactions such as bruising with an incidence of 5% (95% CI = 3% to 7%), headache in 3% (95% CI = from 1% to 5% ), and facial paresis in 2% (95% CI = 1% to 3%) of injection sessions. CONCLUSIONS This is the first paper to obtain and evaluate data on adverse events of BoNT-A from the MHRA. An estimate of the likely complication rate of aesthetic BoNT-A in the UK, according to the MHRA database, is significantly lower than the rate recorded from our meta-analysis of the international literature. This suggests that the MHRA may be underestimating the adverse events of aesthetic BoNT-A treatment, which would have implications for patient safety and informed consent. Therefore, legislative changes may be required to ensure more robust reporting of aesthetic BoNT-A in the UK.
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Affiliation(s)
- David Zargaran
- Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG.
| | - Florence E Zoller
- Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG
| | - Alexander Zargaran
- Department of Medicine, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Afshin Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG
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