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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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2
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Gostimir M, Liou V, Yoon MK. Safety of Botulinum Toxin A Injections for Facial Rejuvenation: A Meta-Analysis of 9,669 Patients. Ophthalmic Plast Reconstr Surg 2023; 39:13-25. [PMID: 35353777 DOI: 10.1097/iop.0000000000002169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To quantitatively evaluate safety profile for botulinum toxin A (BTX-A) injections among patients undergoing treatment for cosmetic indications is produced, with special attention to clinically relevant covariates and their relative impact on safety. METHODS A systematic literature search was performed using PubMed (1996-January 2020) and Embase (1947-January 2020) to identify all randomized controlled trials (RCTs) that reported safety data for patients receiving BTX-A for cosmetic indications compared to placebo. A meta-analysis was performed to determine pooled risk ratios (RR) for treatment-related adverse events (TRAEs) and for specific adverse events. Meta-regression and additional analyses were performed for significant and/or clinically relevant covariates. RESULTS Following the review of 8,690 studies, 32 RCTs involving 9,669 patients were included. The pooled RR of any TRAE occurring after BTX-A injection compared to placebo injection was 1.53 (95% CI, 1.33-1.77; p < 0.001). Statistically significant covariates included individual injection volume and total injection volume. The type of BTX-A formulation, treatment site, total BTX-A units, and BTX-A units per injection were not significant. Specific adverse events more likely to occur following BTX-A injection rather than placebo injection included eyelid/eyebrow malposition (RR 3.55; p < 0.001), facial paresis (RR 2.42; p = 0.316), and headache (RR 1.45; p = 0.003). Injection site reactions and injection site bruising occurred at similar rates in both groups. CONCLUSIONS The overall safety profile of BTX-A is acceptable and consistent with previous publications. The authors' additional analyses provide a relative comparison of the impact of various treatment parameters on safety.
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Affiliation(s)
- Mišo Gostimir
- Ivey Eye Institute, Department of Ophthalmology, Western University, London, Ontario, Canada
| | - Victor Liou
- Department of Ophthalmology, Harvard Medical School
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Michael K Yoon
- Department of Ophthalmology, Harvard Medical School
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Dayan S, Joseph J, Moradi A, Lorenc ZP, Coleman K, Ablon G, Kaufman-Janette J, Cox SE, Campbell A, Munavalli G, Prygova I. Subject Satisfaction and Psychological Well-being with Escalating AbobotulinumtoxinA Injection Dose for the Treatment of Moderate to Severe Glabellar Lines. J Cosmet Dermatol 2022; 21:2407-2416. [PMID: 35266281 PMCID: PMC9322427 DOI: 10.1111/jocd.14906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
Abstract
Background Previous studies indicate that the efficacy and durability of a single AbobotulinumtoxinA (ABO) treatment for moderate to severe glabellar lines may be enhanced with increasing dose, while safety outcomes remain consistent with those of the licensed dose (50 U). Aims Evaluation of subject‐reported indicators of treatment efficacy, satisfaction, and psychological well‐being with ABO dose escalation. Methods A Phase 2, 36‐week, multicenter, randomized, dose‐ranging, double‐blind, placebo‐controlled study was conducted in adults with moderate to severe glabellar lines. Subjects received a single ABO treatment, dosed at 50, 75, 100, or 125 U, or placebo. Efficacy endpoints comprised subject‐assessed improvement in line severity of ≥1‐grade from baseline at maximum frown, global aesthetic improvement scale (GAIS) grade, FACE‐Q™ appraisal of lines, psychological well‐being and age, and subject satisfaction. Results The study included 399 subjects (88.2% were female). Respective responder rates (≥1‐grade improvement) with ABO 50–125 U doses ranged between 96.3%–100% at Week 4, 65.0%–67.9% at Week 24, and 33.8%–44.4% at Week 36. GAIS responder rate and FACE‐Q appraisal of lines showed a similar pattern of change. Satisfaction was high and psychological well‐being was improved from Week 4 through Week 36, with natural, youthful, and refreshed appearance reported for all ABO doses. Conclusions A single ABO treatment (dosed at 50–125 U) provided significant and sustained improvements in glabellar line severity over durations up to 36 weeks, versus placebo. Treatment satisfaction was high with all doses. Participants reported natural and youthful appearance, alongside improvements in psychological well‐being.
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Affiliation(s)
| | - John Joseph
- Clinical Testing of Beverly Hills, Encino, CA, USA
| | | | - Z Paul Lorenc
- Lorenc Aesthetic Plastic Surgery Center, New York, USA
| | - Kyle Coleman
- Etre Cosmetic Dermatology and Laser Center, New Orleans, LA, USA
| | - Glynis Ablon
- Ablon Skin Institute and Research Center, Manhattan Beach, CA, USA
| | | | | | | | - Girish Munavalli
- Dermatology, Laser & Vein Specialists of the Carolinas, PLLC, Charlotte, NC, USA
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Camargo CP, Xia J, Costa CS, Gemperli R, Tatini MD, Bulsara MK, Riera R. Botulinum toxin type A for facial wrinkles. Cochrane Database Syst Rev 2021; 7:CD011301. [PMID: 34224576 PMCID: PMC8407355 DOI: 10.1002/14651858.cd011301.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Botulinum toxin type A (BontA) is the most frequent treatment for facial wrinkles, but its effectiveness and safety have not previously been assessed in a Cochrane Review. OBJECTIVES To assess the effects of all commercially available botulinum toxin type A products for the treatment of any type of facial wrinkles. SEARCH METHODS We searched the following databases up to May 2020: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers, and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs with over 50 participants, comparing BontA versus placebo, other types of BontA, or fillers (hyaluronic acid), for treating facial wrinkles in adults. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Primary outcomes were participant assessment of success and major adverse events (AEs) (eyelid ptosis, eyelid sensory disorder, strabismus). Secondary outcomes included physician assessment of success; proportion of participants with at least one AE and duration of treatment effect. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 65 RCTs, involving 14,919 randomised participants. Most participants were female, aged 18 to 65 years. All participants were outpatients (private office or day clinic). Study duration was between one week and one year. No studies were assessed as low risk of bias in all domains; the overall risk of bias was unclear for most studies. The most common comparator was placebo (36 studies). An active control was used in 19 studies. There were eight dose-ranging studies of onabotulinumtoxinA, and a small number of studies compared against fillers. Treatment was given in one cycle (54 studies), two cycles (three studies), or three or more cycles (eight studies). The treated regions were glabella (43 studies), crow's feet (seven studies), forehead (two studies), perioral (two studies), full face (one study), or more than two regions (nine studies). Most studies analysed moderate to severe wrinkles; mean duration of treatment was 20 weeks. The following results summarise the main comparisons, based on studies of one treatment cycle for the glabella. AEs were collected over the duration of these studies (over four to 24 weeks). Compared to placebo, onabotulinumtoxinA-20 U probably has a higher success rate when assessed by participants (risk ratio (RR) 19.45, 95% confidence interval (CI) 8.60 to 43.99; 575 participants; 4 studies; moderate-certainty evidence) or physicians (RR 17.10, 95% CI 10.07 to 29.05; 1339 participants; 7 studies; moderate-certainty evidence) at week four. Major AEs are probably higher with onabotulinumtoxinA-20 U (Peto OR 3.62, 95% CI 1.50 to 8.74; 1390 participants; 8 studies; moderate-certainty evidence), but there may be no difference in any AEs (RR 1.14, 95% CI 0.89 to 1.45; 1388 participants; 8 studies; low-certainty evidence). Compared to placebo, abobotulinumtoxinA-50 U has a higher participant-assessed success rate at week four (RR 21.22, 95% CI 7.40 to 60.56; 915 participants; 6 studies; high-certainty evidence); and probably has a higher physician-assessed success rate (RR 14.93, 95% CI 8.09 to 27.55; 1059 participants; 7 studies; moderate-certainty evidence). There are probably more major AEs with abobotulinumtoxinA-50 U (Peto OR 3.36, 95% CI 0.88 to 12.87; 1294 participants; 7 studies; moderate-certainty evidence). Any AE may be more common with abobotulinumtoxinA-50 U (RR 1.25, 95% CI 1.05 to 1.49; 1471 participants; 8 studies; low-certainty evidence). Compared to placebo, incobotulinumtoxinA-20 U probably has a higher participant-assessed success rate at week four (RR 66.57, 95% CI 13.50 to 328.28; 547 participants; 2 studies; moderate-certainty evidence), and physician-assessed success rate (RR 134.62, 95% CI 19.05 to 951.45; 547 participants; 2 studies; moderate-certainty evidence). Major AEs were not observed (547 participants; 2 studies; moderate-certainty evidence). There may be no difference between groups in any AEs (RR 1.17, 95% CI 0.90 to 1.53; 547 participants; 2 studies; low-certainty evidence). AbobotulinumtoxinA-50 U is no different to onabotulinumtoxinA-20 U in participant-assessed success rate (RR 1.00, 95% CI 0.92 to 1.08, 388 participants, 1 study, high-certainty evidence) and physician-assessed success rate (RR 1.01, 95% CI 0.95 to 1.06; 388 participants; 1 study; high-certainty evidence) at week four. Major AEs are probably more likely in the abobotulinumtoxinA-50 U group than the onabotulinumtoxinA-20 U group (Peto OR 2.65, 95% CI 0.77 to 9.09; 433 participants; 1 study; moderate-certainty evidence). There is probably no difference in any AE (RR 1.02, 95% CI 0.67 to 1.54; 492 participants; 2 studies; moderate-certainty evidence). IncobotulinumtoxinA-24 U may be no different to onabotulinumtoxinA-24 U in physician-assessed success rate at week four (RR 1.01, 95% CI 0.96 to 1.05; 381 participants; 1 study; low-certainty evidence) (participant assessment was not measured). One participant reported ptosis with onabotulinumtoxinA, but we are uncertain of the risk of AEs (Peto OR 0.02, 95% CI 0.00 to 1.77; 381 participants; 1 study; very low-certainty evidence). Compared to placebo, daxibotulinumtoxinA-40 U probably has a higher participant-assessed success rate (RR 21.10, 95% CI 11.31 to 39.34; 683 participants; 2 studies; moderate-certainty evidence) and physician-assessed success rate (RR 23.40, 95% CI 12.56 to 43.61; 683 participants; 2 studies; moderate-certainty evidence) at week four. Major AEs were not observed (716 participants; 2 studies; moderate-certainty evidence). There may be an increase in any AE with daxibotulinumtoxinA compared to placebo (RR 2.23, 95% CI 1.46 to 3.40; 716 participants; 2 studies; moderate-certainty evidence). Major AEs reported were mainly ptosis; BontA is also known to carry a risk of strabismus or eyelid sensory disorders. AUTHORS' CONCLUSIONS BontA treatment reduces wrinkles within four weeks of treatment, but probably increases risk of ptosis. We found several heterogeneous studies (different types or doses of BontA, number of cycles, and different facial regions) hindering meta-analyses. The certainty of the evidence for effectiveness outcomes was high, low or moderate; for AEs, very low to moderate. Future RCTs should compare the most common BontA (onabotulinumtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, daxibotulinumtoxinA, prabotulinumtoxinA) and evaluate long-term outcomes. There is a lack of evidence about the effects of multiple cycles of BontA, frequency of major AEs, duration of effect, efficacy of recently-approved BontA and comparisons with other treatments.
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Affiliation(s)
- Cristina Pires Camargo
- Laboratory of Microsurgery and Plastic Surgery (LIM-04), School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Jun Xia
- Nottingham China Health Institute, The University of Nottingham Ningbo, Ningbo, China
| | - Caroline S Costa
- Department of Specialised Medicine, Discipline of Dermatology, Universidade Federal do Piaui, Teresina, Brazil
| | - Rolf Gemperli
- Department of Surgery, Discipline of Plastic Surgery, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Dc Tatini
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rachel Riera
- Cochrane Brazil Rio de Janeiro, Cochrane, Petrópolis, Brazil
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5
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Foissac R, Benatar MJ. Influence of botulinum toxin type A esthetic injections on facial expressions. J Cosmet Dermatol 2021; 20:1405-1410. [PMID: 33539679 DOI: 10.1111/jocd.13980] [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: 11/07/2020] [Revised: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Botulinum toxin type A (BoNT-A) injection remains the leading medical cosmetic procedure worldwide, with a high rate of patient satisfaction. However, it still suffers from patients' fear of being unable to transmit their emotions and of looking frozen from unnatural results. AIM This study aimed to determine whether BoNT-A can decrease the intensity of emotions in facial expressions. PATIENTS/METHODS In this single-center prospective study, 42 patient investigators assessed four patients' facial expressions for six emotions and neutral faces, before and after injection of 36 IU or 48 IU of onabotulinumtoxinA, using photographs. Photographs were presented on a tablet to the investigators. RESULTS There were no statistical differences between the before and after photographs for the intensity of emotions for all expressions (P > .05) except for the expression of surprise in the group of patients that received 48 IU of the injection (protocol with injection of the frontalis muscle). All patient investigators answered negatively to the question "Do you think that this patient has a 'frozen face'?". CONCLUSION This study shows that esthetic injection of BoNT-A in the upper face has no negative effects on facial expressions and does not lead to the feared "frozen face" when it is injected with respect for best practice guidelines. This study can be used as an example for patients who have some reticences against BoNT-A injection.
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Affiliation(s)
- Rémi Foissac
- Plastic and reconstructive Surgery, Clinique Saint George, Nice, France
| | - Marc J Benatar
- Plastic and reconstructive Surgery, Clinique Santa Maria, Nice, France
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Smit R, Gubanova E, Kaufman J, Landau M, Molina B, Andriopoulos B, Maisonobe P, Prygova I, Redaelli A. Patient Satisfaction with AbobotulinumtoxinA for Aesthetic Use in the Upper Face: A Systematic Literature Review and Post-hoc Analysis of the APPEAL Study. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:E69-E88. [PMID: 34221231 PMCID: PMC8211347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND: AbobotulinumtoxinA (AboBoNT-A; Dysport®; Ipsen, Boulogne-Billancourt, France/Azzalure®; Galderma, Lausanne, Switzerland) is a botulinum neurotoxin type A approved for aesthetic use in the treatment of glabellar lines in adult patients under 65 years in Europe, the United States, and other countries. OBJECTIVE: We sought to analyze current literature on patient satisfaction with aboBoNT-A for upper facial aesthetic indications. METHODS: A systematic review of literature databases (PubMed/MEDLINE, Embase, the Cochrane Library, and Google Scholar) was performed to identify English-language publications reporting on patients with aesthetic indications (including glabellar lines and wrinkles) receiving aboBoNT-A, that assessed patient and/or physician satisfaction with treatment, with no restrictions on comparator studies. Structured data extraction was used to enable inter-study analysis. A post-hoc analysis was also performed to assess patient satisfaction by sex and age, using results from the noninterventional APPEAL study of patients' satisfaction with aboBoNT-A for treating glabellar lines. RESULTS: Overall, 22 original research papers were identified. Patient satisfaction rates for aboBoNT-A treatment were significantly higher versus placebo from two weeks to between three and five months postinjection. At two to three weeks postinjection, patient satisfaction rates were 52% and 99% across studies. In studies with later time points, patient satisfaction rates were 85 to 87 percent at 5 months and between 25 and 100 percent at 6 months post-injection. Physician satisfaction was also high (97%-100%, across three treatments). No notable differences in patient satisfaction by sex or age were observed in the APPEAL study. CONCLUSION: High rates of patient satisfaction have been achieved with aboBoNT-A treatment for upper facial aesthetic indications. Despite the current recommended interval of ≥12 weeks, satisfaction with the aesthetic results of aboBoNT-A therapy is still evident up to 6 months post-injection in some patients.
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Affiliation(s)
- Riekie Smit
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Elena Gubanova
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Joely Kaufman
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Marina Landau
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Beatriz Molina
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Bill Andriopoulos
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Pascal Maisonobe
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Inna Prygova
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Alessio Redaelli
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
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Nestor M, Cohen JL, Landau M, Hilton S, Nikolis A, Haq S, Viel M, Andriopoulos B, Prygova I, Foster K, Redaelli A, Picaut P. Onset and Duration of AbobotulinumtoxinA for Aesthetic Use in the Upper face: A Systematic Literature Review. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:E56-E83. [PMID: 33488922 PMCID: PMC7819591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE: We sought to analyze the current literature regarding time to onset and duration of effect of abobotulinumtoxinA (aboBoNT-A, Dysport®/Azzalure®) for upper facial aesthetic indications. METHODS: We conducted a systematic review of literature databases (PubMed/MEDLINE, Embase, Cochrane Library, and Google Scholar) to identify English-language publications relevant to: population (patients with aesthetic indications [including glabellar lines and wrinkles]); interventions (aboBoNT-A); comparators (no restrictions); outcomes (efficacy, including onset of action and duration of effect); and settings (clinical). A manual search of review paper bibliographies was performed. Structured data extraction was used to enable interstudy analysis. RESULTS: Overall, 42 original research papers relevant to aboBoNT-A onset and/or duration were identified. All 24 studies assessing efficacy within one week post-injection demonstrated some response at the first time point assessed, and all 37 studies assessing duration showed some response after 12 weeks. Although methodologies for assessing onset and duration differed, when outcomes were refined by reported mean/median, at least 50 percent of patients responding to treatment, or significance versus placebo or baseline at a given time point, onset was most often reported within 2 to 3 days (7 studies), and as early as 24 hours (2 studies). Duration was most often reported as four months (18 studies), although four studies provided evidence that aboBoNT-A efficacy was maintained at five months and three studies at or after six months post-injection. CONCLUSION: This review indicates that aboBoNT-A has a median onset of efficacy of 2 to 3 days and a longer duration of action (3-6 months across studies) than the current labelled minimum treatment interval (12 weeks).
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Affiliation(s)
- Mark Nestor
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Joel L Cohen
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Marina Landau
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Said Hilton
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Andreas Nikolis
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Syed Haq
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Maurizio Viel
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Bill Andriopoulos
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Inna Prygova
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Keith Foster
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Alessio Redaelli
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Philippe Picaut
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
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Melfa F, Siragusa D, Caruso DG, Tunesi L, Zerbinati N, Chirico F, Lo Faro C, Rauso R. An Italian experience of a new personalized injective protocol (Botutouch) for botulinum toxin application in aesthetic medicine. Dermatol Ther 2020; 33:e14395. [PMID: 33040423 DOI: 10.1111/dth.14395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/06/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
Botulinum toxin typeA (BoNTA) is widely used in aesthetic medicine as primary treatment to reduce facial wrinkles. Major unmet needs in the field of the injection techniques include dilution factor, injected volume and site. Since 2013, an innovative protocol has been developed in our clinic that works on a double dilution volume, identifies the injection site according to the specific anatomical-functional characteristics of each patient's musculature and applies a gentle massage to the injected area to optimize the toxin spread in the muscle. We retrospectively retrieved medical records of subjects that underwent aesthetic treatments in our outpatient Italian clinics from 2013. In cobotulinum toxin A was used in double dilution (100 AU in 5 mL of physiologic solution) and followed by a gentle massage after the injection to increase the distribution into the muscle. 197 subjects, most of them drug-naïve (81.7%), underwent 869 BoNTA treatments. On average, higher total units and volumes were applied in first visits or older subjects whereas the lower ones were preferred in following visits or younger subjects. As perceived by the patients, the effects of BoNTA lasted more than 6 months in about 38% of the cases. 95.9% of subjects declared to be satisfied,whereas 5.2% of adverse events were observed (4.8% hematoma, 0.2% ptosis, and 0.2% tenderness). To date, we offer a BoNTA treatment with the aim to maximize the results and consequent patient's satisfaction, with low incidence of complications.
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Affiliation(s)
| | | | | | | | - Nicola Zerbinati
- Department of Dermatology, University of Insubria, Varese, Italy
| | - Fabrizio Chirico
- Department of Maxillo-Facial Surgery, University Federico II, Naples, Italy
| | - Carmelo Lo Faro
- Department of Maxillo-Facial Surgery, University Federico II, Naples, Italy
| | - Raffaele Rauso
- Department of Maxillo-Facial Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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9
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Efficacy, Safety, and Subject Satisfaction After AbobotulinumtoxinA Treatment for Moderate to Severe Glabellar Lines. Dermatol Surg 2020; 46:61-69. [PMID: 31356432 DOI: 10.1097/dss.0000000000002013] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aesthetic use of botulinum toxins is widely accepted in routine treatment of glabellar lines. OBJECTIVE To strengthen existing efficacy and safety data, and examine subject satisfaction concerning abobotulinumtoxinA (ABO) treatment for moderate to severe glabellar lines. MATERIALS AND METHODS A 150-day prospective, single-dose, multicenter, randomized, parallel-group, placebo-controlled, double-blind study of 300 subjects treated with ABO (50 Units [U]). Response was defined as having no or mild glabellar lines after treatment (primary objective was Day 30 response). Glabellar line severity, onset and duration of effect, satisfaction, treatment emergent adverse events (TEAEs), and treatment-related adverse events (TRAEs) were assessed. RESULTS Median time to onset of effect was 2 days. Day 30, ABO treatment response was 89% and 85% for investigator and subject assessments, respectively (p < .001 vs placebo). At Day 120, 60% of subjects demonstrated ≥1 grade improvement and 45% at Day 150. Subject satisfaction concerning glabellar line appearance was high (93%) at Day 14 and maintained by 35% through Day 150 with ABO treatment. No serious AEs were related to study treatment. CONCLUSION Most ABO-treated subjects sustained ≥1 grade glabellar line improvements over 120 days, and satisfaction was maintained by >30% of subjects throughout 150 days. ABO was well tolerated.
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10
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Clinical Assessment of 2 Licensed AbobotulinumtoxinA Injection Volumes for the Treatment of Glabellar Lines. Dermatol Surg 2020; 45:1274-1284. [PMID: 30893159 DOI: 10.1097/dss.0000000000001926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Two licensed reconstitution volumes may be used to achieve the recommended abobotulinumtoxinA (ABO) dose for glabellar line correction. OBJECTIVE Comparison of efficacy, safety, and subject satisfaction concerning treatment of moderate to severe glabellar lines with 2 different ABO reconstitution volumes. MATERIALS AND METHODS Phase IV, prospective, randomized, multicenter, subject- and evaluator-blinded study: 60 subjects received 1 ABO (50 units) treatment, administered as a 1.5- or 2.5-mL reconstitution. Primary objective was Day 30 improvements (≥1-point) in glabellar line severity. Onset of effect, duration, subject satisfaction, and treatment-related adverse events (AEs) were assessed. RESULTS At Day 30, 90.0% and 86.7% of subjects achieved ≥1-point improvements with 1.5- and 2.5-mL reconstitutions, respectively. Median time to onset of effect was 48 hours after treatment. At 24 hours, 26.7% achieved ≥1-point improvements with the 2.5-mL reconstitution versus 6.7% with the 1.5-mL reconstitution. Maximum response was at Day 14, and >40% maintained efficacy through Day 120 in each group. High subject satisfaction was sustained throughout observation. Most AEs were mild. No serious AEs were reported. CONCLUSION Both ABO reconstitutions were well tolerated and effective in correcting glabellar lines with no significant differences concerning efficacy or duration of effect. No serious AEs were reported.
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11
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Warren H, Welch K, Coquis-Knezek S. AbobotulinumtoxinA for Facial Rejuvenation: What Affects the Duration of Efficacy? Plast Surg Nurs 2020; 40:37-44. [PMID: 32102079 DOI: 10.1097/psn.0000000000000292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AbobotulinumtoxinA (Dysport) has a long history as a safe and effective treatment option for aesthetic rejuvenation. One of the key measures of botulinum toxin efficacy is the persistence of clinically meaningful results. The duration of efficacy depends on different factors, many of which can be controlled by the clinician to better achieve their desired results. In this review, we discuss how dose, individual patient variation, and injection technique affect the duration of botulinum toxins. Increased duration may result from increased dose or more precise placement of the toxin in the muscle. The varying anatomy and behavior of patients can affect duration as well. Measures of duration in clinical studies vary, but both a 1-grade improvement on the glabellar line severity scale and patient-reported outcomes are key measures. The clinical effects of Dysport can last up to 5 months, and patients in Dysport clinical studies remained satisfied with treatment for up to 6 months. Dysport has a legacy of safety, efficacy, and high subject satisfaction demonstrated through studies and clinical experience. Building on that legacy by correctly dosing the subject, properly accounting for the individual subject anatomy and behavior, and using specific injection techniques can help ensure that your patients have the longest lasting results.
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Affiliation(s)
- Hermine Warren
- Hermine Warren, DNP, APRN, CANS, CNM, is an advanced practice RN, GenNow faculty and a GAIN trainer for Galderma. She is also PALETTE faculty. She is at Facialogy Medical, Inc., Encino, CA
- Kim Welch, BSN, RN, CANS, is an aesthetics specialist GenNow faculty and a GAIN trainer for Galderma. She is at Esperance Aesthetic Wellness, Coppell, TX
- Sarah Coquis-Knezek, PhD, is an associate medical affairs advisor at Galderma Laboratories, L.P., Fort Worth, TX
| | - Kim Welch
- Hermine Warren, DNP, APRN, CANS, CNM, is an advanced practice RN, GenNow faculty and a GAIN trainer for Galderma. She is also PALETTE faculty. She is at Facialogy Medical, Inc., Encino, CA
- Kim Welch, BSN, RN, CANS, is an aesthetics specialist GenNow faculty and a GAIN trainer for Galderma. She is at Esperance Aesthetic Wellness, Coppell, TX
- Sarah Coquis-Knezek, PhD, is an associate medical affairs advisor at Galderma Laboratories, L.P., Fort Worth, TX
| | - Sarah Coquis-Knezek
- Hermine Warren, DNP, APRN, CANS, CNM, is an advanced practice RN, GenNow faculty and a GAIN trainer for Galderma. She is also PALETTE faculty. She is at Facialogy Medical, Inc., Encino, CA
- Kim Welch, BSN, RN, CANS, is an aesthetics specialist GenNow faculty and a GAIN trainer for Galderma. She is at Esperance Aesthetic Wellness, Coppell, TX
- Sarah Coquis-Knezek, PhD, is an associate medical affairs advisor at Galderma Laboratories, L.P., Fort Worth, TX
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12
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Abstract
Several formulations of Botulinum toxin serotype A (BoNT-A) for aesthetic indications are available, with numbers likely to increase. Preparations are not interchangeable, based on dose unit comparisons.
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13
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Neurophysiological Measures of Efficacy and Safety for Botulinum Toxin Injection in Facial and Bulbar Muscles: Special Considerations. Toxins (Basel) 2017; 9:toxins9110352. [PMID: 29084148 PMCID: PMC5705967 DOI: 10.3390/toxins9110352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 12/27/2022] Open
Abstract
Botulinum toxin (BoNT) injections into facial and bulbar muscles are widely and increasingly used as medical treatments for cervical and facial dystonia, facial hemispasm, correction of facial palsy, hyperhidrosis, as well as cosmetic treatment of glabellar lines associated with grief and anger. Although BoNT treatment is generally considered safe, the diffusion of the toxin to surrounding muscles may result in complications, including difficulties swallowing, in a dose-dependent manner. The sensitivity of clinical examination for detecting adverse events after BoNT treatment is limited. Few reports have highlighted the potential effects on other muscles in the facial area due to the spreading of the toxin. The possibilities of spreading and thus unknown pharmacological BoNT effects in non-targeted muscles emphasise the importance of correct administration of BoNT in terms of dose selection, injection points, and appropriate effect surveillance. In this review article, we will focus on novel objective measures of efficacy and safety regarding BoNT treatment of facial muscles and the reasons why this is important.
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