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Pucchio AA, Quinn MP. Inferior Oblique Palsy After Cosmetic Botox Injection for Glabellar Lines: A Case Report. J Neuroophthalmol 2024; 44:e427-e428. [PMID: 36857138 DOI: 10.1097/wno.0000000000001816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Aidan A Pucchio
- School of Medicine (AP), Queen's University, Kingston, Canada; and Department of Ophthalmology (MPQ), Queen's University, Kingston, Canada
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2
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Lazar M, De La Garza H, Vashi NA. Side effect profile and expectations with sclerotherapy across Fitzpatrick skin types. J Am Acad Dermatol 2024:S0190-9622(24)02545-3. [PMID: 39069262 DOI: 10.1016/j.jaad.2024.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/24/2024] [Accepted: 06/09/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Michelle Lazar
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Henriette De La Garza
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
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3
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Farashi F, Ghoncheh M, Ghasemian Moghaddam MR, Soroosh Z. Evaluation of people's satisfaction with botulinum toxin injection for facial rejuvenation based on age. J Cosmet Dermatol 2024; 23:2380-2385. [PMID: 38500014 DOI: 10.1111/jocd.16289] [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: 02/04/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Botulinum toxin type A injections are widely used for facial rejuvenation; however, research on people's satisfaction based on age is limited. This study assessed patient satisfaction with botulinum toxin injections for forehead, glabella, and periorbital wrinkles in Birjand, Iran. PATIENTS AND METHODS The current study examined 150 people aged 18 to 70 who requested botulinum toxin type A injection in the forehead, glabellar, and periorbital area in 2022, who visited the plastic surgery clinic and the authors' offices in Birjand City. To check patients' satisfaction, Facial Lines Treatment Satisfaction (FTS) Questionnaire was used. One month after botulinum toxin type A injection, this questionnaire was completed by the clients. Also, the brand type of botulinum toxin, age, gender of the clients, frequency of visits, and complications were collected in the relevant checklist. RESULTS The average age of participants was 38.8 ± 8.29 years with 73.3% being female. Masport botulinum toxin (MasoonDarou Pharmaceutical Company, I.R. Iran) was the most frequently used botulinum toxin brand at 66.7%. The average satisfaction score with the result of botulinum toxin injection in the forehead/glabella and periorbital area, in the age group under 30 years and 30-40 years, was significantly higher than in the age group over 50 years. The same indicators in the age group under 30 years old were significantly higher than in the 30-40 age group (p < 0.05). Furthermore, brand selection and the number of visits (first-time vs. second-time clients) demonstrated varied outcomes in satisfaction. There was a total of 62.7% side effects postinjection, with varying degrees of severity.
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Affiliation(s)
| | - Mahdi Ghoncheh
- Department of Surgery, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Zahra Soroosh
- Department of Family and Community Medicine, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
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Whiteley MS, Davey SE, Placzek GM. The access and invasiveness-based classification of medical procedures to clarify non-invasive from different forms of minimally invasive and open surgery. J Minim Access Surg 2024; 20:301-310. [PMID: 39047678 PMCID: PMC11354956 DOI: 10.4103/jmas.jmas_240_23] [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: 08/06/2023] [Revised: 10/09/2023] [Accepted: 11/20/2023] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The rapid development of less invasive and traumatic medical procedures has resulted in a mixture of terms used to describe them, without any agreed definition for each. This is confusing to both medical professionals and patients and can lead to unrealistic patient expectations. The aim of this article is to show the current confused nomenclature and to suggest a new, simple classification based on access and invasiveness (AI) that can be applied to any medical procedure. METHODS We performed an online search for definitions for 'non-invasive', 'non-surgical', 'minimally invasive', 'minimal access', 'pinhole' and 'keyhole'. We then searched peer-reviewed medical papers (PRMPs) and patient facing websites (PFWs) for the following index procedures, to see which of the original 6 terms were used to describe them: transvaginal ultrasound, sclerotherapy for leg veins, botulinum toxin injections, dermal fillers, endovenous thermal ablation and laparoscopic gall bladder removal. RESULTS We found a wide variety of definitions for each of the initial terms. In both PRMPs and PFWs, there were a variety of terms used for each index procedure (i.e.: transvaginal ultrasound, injections of sclerotherapy, botulinum toxin or dermal fillers being both 'non-invasive' and 'minimally invasive') showing confusion in the classification of procedures. We suggested the 'AI classification' based on access (A - none, B - natural orifice or C - penetrating an epithelial surface) and invasiveness (1 - none, 2 - surface damage, 3 - needle = <21G, 4 - cannula >21G but not a surgical trocar, 5 - surgical trocars or small incisions and 6 - incisions). CONCLUSION The current confusion of terms used for procedures that are less invasive than the open surgical alternatives leads to confusion and possible false patient expectations. We have proposed an AI classification that can be applied easily to any procedure, giving a uniform classification for medical professionals and patients to understand.
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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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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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Xie Y, Yang X, Liang H, Bo H, Lu J, Guo Q, Li L, Moon HJ, Li Q. A Phase-III Noninferiority, Randomized Controlled Trial of Letibotulinum Toxin A for the Improvement of Moderate-to-Severe Glabellar Wrinkles in China. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5525. [PMID: 38204875 PMCID: PMC10781123 DOI: 10.1097/gox.0000000000005525] [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: 06/21/2023] [Accepted: 11/02/2023] [Indexed: 01/12/2024]
Abstract
Background Letibotulinum toxin A has an established efficacy and safety profile for aesthetic treatment of glabellar wrinkles. This study was conducted to demonstrate the noninferiority of letibotulinum toxin A versus onabotulinum toxin A in improving the appearance of moderate-to-severe glabellar wrinkles in Chinese patients. Methods This phase-III multicenter, randomized, parallel positive control, double-blinded study compared the efficacy and safety of letibotulinum toxin A and onabotulinum toxin A. Eligible participants were randomized 3:1 to receive 20 U of letibotulinum toxin A or onabotulinum toxin A and were observed for 16 weeks postinjection. The primary endpoint was noninferiority in the proportion of study participants receiving a score of 0 or 1 for glabellar wrinkles on a four-point photographic evaluation scale, as assessed by an institution evaluator at maximum frown at week 4. Secondary endpoints included assessments at rest, photographic assessment of efficacy, and subjective self-assessment of the study participants. Results The proportion of participants (N = 500) receiving a score of 0 or 1 at maximum frown by the institution evaluator at week 4 was 88.49% for letibotulinum toxin A and 87.39% for onabotulinum toxin A (difference, 1.10%; 95% confidence interval, -5.02 to 8.82; P = 0.7469). No significant differences were observed between the treatments for secondary efficacy or safety endpoints. Participants' self-assessment and satisfaction tended to be higher for letibotulinum toxin A than onabotulinum toxin A. Conclusion Letibotulinum toxin A is noninferior to onabotulinum toxin A in improving the appearance of moderate-to-severe glabellar wrinkles in Chinese patients.
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Affiliation(s)
- Yun Xie
- From the Department of Plastic and Reconstructive Surgery, Ninth People’s Hospital Affiliated Medical College, Shanghai Jiao Tong University, Shanghai, China
| | - Xiumin Yang
- Department of Dermatovenereology, Capital Medical University, Beijing Tongren Hospital, Beijing, China
| | - Hong Liang
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongliang Bo
- Department of Burns and Plastic Surgery, First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, China
| | - Jianyun Lu
- Department of Dermatology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Qing Guo
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Qingfeng Li
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Zargaran D, Zargaran A, Terranova T, Khaledi H, Robinson A, Davies J, Weyrich T, Mosahebi A. Profiling UK injectable aesthetic practitioners: A national cohort analysis. J Plast Reconstr Aesthet Surg 2023; 86:150-154. [PMID: 37717299 DOI: 10.1016/j.bjps.2023.06.057] [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: 03/02/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION The United Kingdom (UK) injectables market has been growing rapidly with a lack of robust regulation and to date, no information regarding the profile of practitioners has been published. AIM We aim to provide a descriptive and qualitative analysis of the advertised practitioners in the United Kingdom. METHODS We performed a systematic search using the internet search engine Google to perform a qualitative descriptive analysis of aesthetic practitioners in the UK. For each contiguous country in the UK: England, Scotland, and Wales, five searches were performed. The list of practitioners was then cross-referenced with professional regulatory bodies, with extraction of registration number, date of registration and presence or absence from the Specialist Register or General Practitioner Register. RESULTS 3000 websites were visited and evaluated. 1224 independent clinics with 4405 practitioners were identified. 738 were identified as those in business support functions and the remaining 3667 practitioners were undertaking injectable practice. The profile of professions were doctors 32%, nurses 13%, dentists 24% and dental nurses 8%. Of the 1163 doctors identified 481 were on the specialist register (41%) and 219 were on the GP register (19%). 27 specialties were represented in this cohort analysis. Plastic Surgery formed the majority of those who were on the specialist register at 37%, followed by Dermatology at 18%. CONCLUSION This paper is the first to describe the range of practitioners, their professional backgrounds and experience who perform non-surgical aesthetic interventions. The range of backgrounds may have an impact on the potential risks to patients and will be an important consideration in proposed legislation to introduce licensing to the industry.
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Affiliation(s)
- David Zargaran
- Department of Plastic Surgery, University College London, London, UK.
| | | | - Tom Terranova
- QUAD A - American Association for the Accreditation of Ambulatory Plastic Surgery Facilities (AAAAPSF), IL, USA
| | - Helia Khaledi
- Department of Plastic Surgery, University College London, London, UK
| | | | - Julie Davies
- UCL Global Business School for Health, University College London, London, UK
| | - Tim Weyrich
- Department of Computer Science, University College London, London, UK; Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Germany
| | - Afshin Mosahebi
- Department of Plastic Surgery, University College London, London, UK
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Zargaran D, Zargaran A, Sousi S, Knight D, Cook H, Woollard A, Davies J, Weyrich T, Mosahebi A. Quantitative and qualitative analysis of individual experiences post botulinum toxin injection - United Kingdom Survey. SKIN HEALTH AND DISEASE 2023; 3:e265. [PMID: 37799369 PMCID: PMC10549845 DOI: 10.1002/ski2.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/29/2023] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
Introduction In the United Kingdom (UK), complications that arise following the administration of Botulinum Toxin are reported to the Medicines and Health Regulatory Agency (MHRA) via the Yellow Card Reporting Scheme. Over the past decade, there has been a significant increase in the number of non-surgical aesthetic procedures. Concerns have been raised that the MHRA is not fully capturing complications in terms of volume and impact on patients. Aim This novel study explores the lived experiences of individuals who have experienced an adverse event following administration of Botulinum Toxin for aesthetic purposes. Using a combination of qualitative and quantitative methodologies, this analysis evaluates data relating to long-lasting physical, psychological, emotional, and financial sequelae of complications arising from cosmetic Botulinum Toxin injections in the UK. Methods A mixed method, qualitative and quantitative approach was adopted to gain comprehensive insights into patients' experiences. A focus group which comprised patient representatives, psychologists, and researchers reached a consensus on a 17-question survey which was disseminated via social media channels. Deductive thematic analysis was used to analyse coded themes. Furthermore, for secondary analysis, sentiment analysis was used computationally as an innovative approach to identify and categorise free text responses associated with sentiments using natural language processing (NLP). Results In the study, 655 responses were received, with 287 (44%) of respondents completing all questions. The mean age of respondents was 42.6 years old. 94.1% of respondents identified as female. In the sample, 79% of respondents reported an adverse event following their procedure, with the most common event being reported as 'anxiety'. Findings revealed that 69% of respondents reported long-lasting adverse effects. From the responses, 68.4% reported not having recovered physically, 63.5% of respondents stated that they had not recovered emotionally from complications, and 61.7% said that they have not recovered psychologically. In addition, 84% of respondents stated that they do not know who regulates the aesthetics industry. Furthermore, 92% of participants reported that their clinic or practitioner did not inform them about the Yellow Card Reporting Scheme. The sentiment analysis using the AFINN Lexicon yielded adjusted scores ranging from -3 to +2, with a mean value of -1.58. Conclusion This is the largest survey in the UK completed by patients who experienced an adverse outcome following the aesthetic administration of Botulinum Toxin. Our study highlights the extent of the challenges faced by patients who experience an adverse event from physical, emotional, psychological, and financial perspectives. The lack of awareness of MHRA reporting structures and the lack of regulation within the UK's cosmetic injectables sector represent a significant public health challenge.
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Affiliation(s)
- David Zargaran
- Department of Plastic SurgeryUniversity College LondonLondonUK
- British Association of Aesthetic Plastic Surgeons (BAAPS) AcademyLondonUK
| | | | - Sara Sousi
- Department of Plastic SurgeryUniversity College LondonLondonUK
| | | | - Hannah Cook
- Department of Plastic SurgeryUniversity College LondonLondonUK
| | - Alexander Woollard
- Department of Plastic SurgeryUniversity College LondonLondonUK
- Cosmetic Practice Standards Authority (CPSA)LondonUK
| | - Julie Davies
- UCL Global Business School for HealthUniversity College LondonLondonUK
| | - Tim Weyrich
- Department of Computer ScienceUniversity College LondonLondonUK
- Friedrich‐Alexander University (FAU) Erlangen‐NürnbergErlangenGermany
| | - Afshin Mosahebi
- Department of Plastic SurgeryUniversity College LondonLondonUK
- British Association of Aesthetic Plastic Surgeons (BAAPS) AcademyLondonUK
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Rossiter M, Zargaran D, Zargaran A, Terranova T, Rosenblatt W, Hamilton S, Mosahebi A. UK esthetics associations: A robust safety net or credibility accessories? J Plast Reconstr Aesthet Surg 2023; 84:521-530. [PMID: 37421675 DOI: 10.1016/j.bjps.2023.05.033] [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: 04/09/2023] [Accepted: 05/15/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Currently, safe practice in the UK esthetics industry is largely reliant on self-regulatory bodies. If these bodies do not maintain high standards of safety guidelines and properly accredit practitioners, patient safety may be at risk. To our knowledge, no studies have addressed cosmetic self-regulatory bodies and their websites on Google, the most commonly used information source. This study aimed to map self-regulatory bodies on Google and evaluate their roles in the current UK esthetics industry. METHOD We conducted a systematic search of Google Search results using eight search terms. The first 100 search results were screened against our eligibility criteria. We searched each website of a self-regulatory body for their requirements to join registers, membership fees, and features listed on the UK government's criteria for an effective self-regulatory body. RESULTS We identified 22 self-regulating bodies for the UK esthetics industry. Only 15% of registers required an in-person assessment of cosmetic skills to qualify for membership. Of the self-regulatory bodies, 65% did not set clear standards and guidelines for practice. No qualifications were required by 14% of surgical and 31% of non-surgical bodies. The mean membership fee was £331. CONCLUSION This study uncovered important information about the self-regulation of the esthetics industry in the UK. A significant majority of self-regulatory bodies did not meet best practices, potentially putting patients at risk. We recommend further studies screening a higher number of pages in a Google Search to scope all other existing self-regulatory bodies, due to the creation of Google "filter bubbles."
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Affiliation(s)
- M Rossiter
- University College London, London, UK; Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.
| | - D Zargaran
- University College London, London, UK; Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - A Zargaran
- University College London, London, UK; Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | | | | | - S Hamilton
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - A Mosahebi
- University College London, London, UK; Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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Zargaran D, Zargaran A, Sousi S, Woollard A, Davies J, Weyrich T, Mosahebi A. Cosmetic business mechanics in London: A cross-sectional analysis and audit of ASA compliance. J Cosmet Dermatol 2023; 22:2520-2527. [PMID: 37017936 DOI: 10.1111/jocd.15750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION The proliferation of providers and practitioners of cosmetic botulinum toxin and dermal filler has profound public health implications. The Advertising Standards Authority (ASA) regulates the use of advertising materials in the United Kingdom and prohibits the promotion of prescription-only medicines. AIMS We aim to perform a cross-sectional analysis of the practitioners in London, UK to evaluate the distribution of clinics within Greater London, prices advertised for interventions, and compliance with the ASA code. We also aim to identify whether there are any differences in cost of botulinum toxin or dermal filler between the boroughs. METHODS Between December 2021 and January 2022, we performed a systematic search using the internet search engine Google. Five searches were performed (1) [london] botox, (2) [london] botulinum toxin, (3) [london] anti wrinkle injection, (4) [london] filler, (5) [london] dermal filler. One hundred websites per search string were systematically reviewed and those which met the inclusion/exclusion criteria of each search string were included and analyzed. Each clinic's product/service range compliance with the ASA/CAP code was assessed. Any reference to Botulinum Toxin or anti-wrinkle injections was noted and analyzed. Further analysis would look to calculate price per milliliter (mL) of botulinum toxin and dermal filler per borough and to calculate whether there were any statistical differences between the 32 different London boroughs. RESULTS A total of 500 websites were visited and evaluated. After removal of duplicates, a total of 233 independent clinics was identified. A total of 206 out of the 233 clinics sampled (88%) were in direct infringement of the enforcement notice through advertising a prescription medicine. The overall average cost per mL of dermal filler was £330.89 and there was a statistically significant variance across London boroughs (p < 0.05). The overall average cost per mL of Botulinum Toxin was £284.45 and the variance across London boroughs was close to significant (p = 0.058). CONCLUSION This paper demonstrates poor compliance with the ASA/CAP guidelines and further provides an insight into the industry mechanics associated with aesthetic injectables in a major UK city, identifying regional variance in price and clinic density. The advertising of prescription-only medication may pose a potential risk to patients and will be an important consideration in proposed legislation to introduce licensing to the industry.
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Affiliation(s)
- David Zargaran
- Department of Plastic Surgery, University College London, London, UK
| | | | - Sara Sousi
- Department of Plastic Surgery, University College London, London, UK
| | | | - Julie Davies
- UCL Global Business School for Health, University College London, London, UK
| | - Tim Weyrich
- Department of Computer Science, University College London, London, UK
- Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Afshin Mosahebi
- Department of Plastic Surgery, University College London, London, UK
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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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Cox K, Ghebrehiwet M, Kee M, Rucker B, Flores H, Ottwell R, Vassar M. Assessing the Reporting of Harms in Systematic Reviews Focused on the Therapeutic and Cosmetic Uses of Botulinum Toxin. Clin Drug Investig 2023; 43:85-95. [PMID: 36626045 DOI: 10.1007/s40261-022-01235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE The expanding use of botulinum toxin (BoNT) in medical practice demonstrates the need to highlight whether there is adequate information regarding its safety profile. The aim of our study was to identify completeness of harms reporting for BoNT treatment within systematic reviews (SRs), assess quality of SRs using the AMSTAR-2 tool, and determine the degree of overlap among primary studies within each SR. METHODS On May 31, 2022, we searched Embase, Epistemonikos, MEDLINE, and the Cochrane Database of Systematic Reviews for SRs on BoNT therapy. Screening and data extraction were performed in a masked, duplicate fashion. AMSTAR-2 was used to evaluate the methodological quality of included SRs. Corrected covered area (CCA) was calculated for SR dyads. RESULTS Of the 90 included SRs, we found that 70 completed less than 50% of harms items. The most reported items were BoNT as a favorable intervention (73/90, 81.1%) and harms as a primary outcome (72/90, 80.0%). The least reported items were grades and severity scales used to classify harms (8/90, 8.9%) and number of treatment discontinuations in each arm (10/90, 11.1%). Eighty-three SRs were rated "critically low" (83/90, 92.2%), while 5 SRs were rated "high" (5/90, 5.6%) via AMSTAR-2 tool. Significant associations were found between completion of harms reporting and: (1) a "critically low" appraisal on AMSTAR-2 tool (p = 0.0060) and (2) whether harms was reported as a primary outcome (p = 0.0001). The total CCA overlap was determined to be 0.8%. CONCLUSION Our results demonstrate that harms are underreported within BoNT SRs. Because healthcare professionals often refer to SRs to guide clinical decision making, it is important to continue to explore shortcomings among BoNT literature in future studies.
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Affiliation(s)
- Katherine Cox
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA.
| | - Merhawit Ghebrehiwet
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA
| | - Micah Kee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA
| | - Brayden Rucker
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA
| | - Holly Flores
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA
| | - Ryan Ottwell
- Department of Dermatology, St. Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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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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