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Rosales Santillan M, Ozog D, Wu W. Using Neuromodulators to Improve Scar Formation, Keloids, Rosacea, and Antiaging. Dermatol Surg 2024; 50:S91-S96. [PMID: 39196841 DOI: 10.1097/dss.0000000000004353] [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: 08/30/2024]
Abstract
BACKGROUND Botulinum toxin A (BoNT-A) treatment has many uses in dermatology. Its mechanism of action and long-term effects for scar formation, rosacea, and antiaging are still being investigated. OBJECTIVE To conduct a literature review on BoNT-A to further investigate its use in scar formation, rosacea, and antiaging. METHODS A literature review was conducted using PubMed on botulinum toxin treatment for scar formation, rosacea, and antiaging. Studies discussing the toxin mechanism of action and treatment algorithm were included. The authors also provided their personal experience in BoNT-A use for these 3 conditions. RESULTS The mechanism of action of Botulinum toxin A in improving scar formation, rosacea, and antiaging is now better understood. While it is effective in the short term, little is still known about how frequently treatment needs to be repeated and if there are any long-term effects. CONCLUSION While in vitro studies have supporting evidence on the mechanism of action of BoNT-A on scar formation, rosacea, and antiaging, further studies are needed to identify long-term treatment effects.
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Affiliation(s)
| | - David Ozog
- Department of Dermatology, Henry Ford Health, Detroit, Michigan
- College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Woffles Wu
- Woffles Wu Aesthetic Surgery and Laser Centre, Singapore
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de Almeida AT, de Sanctis Pecora C, Marques ER, Contin L, de Almeida CT, da Cunha AL. Assessment of the Efficacy and Durability of IncobotulinumtoxinA in the Treatment of the Upper Face in Adult Women. Dermatol Ther (Heidelb) 2024; 14:2093-2108. [PMID: 38954382 PMCID: PMC11333665 DOI: 10.1007/s13555-024-01216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION IncobotulinumtoxinA (Xeomin®) is used in the treatment of dynamic wrinkles and the aesthetic repositioning of facial structures. The duration of its muscular effect typically extends for around 4 months. However, the residual aesthetic benefit can be observed for a longer period. To date, the long-term aesthetic benefit of incobotulinumtoxinA in facial aesthetics has not been systematically evaluated. This study aimed to evaluate longitudinally the duration and aesthetic benefits of incobotulinumtoxinA in the treatment of the upper face in adult women. METHODS A quasi-experimental, evaluator-blind, clinical trial involving 28 adult women (30-60 years old) with facial movement lines, undergoing treatment of the upper face with incobotulinumtoxinA by two injectors, following an individualized protocol (ONE21 and glabellar contraction patterns) was performed. Participants were evaluated on the day of the intervention (day 0) and days 30, 120, 180, and 240, and subjected to standardized photographs. The following outcomes were evaluated blindly at each visit: Merz Aesthetics Facial Contraction Scale (MAS), GAIS (Global Aesthetic Improvement Scale), and patient satisfaction. Adverse effects were evaluated at each visit. RESULTS Participants ranged in age from 30 to 60 years, 93% were self-declared white, and most of their baseline MAS scores for dynamic lines were moderate and severe. All the parameters presented significative reduction from baseline until day 180. At day 240, the dynamic MAS scores were lower than baseline for forehead lines in 15.4% (95% confidence interval (CI) 0.8-30.0%) of the participants, for glabellar lines in 38.5% (95% CI 18.8-58.1%), and for crow's feet lines in 26.9% (95% CI 9.0-44.8%). Aesthetic improvement compared to baseline was identified in 35% (CI 95% 23‒50%) of the participants at day 240, and 62% (CI 95% 42‒81%) of the sample kept reporting some satisfaction with the procedure. CONCLUSION The aesthetic treatment of the upper face with incobotulinumtoxinA demonstrates enduring clinical benefits, and patient satisfaction lasting up to 180 days in most participants. The length of efficacy, which exceeded those reported in the literature, may be attributed to the use of techniques based on individualized assessment such as ONE21 and glabellar patterns of contraction.
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Affiliation(s)
- Ada Trindade de Almeida
- Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil.
- For Trials Pesquisa Clínica São Paulo, São Paulo, Brazil.
| | | | - Elisa R Marques
- Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
- For Trials Pesquisa Clínica São Paulo, São Paulo, Brazil
| | - Leticia Contin
- Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
- For Trials Pesquisa Clínica São Paulo, São Paulo, Brazil
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Chen L, Cui L, Ran J, Liu Z, Zhu X. Transdermal delivery of botulinum toxin-A through phosphatidylcholine/cholesterol nanoliposomes for treatment of post-acne scarring. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2024; 35:41. [PMID: 39073502 PMCID: PMC11286643 DOI: 10.1007/s10856-024-06810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024]
Abstract
As an acne sequela, post-acne scarring (PSA) has huge negative impact on sufferers' quality of life because of aesthetical embarrassment. Transdermal delivery of botulinum toxin-A (BTXA) is a promising strategy for PAS treatment, but currently reported approaches are far from satisfactory. In this work, phosphatidylcholine/cholesterol (PC/Chol) nanoliposomes were utilized for encapsulation and transdermal delivery of BTXA. The composition, structure, morphology, size, size distribution, etc. of as-prepared BTXA@liposome nanoparticles were investigated in detail. Simulated transdermal delivery assay indicated that the diffusion depth of the BXTA@liposome nanoparticles was nearly 8 times that of pure BTXA and reached 380 μm. 12 facial PSA patients were recruited to evaluate the curative effect of the BTXA@liposome nanoparticles on PSA. Through ECCA (échelle d'évaluation clinique des cicatrices d'acné) scoring and self-evaluation of patients, the resultant data indicated that compared to hyaluronic acid (HA) hydrogel treatment the BTXA@liposome/HA hydrogel treatment could better relieve PSA to some extent but didn't show significant advantage. Further work is needed to verify the feasibility and curative effect of this method in PSA treatment in the future.
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Affiliation(s)
- Lannan Chen
- Department of Medical Cosmetology, The First Clinical Medical College of China Three Gorges University, Yichang Central People's Hospital, Institute of Medical Cosmetology, China Three Gorges University, Yichang, China
| | - Lei Cui
- Department of Medical Cosmetology, The First Clinical Medical College of China Three Gorges University, Yichang Central People's Hospital, Institute of Medical Cosmetology, China Three Gorges University, Yichang, China.
| | - Jiabing Ran
- College of Biological & Pharmaceutical Sciences, China Three Gorges University, Yichang, China.
- Hubei Key Laboratory of Natural Products Research and Development, China Three Gorges University, Yichang, China.
| | - Zhengrui Liu
- Department of Medical Cosmetology, The First Clinical Medical College of China Three Gorges University, Yichang Central People's Hospital, Institute of Medical Cosmetology, China Three Gorges University, Yichang, China
| | - Xiongbin Zhu
- College of Biological & Pharmaceutical Sciences, China Three Gorges University, Yichang, China
- Hubei Key Laboratory of Natural Products Research and Development, China Three Gorges University, Yichang, China
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4
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Pazyar N, Ashoori S, Mahdianrad A, Seyedtabib M. Comparison of the effect of intra-dermal injection of botulinum toxin and normal saline in the treatment of facial skin pores. J Family Med Prim Care 2024; 13:1797-1803. [PMID: 38948607 PMCID: PMC11213392 DOI: 10.4103/jfmpc.jfmpc_1327_23] [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: 08/14/2023] [Revised: 11/12/2023] [Accepted: 12/05/2023] [Indexed: 07/02/2024] Open
Abstract
Background and Purpose Skin pores (SPs) are normal and benign skin structures that are mostly located on the face (nose, cheeks, etc.) that cause many aesthetic concerns or complaints. One known effective treatment is botulinum toxin A (BTXA), which is also approved for the treatment of strabismus, blepharospasm, muscle spasm, cervical dystonia, glabella wrinkles, and primary axillary hyperhidrosis. Therefore, the aim of this study was to compare the effect of intra-dermal injection of botulinum toxin and normal saline serum (NSS) in the treatment of large facial pores. Methods The study included 25 people who referred to the skin clinic of Imam Khomeini Hospital in Ahvaz from June 2021 to January 2022 for the treatment of large facial skin pores. Randomly, some subjects were injected with botulinum toxin at ten points, and each point was equivalent to 2.5 units of Masport (500 units vial of Masport diluted with 10 ml of NSS). Some other people were injected with 0.05 ml of NSS by intra-dermal injection at ten points. Finally, the data were analyzed using SPSS-Ver. 22 software. Results Based on optical coherence tomography results, it was determined that the diameter of facial pores decreased significantly (P = 0.011). Dermoscopy showed a significant decrease in the average size of facial pores (P < 0.011), and also, the pore score decreased significantly (P = 0.021). In addition, the results showed that the size of skin pores and facial fat on both sides of the face did not decrease significantly from the patients' point of view (P = 0.71). Conclusion Based on the results of the present study, it can be concluded that intra-dermal injection of botulinum toxin is an effective and safe method to control facial pores, which showed acceptable results after 3 months.
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Affiliation(s)
- Nader Pazyar
- Department of Dermatology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Ashoori
- Dermatology Resident, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Atefeh Mahdianrad
- Department of Ophthalmology, Faculty of Medicine, Infectious Ophthalmic Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Seyedtabib
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Zhantleuova A, Leese C, Andreou AP, Karimova A, Carpenter G, Davletov B. Recent Developments in Engineering Non-Paralytic Botulinum Molecules for Therapeutic Applications. Toxins (Basel) 2024; 16:175. [PMID: 38668600 PMCID: PMC11054698 DOI: 10.3390/toxins16040175] [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: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024] Open
Abstract
This review discusses the expanding application of botulinum neurotoxin in treating neurological conditions. The article specifically explores novel approaches to using non-paralytic botulinum molecules. These new molecules, such as BiTox or el-iBoNT, offer an alternative for patients who face limitations in using paralytic forms of botulinum neurotoxin due to concerns about muscle function loss. We highlight the research findings that confirm not only the effectiveness of these molecules but also their reduced paralytic effect. We also discuss a potential cause for the diminished paralytic action of these molecules, specifically changes in the spatial parameters of the new botulinum molecules. In summary, this article reviews the current research that enhances our understanding of the application of new botulinum neurotoxins in the context of common conditions and suggests new avenues for developing more efficient molecules.
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Affiliation(s)
- Aisha Zhantleuova
- Department of Biophysics, Biomedicine and Neuroscience, Al-Farabi Kazakh National University, Almaty A15E3C7, Kazakhstan; (A.Z.); (A.K.)
| | - Charlotte Leese
- Department of Biomedical Science, University of Sheffield, Sheffield S10 2JA, UK;
| | - Anna P. Andreou
- Headache Research, Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE1 1UL, UK;
- Neuresta, Inc., San Diego, CA 91991, USA
| | - Altynay Karimova
- Department of Biophysics, Biomedicine and Neuroscience, Al-Farabi Kazakh National University, Almaty A15E3C7, Kazakhstan; (A.Z.); (A.K.)
| | - Guy Carpenter
- Salivary Research, Centre for Host-Microbiome Interactions, Faculty of Dental, Oral & Craniofacial Sciences, King’s College London, London SE1 1UL, UK;
| | - Bazbek Davletov
- Department of Biomedical Science, University of Sheffield, Sheffield S10 2JA, UK;
- Neuresta, Inc., San Diego, CA 91991, USA
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Dayel SB, Hussein RS, Gafar HH. The role of botulinum neurotoxin BoNT-A in the management of oily skin and acne vulgaris: A comprehensive review. Medicine (Baltimore) 2024; 103:e37208. [PMID: 38394550 PMCID: PMC11309636 DOI: 10.1097/md.0000000000037208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
Oily skin and acne vulgaris are prevalent dermatological conditions with a significant impact on both physical and emotional well-being. Despite numerous available treatments, there is a pressing need for effective, long-term solutions. Botulinum Neurotoxin (BoNT-A) has emerged as a potential therapeutic option. However, existing reviews in this area are often limited. This review aims to comprehensively assess the use of BoNT-A in managing oily skin and acne vulgaris while addressing gaps in previous publications. It integrates the latest research, clinical trials, and case studies to provide an up-to-date analysis of BoNT-A mechanisms of action, efficacy, safety, and long-term outcomes. The review systematically analyzes existing evidence, critically evaluates study strengths and limitations, and explores potential synergies with other treatments. It also examines the safety profile of BoNT-A and its potential long-term effects. This review uncovers promising insights into how BoNT-A affects oily skin and acne vulgaris, including its ability to regulate sebum production, reduce inflammation, and potentially shrink pore size. It provides a comprehensive overview of relevant studies and clinical trials, detailing their methodologies, protocols, measures, and results. Collectively, these studies show significant reductions in sebum production, increased patient satisfaction, and smaller pores following BoNT-A treatment. In conclusion, this review addresses knowledge gaps and provides a comprehensive analysis of BoNT-A as a therapeutic option for oily skin and acne vulgaris. By consolidating evidence and highlighting areas for further investigation, it guides clinicians and researchers toward more effective, personalized treatments for individuals with these dermatological challenges.
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Affiliation(s)
- Salman Bin Dayel
- Department of Dermatology, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ramadan S. Hussein
- Department of Dermatology, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Huda H. Gafar
- Clinical Pathology Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Ali S, AL Bukhari F, Al Nuaimi K, Elenany H, Fakih-Gomez N, Ghannam S, Haidar R, Isse N, Labib N, Mosahebi A, Ravichandran S, Turkmani MG, Youssef C. Consensus Statement on the Use of Botulinum Neurotoxin in the Middle East. Clin Cosmet Investig Dermatol 2023; 16:2899-2909. [PMID: 37869533 PMCID: PMC10590140 DOI: 10.2147/ccid.s420921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/25/2023] [Indexed: 10/24/2023]
Abstract
Background Aesthetic minimally invasive procedures have become very popular and culturally acceptable among Middle Eastern populations. Botulinum neurotoxin type A (BoNTA) is a valuable treatment modality for many cosmetic as well as therapeutic indications. The presence of BoNTA in our toolkit has revolutionized the field of aesthetic medicine to the point where it is now one of the most commonly performed cosmetic procedures worldwide. This consensus considers popular on- and off-label BoNTA indications in the Middle East. Methods A multinational group of ten key opinion leaders, experts in facial plastic surgery and dermatology, convened the Middle East Aesthetics Consensus Group and reviewed the aesthetic applications of BoNTA. Recommendations and position statements were drafted based on the integration of the panel's clinical experience with published data, targeted to the practices implemented in the Middle Eastern and the global population. Results Guidance statements are presented covering Middle Eastern facial characteristics and beauty ideals, BoNTA characteristics, pre-operative counselling, treatment indications and anatomical considerations, off-label and special uses including high-dose recommendations, and post-treatment advice. Throughout, an evidence-based approach to selection of products and injection techniques is provided, supplemented by the experts' advice on injections dosages and placement. Conclusion This consensus reflects the knowledge and expertise of physicians practicing in the Middle East. The panel acknowledged the use of on-label indications and variability in the toxin formulations and immunogenicity and agreed upon a wide use of "off-label" indications.
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Affiliation(s)
- Shazia Ali
- Department of Dermatology, University of Wales College of Medicine, Cardiff, Wales, UK
- TrueMe Medical Centre, Jeddah, Kingdom of Saudi Arabi
| | - Faten AL Bukhari
- Department of Dermatology, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Khaled Al Nuaimi
- Department of Dermatology, College of Medicine, Sharjah University, Sharjah, United Arab Emirates
| | - Hossam Elenany
- Department of Dermatology and Aesthetic Medicine, DaO Derma, Cairo, Egypt
| | - Nabil Fakih-Gomez
- Department of Facial Plastic Surgery, Fakih Hospital, Khaizaran, Lebanon
| | - Sahar Ghannam
- Department of Dermatology, Alexandria University, Alexandria, Egypt
| | - Rami Haidar
- Skin Experts Polyclinic, Dubai, United Arab Emirates
| | - Nicanor Isse
- Department of Dermatology, Medcare Hospital and Clinics, Dubai, United Arab Emirates
| | - Nancy Labib
- Department of Dermatology, Medcare Hospital and Clinics, Dubai, United Arab Emirates
| | - Afshin Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, London, UK
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Bazargan AS, Tabavar A, Roohaninasab M, Ali ZN, Tavana Z, Montazeri SSM, Jafarzadeh A. Evaluation of the effect of botulinum toxin injection in aggravating or improving seborrheic dermatitis symptoms: A prospective, single-arm clinical trial. Skin Res Technol 2023; 29:e13478. [PMID: 37881062 PMCID: PMC10517391 DOI: 10.1111/srt.13478] [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: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Considering the proven therapeutic effect of botulinum toxin and the pathophysiology of seborrheic dermatitis, conflicting hypotheses have been put forward regarding the effect of injection of this toxin on the improvement or exacerbation of seborrheic dermatitis. Because of the lack of consistent studies investigating this relationship, we decided to conduct this study to investigate the effect of local botulinum toxin injection on sebum production and improvement or worsening of seborrheic dermatitis lesions. METHOD This study was a prospective, single-arm clinical trial that involved the injection of botulinum toxin into 20 patients with complaints of skin wrinkles and simultaneous symptoms of seborrheic dermatitis. The trial was conducted at a dermatology clinic between March 2019 and March 2021. Two important characteristics of these patients were seborrheic dermatitis on the face or scalp and a referral for botulinum toxin injection to remove facial wrinkles. The Seborrheic Dermatitis Area and Severity Index (SDASI) was used to determine the severity of symptoms. RESULTS In study of 20 patients with an average age of 40 years, despite the decrease in the average scores of all examined criteria of seborrheic dermatitis symptoms in study, 1 month after botulinum toxin injection, no significant effect of using this toxin was seen on the improvement of patients' symptoms (p value >0.05). CONCLUSION Despite the emphasis of many studies on the effectiveness of botulinum toxin in reducing the activity of sebaceous glands, the use of botulinum toxin as a therapeutic modality for control the symptoms of seborrheic dermatitis is not suggested by this study. Conducting studies in which the location and technique of injection and the follow-up intervals of patients in them are based on the standard of other studies, are the suggestions made by comparing the results and method of the current study with other studies.
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Affiliation(s)
- Afsaneh Sadeghzadeh Bazargan
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
- Skin and Stem Cell Research Center, Tehran University of Medical SciencesTehranIran
| | - Anahita Tabavar
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Masoumeh Roohaninasab
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
- Skin and Stem Cell Research Center, Tehran University of Medical SciencesTehranIran
| | - Zahra Naeimaei Ali
- Student Research Committee, Iran University of Medical SciencesTehranIran
| | - Zeynab Tavana
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | | | - Alireza Jafarzadeh
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
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Abstract
Botulinum neurotoxins (BoNTs) are multi-domain proteins whose potent and selective actions on nerve endings have led to innovations in both basic and clinical science. The various BoNT domains are responsible for binding to gangliosides and proteins associated with nerve cell membranes, internalization into the cell, and cleavage of one or more SNARE (soluble N-ethylmaleimide sensitive factor attachment protein receptor) proteins necessary for vesicle docking and fusion. Novel modifications to BoNT molecules, such as the creation of chimeras, helped identify the protein domains responsible for various aspects of BoNT action, such as localized effects. Other molecular modifications have been introduced in attempts to increase the specificity of BoNTs for autonomic or sensory neurons, with the ultimate goal of optimizing therapeutic selectivity. This research, in turn, has led to the development of BoNT-based proteins that can target non-SNARE substrates such as phosphatase and tensin homolog (PTEN). Still others are developing different BoNT serotypes, subtypes, or variants that are longer- or shorter-acting or have faster onset for various clinical purposes. New formulations of BoNTs that provide convenience for both patients and physicians are under investigation. Novel clinical uses are being evaluated for onabotulinumtoxinA, including in the prevention of post-operative atrial fibrillation. All these innovations capitalize on the unique properties of BoNTs, which continue to intrigue scientists and clinicians across numerous fields of study.
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Affiliation(s)
| | - J Oliver Dolly
- International Centre for Neurotherapeutics, Dublin City University, Dublin, Ireland
| | - Mitchell F Brin
- Allergan/AbbVie, Irvine, CA, USA
- University of California, Irvine, CA, USA
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10
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Hexsel D, Valente-Bezerra I, Mosena G, Oakim Mourao MA, Fabris VC. Subjective and Objective Measurements of the Facial Effects of Microdoses of Botulinum Toxin. Dermatol Pract Concept 2023; 13:e2023168. [PMID: 37557136 PMCID: PMC10412053 DOI: 10.5826/dpc.1303a168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Studies have suggested that botulinum toxin A may improve skin quality, and application protocols using hyper-diluted doses of botulinum toxin (microdosing) have been studied as a way to achieve therapeutic goals without fully paralyzing the targeted muscles. OBJECTIVES To evaluate the effects of a combined protocol utilizing both the standard dosing and the microdosing of AbobotulinumtoxinA for the improvement of skin quality, measured by objective and subjective measurements. METHODS Thirty patients were treated with botulinum toxin using both the standard technique and the microdosing technique. Objective (Sebumeter®, Mexameter® and digital dermoscopy pictures) and subjective (Global Aesthetic Improvement Scale and a clinical scale for evaluating the quality of facial skin) measurements of the effects in the treated areas were taken to assess the efficacy of the treatment. RESULTS Digital dermoscopy showed a marked reduction of erythema and telangiectasias. Erythema and telangiectasias improved both on objective and subjective measurements. Skin oleosity, static rhytids, papules and pustules and enlarged pores improved on subjective measurements. Patient satisfaction was high (93%) despite the high rate of adverse events (56%). CONCLUSIONS The combined application of standard doses and microdoses of AbobotulinumtoxinA is effective in improving the overall quality of facial skin. The effects on erythema and telangiectasias suggest that it is an effective treatment option for patients with erythematotelangiectatic rosacea. When applying microdoses of botulinum toxin in the lower and mid-face, the doses and pattern of injection should be customized for each patient to reduce the occurrence of adverse events.
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Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, Rio Grande do Sul, Brazil
- Hexsel Dermatologic Clinic, Porto Alegre, Rio Grande do Sul, Brazil
| | - Indira Valente-Bezerra
- Brazilian Center for Studies in Dermatology, Porto Alegre, Rio Grande do Sul, Brazil
- Hexsel Dermatologic Clinic, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela Mosena
- Brazilian Center for Studies in Dermatology, Porto Alegre, Rio Grande do Sul, Brazil
- Hexsel Dermatologic Clinic, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Vitor Costa Fabris
- Brazilian Center for Studies in Dermatology, Porto Alegre, Rio Grande do Sul, Brazil
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Li R, Chen X, Sun H, Hao L, Luo S. Application of 3-Dimensional Technology for Evaluating Muscular Type and Muscle-Fat Pad Mixed-Type Nasolabial Folds With Botulinum Toxin-A Treatment. Aesthet Surg J 2023; 43:NP271-NP282. [PMID: 36536480 DOI: 10.1093/asj/sjac341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Botulinum toxin-A (BTX-A) is used in the treatment of nasolabial folds (NLFs). However, lighting and clinician subjectivity play a major role in evaluating the efficacy of this treatment. OBJECTIVES By applying 3-dimensional (3D) technology, this study aimed to quantitatively evaluate the effects of BTX-A injection on muscular (M) and muscle-fat pad mixed-type (MF) NLFs. METHODS BTX-A was injected into bilateral marked points on the NLFs, where the levator labii alaeque nasi, zygomaticus minor, and zygomaticus major pull the skin to form the NLF (2 U at each injection site). Pretreatment and posttreatment 3D facial images were captured with static and laughing expressions. The curvature, width, depth, and lateral fat volume of the NLFs were measured to compare the therapeutic efficacy for type M and MF NLFs. RESULTS Thirty-nine patients with type M and 37 with type MF NLFs completed the follow-up data. In these patients, the curvature, width, and depth of the NLF showed a significant reduction at 1 month and gradually recovered at 3 and 6 months after treatment, with more significant improvement when laughing than when static. Variations compared to the pretreatment values of type MF were greater than those of type M at each time point. The lateral fat volume of the type MF NLF was significantly reduced (P < .05). CONCLUSIONS 3D technology can quantitatively evaluate the effects BTX-A injection for treating type M and type MF NLFs. BTX-A is more effective on type MF than on type M NLFs. LEVEL OF EVIDENCE: 4
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Sun Y, Li Y, Zhang Y, Dong R, Lan X, Zhang M, Yu N, Long X. Unparallel improvement patterns of dynamic wrinkles and skin quality after botulinum toxin type A treatment on the upper face. Skin Res Technol 2023; 29:e13309. [PMID: 36973993 PMCID: PMC10155803 DOI: 10.1111/srt.13309] [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: 02/04/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Botulinum toxin type A (BoNT-A) can not only reduce the dynamic wrinkles but also improve the skin quality. This study aims to quantitaively and comprehensively assess the improvement of dynamic wrinkles and skin quality following BoNT-A treatment on the upper face. METHODS Patients were recruited to receive BoNT-A treatment of the glabellar, frontal, and lateral periorbital wrinkles. Antera 3D camera was used to evaluate the skin quality and dynamic wrinkle severity. Follow-up visits were at 1 week, 1 month, 3 months, and 6 months after treatment. Different filters were utilized to quantitatively detect the severity of fine wrinkles (FWS), the volume of pores (PV), the roughness of skin texture (STR), and the severity of dynamic wrinkles (DWS). RESULTS Twenty-four participants (average 30.5 ± 7.2 years) were recruited. The significant improvement of PV, FWS, and STR in different areas usually maintained from 1 to 6 months after injections but of DWS only existed within 3 months. For each area, the improvement rates of FWS, PV, and STR peaked at 3 months or 6 months after treatment while the maximal improvement of DWS was observed at 1 month posttreatment. CONCLUSION After BoNT-A treatment for dynamic wrinkles on the upper face, the skin quality of target regions can also be ameliorated. The improvement of skin quality and dynamic wrinkles presented unparallel patterns. The former is with a slower onset but longer duration while the latter exhibits a more rapid onset but shorter duration.
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Affiliation(s)
- Yixin Sun
- Department of Plastic SurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yunzhu Li
- Department of Plastic SurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yixuan Zhang
- Department of Plastic SurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ruijia Dong
- Department of Plastic SurgeryBeijing Tsinghua Changgung Hospital, Tsinghua UniversityBeijingChina
| | - Xinze Lan
- School of ComputingNational University of SingaporeSingaporeSingapore
| | - Mengyuan Zhang
- Department of Plastic SurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Nanze Yu
- Department of Plastic SurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiao Long
- Department of Plastic SurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Salem RM, Salah SAE, Ibrahim SE. Microbotox injection versus its topical application following microneedling in the treatment of wide facial pores: A split face comparative study. J Cosmet Dermatol 2023; 22:1249-1255. [PMID: 36606384 DOI: 10.1111/jocd.15590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Enlarged facial pores and seborrhea are common cosmetic problems. Mesobotox has been proved to be effective safe therapeutic option. OBJECTIVE To compare the efficacy and longevity of intradermal mesobotox injection versus its topical application with microneedling for treatment of wide facial pores and seborrhea. MATERIALS AND METHODS This split face study was conducted on 20 patients with enlarged facial pores and seborrhea. One side of the face was treated with intradermal injection of botulinum toxin, the other was treated with its topical application following microneedling. Patient evaluation was performed after 1 month then after 4 months. CONCLUSION Microbotox can effectively and safely minimize enlarged facial pores with no downtime. Intradermal injection showed more patient satisfaction on the basis of greater efficacy, longevity of treatment than its topical application following microneedling.
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Affiliation(s)
| | | | - Samah Ezzat Ibrahim
- Dermatology and Andrology, Faculty of Medicine-Benha University, Benha, Egypt
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14
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Ibrahim AM, Omar GAB, Hamdino M. Long‐pulsed
Nd:
YAG
laser (1064 nm) versus intralesional botulinum toxin type (A) in acne vulgaris therapy: a split face study. Int J Dermatol 2022; 62:822-830. [PMID: 36468835 DOI: 10.1111/ijd.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/06/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acne can be considered more than a cosmetic concern due to its large impact on patients' quality of life. There are various therapeutic options for inflammatory acne, but inconvenience and undesirable side effects prompted a search for more acceptable treatments. This study aimed to compare the clinical efficacy and safety of long-pulsed Nd: YAG laser 1064 nm versus intralesional botulinum toxin type-A (BTX-A) in inflammatory acne therapy. METHODS A prospective randomized split-face comparative study involved 30 patients with inflammatory acne. Each patient received long-pulsed Nd: YAG 1064 nm laser on one side, and intralesional BTX-A on the other side, monthly until improvement or maximum three sessions. Cases were assessed by acne lesions counting and grading of severity by Investigator's Global Assessment of acne (IGAs) at baseline, each session, and after 3 months follow-up. RESULTS A highly statistically significant improvement in lesions count and IGAs for both sides was observed, with statistically non-significant difference between both sides at end of treatment sessions. While, after 3 months follow-up, there was a more significant improvement at laser side. CONCLUSION Both long-pulsed Nd: YAG laser 1064 nm and intralesional BTX-A are safe and effective for acne therapy. Nd-YAG laser has a more prolonged efficacy and lower recurrence rate than intralesional BTX-A.
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Affiliation(s)
- Asia Mohammed Ibrahim
- Dermatology and Venereology Department Faculty of Medicine for Girls Al‐Azhar University Cairo Egypt
| | - Ghada Abdel Badea Omar
- Dermatology and Venereology Department Faculty of Medicine for Girls Al‐Azhar University Cairo Egypt
| | - Mervat Hamdino
- Dermatology and Venereology Department Faculty of Medicine for Girls Al‐Azhar University Cairo Egypt
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Birkett L, Dhar S, Singh P, Mosahebi A. Botulinum Toxin A in the Management of Acne Vulgaris: Evidence and Recommendations. Aesthet Surg J 2022; 42:NP507-NP509. [PMID: 35171221 PMCID: PMC9208820 DOI: 10.1093/asj/sjac037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Liam Birkett
- Corresponding Author: Dr Liam Birkett, 1106 Cassia Point, 2 Glasshouse Gardens, Stratford, London E20 1HW, UK. E-mail:
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Rho NK, Gil YC. Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism. Toxins (Basel) 2021; 13:817. [PMID: 34822601 PMCID: PMC8626011 DOI: 10.3390/toxins13110817] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Intradermal injection of botulinum neurotoxin is a frequently performed procedure in aesthetic dermatology to improve facial skin tone, texture, fine wrinkles, and enlarged pores. In practice, botulinum neurotoxin type A is also used to reduce skin oiliness of the face. There is increasing evidence that acetylcholine plays specific roles in sebum production, suggesting that botulinum neurotoxin type A may reduce sebum production by interfering with cholinergic transmission between sebaceous glands and autonomic nerve terminals. Botulinum neurotoxins can also inhibit several pathogenetic components of acne development, suggesting that botulinum neurotoxins can be used as a safe and effective treatment modality for acne and other skin disorders related to overactivity of sebaceous glands. This review aims to explore the current evidence behind the treatment of facial seborrhea and acne with botulinum neurotoxin type A.
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Affiliation(s)
- Nark-Kyoung Rho
- Department of Dermatology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea;
- Leaders Aesthetic Laser & Cosmetic Surgery Center, Seoul 06014, Korea
| | - Young-Chun Gil
- Department of Anatomy, Chungbuk National University School of Medicine, Cheongju 28644, Korea
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