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Konda SM, Woodward JA. A Comprehensive Review of Use of Neurotoxins for Periocular Rejuvenation. Int Ophthalmol Clin 2024; 64:51-59. [PMID: 38910505 DOI: 10.1097/iio.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
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2
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Carruthers J, Carruthers A, Blitzer A, Eadie N, Brin MF. Treatment of glabellar lines with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine (Baltimore) 2023; 102:e32375. [PMID: 37499082 PMCID: PMC10374180 DOI: 10.1097/md.0000000000032375] [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] [Indexed: 07/29/2023] Open
Abstract
OnabotulinumtoxinA is an injectable medication that produces muscle relaxation through local chemical denervation at the neuromuscular junction. Discovery of onabotulinumtoxinA's aesthetic benefits occurred serendipitously in the 1980s at the intersection of several medical disciplines, including ophthalmology, neurology, otolaryngology, and dermatology. Patients receiving onabotulinumtoxinA for blepharospasm, hemifacial spasm, and dystonia noticed their periorbital wrinkles disappearing, particularly frown lines between the eyebrows called glabellar lines (GL). Aesthetic use of onabotulinumtoxinA necessitated rigorous training programs and vigilant monitoring by Allergan. Approval for the GL indication was based on 2 similarly designed, double-blind, randomized, multicenter clinical studies. Subjects with moderate to severe GL receiving onabotulinumtoxinA achieved significantly greater improvement in GL severity than those receiving placebo. In subsequent studies, more than 80% of subjects were satisfied with onabotulinumtoxinA treatment through day 60, and many reported looking approximately 4 years younger at weeks 4 and 12 than at baseline. OnabotulinumtoxinA has a rapid onset of action, and peak effect occurs between 30 and 60 days. The median duration of response for dynamic GL in the initial studies was 120 days and response progressively improved with subsequent treatments. OnabotulinumtoxinA was well tolerated, and the 2 most common adverse events, headache and blepharoptosis, tended to decrease in frequency with repeat treatment. The novel use of onabotulinumtoxinA for treating GL was an important step in addressing the clinical need for a noninvasive, straightforward, office-based procedure for facial lines that also left patients extremely satisfied with its treatment effects and represented the beginning of its widespread use for numerous aesthetic indications.
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Affiliation(s)
| | | | - Andrew Blitzer
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- Mount Sinai West Hospital Center, New York, NY, USA
| | - Nina Eadie
- Former employee of Allergan plc, Irvine, CA, USA
| | - Mitchell F Brin
- Allergan/AbbVie, Irvine, CA, USA
- University of California, Irvine, CA, USA
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Rasteau S, Savoldelli C, Winter C, Lerhe B, Castillo L, Kestemont P. Botulinum toxin type A for the treatment of excessive gingival display - A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e717-e723. [PMID: 35577306 DOI: 10.1016/j.jormas.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
Gummy smile has traditionally been treated with invasive or demanding surgical and orthodontic techniques. Several studies have shown that targeted injection of the upper lip elevator muscles with botulinum toxin is an effective treatment for this condition. However, no standardized injection protocol with reproducible results has yet been published. A systematic review of the literature has been performed using Medline, Scopus, and Embase. All articles relevant to the research question were analyzed. After removing duplicates, 162 articles were selected, of which 9 were included in the analysis after applying exclusion and inclusion criteria, for a total of 269 patients. Onabotulinum toxin type A (ONA-BoNTA) was used in 7 studies and abobotulinum toxin type A (ABO- BoNTA) in 2 studies, at various dilutions. The number of sites injected varied from 1 to 3 per side, with variable targeting of the Levator labii superioris alaeque nasalis, Levator labii superioris, Zygomaticus minor, Zygomaticus major and Orbicularis oris. The dose used per side varied from 1.25 to 6 U of ONA-BoNTA and from 2.5 to 7.5 U of ABO- BoNTA. The injection protocol was tailored to the type of gingival smile in one study only, another study compared results of targeting two different muscles, and one study evaluated different dosages of toxin for the same injection site. The average improvement ranged from 24.85% to 99.65% and the effect persisted from 12 to 36 weeks. Very good patient satisfaction was reported in 6 studies. Fourteen adverse events were reported, all of them mild and transient. The treatment of gummy smile by botulinum toxin injection is effective, safe, rapid, minimally invasive and reversible. Protocols vary widely in the literature and no standardized procedure emerges. A patient-specific approach, adapted to their anatomy, type of gummy smile and the severity of the exposure seems to be the most appropriate. Randomized controlled studies are needed to make this approach more systematic.
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Affiliation(s)
- Simon Rasteau
- Maxillo-Facial Surgery, Facial Plastic Surgery, Stomatology and Oral Surgery, Hospices Civils de Lyon, Lyon-Sud Hospital - Claude-Bernard Lyon 1 University, 165 chemin du Grand-Revoyet 69495, Pierre-Bénite 69310, France; University Institute of the Face and Neck, Côte d'Azur University, Nice University Hospital, 31 Avenue de Valombrose, Nice 06100, France.
| | - Charles Savoldelli
- University Institute of the Face and Neck, Côte d'Azur University, Nice University Hospital, 31 Avenue de Valombrose, Nice 06100, France
| | - Cécile Winter
- Saint George Aesthetic Clinic, 2 Avenue de Rimiez, Nice 06105, France
| | - Barbara Lerhe
- University Institute of the Face and Neck, Côte d'Azur University, Nice University Hospital, 31 Avenue de Valombrose, Nice 06100, France
| | - Laurent Castillo
- University Institute of the Face and Neck, Côte d'Azur University, Nice University Hospital, 31 Avenue de Valombrose, Nice 06100, France
| | - Philippe Kestemont
- University Institute of the Face and Neck, Côte d'Azur University, Nice University Hospital, 31 Avenue de Valombrose, Nice 06100, France; Saint George Aesthetic Clinic, 2 Avenue de Rimiez, Nice 06105, France
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Zhong Y, Cao D, Zhou S, Duan H, Wei M, Yu Z. A Single-Blinded Prospective Study on Using Botulinum Toxin Type A for Reducing Alar Mobility. Aesthet Surg J 2022; 42:460-469. [PMID: 34533193 DOI: 10.1093/asj/sjab343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With widespread utilization of instant social media, people desire a minimally invasive treatment to improve alar dynamic aesthetic, but few practical procedures on reducing alar mobility have been conducted. OBJECTIVES This study aimed to verify the effects of botulinum toxin on reducing nasal alar mobility and provide a supplemental treatment of rhinoplasty. METHODS This single-blind prospective study included a cohort of 20 participants with the desire to improve their alar dynamic aesthetic. The experimental group was injected with 3U botulinum toxin type A at dilator naris anterior, dilator naris vestibularis, levator labii superioris alaeque nasi, and dilator naris, and the control group received the equivalent of saline. Standardized facial movement (from rest to maximum smile without revealing teeth) was recorded with a 3-dimensional imaging system. The changes between rest and maximum smile statuses represented alar mobility and were generated by MOBILITY=WIDTHsmile-WIDTHrestWIDTHrest×100 % . Alar mobility and root mean square analysis were employed for postoperative evaluations. RESULTS In the experimental group, alar flaring mobility decreased from 10.05% ± 6.40% to 4.91% ± 3.48%(P < 0.05), and alar base mobility decreased from 16.83% ± 5.69% to 12.50% ± 4.89% (P < 0.05), whereas no significant changes in alar mobility were found in the control group. In root mean square analysis, changes in the experimental group were significantly higher than in the control group (P < 0.05). CONCLUSIONS Botulinum toxin type A can effectively restrain alar mobility without any significant adverse events and improve alar dynamic esthetic, which can serve as a minimally invasive method or supplemental treatment for rhinoplasty. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Yehong Zhong
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dejun Cao
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sizheng Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huichuan Duan
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Wei
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheyuan Yu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Immunogenicity of botulinum toxin. Arch Plast Surg 2022; 49:12-18. [PMID: 35086302 PMCID: PMC8795657 DOI: 10.5999/aps.2021.00766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 11/07/2021] [Indexed: 11/08/2022] Open
Abstract
Botulinum toxin treatment is the most common non-surgical cosmetic treatment. Although there are many available treatments using botulinum toxin, their effects are temporary and repeated injections are required. These frequent injections can trigger an immunological response. In addition, botulinum toxin acts as an antigen in the body; thus, its effect disappears progressively due to this immunological reaction, which may cause treatment failure. Active botulinum toxin consists of a core neurotoxin and complexing proteins, the exact effects of which remain unclear. However, the complexing proteins are closely related to the immune response and the formation of neutralizing antibodies. Since neutralizing antibodies can lead to treatment failure, their formation should be prevented. Furthermore, various methods of detecting neutralizing antibodies have been used to predict treatment failure.
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Effective Locations for Injecting Botulinum Toxin into the Mentalis Muscle; Cadaveric and Ultrasonographic Study. Toxins (Basel) 2021; 13:toxins13020096. [PMID: 33514053 PMCID: PMC7911364 DOI: 10.3390/toxins13020096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 11/28/2022] Open
Abstract
The mentalis muscle is now considered key structures when performing procedures for rejuvenating the lower face. The aim of this study was to determine the anatomical morphology and location of the mentalis muscle and thereby provide anatomical information for facilitating clinical procedures designed to rejuvenate the lower face. Forty-four adult hemifaces from five Thai cadavers and 21 Korean cadavers were dissected to identify the locations of the mentalis muscle. Sixty-six hemifaces from 33 healthy young Korean subjects were included in an ultrasonographic study. The depth of the mentalis muscle below the skin surface, the thickness of the mentalis muscle, and the distance from the bone to the mentalis muscle were measured at the two points that were 5 mm lateral to the most-prominent point of the chin. The mentalis muscle was classified into two types based to its shape: in type A (86.4%, 38 of the 44 cases) it was dome shaped in three dimensions, while in type B (13.6%, 6 of the 44 cases) it was flat. The mentalis muscle was present mostly at the area 5–10 mm from the midsagittal line and 20–30 mm from a horizontal line connecting the mouth corners. The mentalis muscle was present between depths of 6.7 to 10.7 mm below the skin. This new information about the location of the mentalis muscle may help when identifying the most effective and safe botulinum toxin injection points and depths during esthetic procedures for weakened facial rhytides on the lower face.
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Zidan A, Hussaini S, Gibson S, Brooks G, Mejico L. Onabotulinumtoxin Type A reconstitution with preserved versus preservative-free saline in chronic migraine (B-RECON). A randomised, double-blind trial. Int J Clin Pract 2020; 74:e13522. [PMID: 32350975 DOI: 10.1111/ijcp.13522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Onabotulinumtoxin type A (BoNTA) is manufactured as powder that requires reconstitution with normal saline prior to injection. Previous literature has suggested that preserved saline (PS) exerts a local anaesthetic effect, and reduces the procedure discomfort when used in reconstitution in lieu of preservative-free saline (PFS). However, this was mainly studied in the aesthetics indications of BoNTA, and never in its use for the treatment of chronic migraine. The distinction is important as chronic migraine population suffers high incidence of scalp allodynia which makes it more prone to injection site pain. In addition, the pain of the procedure itself may be related to the spike of migraine frequency in the immediate postprocedural period which can occur in up to 5% of patients receiving the treatment. Our trial aimed to study the difference in procedural pain scale, and postprocedural headache rating with the use of PS vs PFS in constitution of BoNTA when used as a treatment for chronic migraine. METHODS 68 subjects were consecutively enrolled in an outpatient setting at a large tertiary headache centre over a period of 6 months. Subjects were randomised into PS or PFS group. BoNTA was administered as per standard protocol in both groups. Injection site pain scores and frequency of headache days in the immediate following week were recorded. Wilcoxon rank sum tests were used to compare differences in between groups using SPSS software. RESULTS Analysis (SAS V 9.4) revealed that those receiving [PF] had significantly higher procedure pain scores than those receiving [P] (5.3 vs 3.2, respectively). There was no difference in the headache or migraine frequency in the immediate postprocedural period. CONCLUSION This study supports the use of PS (bacteriostatic) over PFS for reconstitution of BoNTA in chronic migraine as it reduces the discomfort of the injection sites.
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Affiliation(s)
- Awss Zidan
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Sharmeen Hussaini
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Sandra Gibson
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Gary Brooks
- Center for Research and Evaluation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Luis Mejico
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
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Delpachitra SN, Sklavos AW, Dastaran M. Clinical uses of botulinum toxin A in smile aesthetic modification. Br Dent J 2019; 225:502-506. [PMID: 30264779 DOI: 10.1038/sj.bdj.2018.755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 11/09/2022]
Abstract
In this article we review the pharmacodynamics of commercially available preparations of botulinum toxin type A, and discuss the potential uses of the drug in smile modification. A major emphasis is placed on applications relevant to modern dental practice, and to the complications arising from its use. Botulinum toxin A, when applied correctly, is a safe and effective means of achieving aesthetic smile modification, with limited data on any demonstrable long-term adverse effects.
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Affiliation(s)
- S N Delpachitra
- Lead Registrar, Oral and Maxillofacial Surgery The Royal Dental Hospital of Melbourne 720 Swanston St, Carlton Australia, 3,053 E
| | - A W Sklavos
- Oral and Maxillofacial Surgery Resident The Royal Dental Hospital of Melbourne 720 Swanston St, Carlton Australia, 3,053 E
| | - M Dastaran
- Consultant Oral and Maxillofacial Surgeon, The Royal Melbourne Hospital 300 Grattan Street, Parkville Australia 3050
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9
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Seo MS, Kim YI, Kang KK, Oh SK, Sung SE, Jung YS, Cho JY, Song H, Hwang DY, Park SJ, Kim KS. Comparison study of the response with botulinum toxin muscle injection in the ICR mice from three different sources. Lab Anim Res 2019; 35:11. [PMID: 32257899 PMCID: PMC7081521 DOI: 10.1186/s42826-019-0010-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
Botulinum-toxin A (BoNT/A) is a widely used not only for cosmetics but also for various experimental purposes including muscle-related research. In this study, we applied BoNT/A to mouse muscle of three different sources to compare and evaluate the biological and pathological response. The three different mouse sources consist of Korl:ICR (Korea FDA source), A:ICR (USA source) and B:ICR (Japan source) which were purchased from each different vendors. To compare the responses of ICR mice with BoNT/A muscle injection, we examined the body weight, hematological and serum biochemistry analysis. Also, we evaluated the muscle change by histopathological analysis and gene expression patterns of muscle-related target by qPCR. The body weight gain was decreased in the BoNT/A-treated group compared with the control group. In clinical pathologic analysis and gene expression patterns, the data showed that the responses in the BoNT/A-treated group were similar compared with the control group. Decreased muscle fiber was observed in BoNT/A-treated group compared with control group, while Korl:ICR showed a little low response with the other mouse sources. In conclusion, our results suggest that three different sources ICR mice (Korl:ICR, A:ICR and B:ICR) have a similar biological and pathological responses in BoNT/A muscle injection.
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Affiliation(s)
- Min-Soo Seo
- 1Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | | | - Kyung-Ku Kang
- 1Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | - Se-Kyung Oh
- 1Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | - Soo-Eun Sung
- 1Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea
| | - Young-Suk Jung
- 3Department of Pharmacy, College of Pharmacy, Pusan National University, Busan, Korea
| | - Joon Yong Cho
- 4Department of Health and Exercise Science, Korea National Sport University, 88-15 Oryung-dong, Songpa-gu, Seoul, Korea
| | - HyunKeun Song
- Central Research Institute, Kine sciences, F1, Milovany, 28, Inchon-ro, Seongbuk-gu, Seoul, Korea
| | - Dae Youn Hwang
- 6Department of Biomaterials Science, College of Natural Resources & Life Science/Life and Industry Convergence Research Institute, Pusan National University, Miryang, Korea
| | - Sang-Joon Park
- 7Laboratory of Histology, College of Veterinary Medicine, Kyungpook National University, Daegu, Korea
| | - Kil Soo Kim
- 1Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea.,8College of Veterinary Medicine, Kyungpook National University, Daegu, Korea
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Shome D, Kapoor R, Khare S. Two different types of botulinum toxins: Is there a difference in efficacy and longevity? J Cosmet Dermatol 2019; 18:1635-1641. [DOI: 10.1111/jocd.12949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 01/17/2019] [Accepted: 02/18/2019] [Indexed: 01/14/2023]
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Samizadeh S, De Boulle K. Botulinum neurotoxin formulations: overcoming the confusion. Clin Cosmet Investig Dermatol 2018; 11:273-287. [PMID: 29910630 PMCID: PMC5988049 DOI: 10.2147/ccid.s156851] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Botulinum toxin A is produced by anaerobic spore-forming bacteria and is used for various therapeutic and cosmetic purposes. Botulinum toxin A injections are the most popular nonsurgical procedure worldwide. Despite an increased demand for botulinum toxin A injections, the clinical pharmacology and differences in formulation of commonly available products are poorly understood. The various products available in the market are unique and vary in terms of units, chemical properties, biological activities, and weight, and are therefore not interchangeable. For safe clinical practice and to achieve optimal results, the practitioners need to understand the clinical issues of potency, conversion ratio, and safety issues (toxin spread and immunogenicity). In this paper, the basic clinical pharmacology of botulinum toxin A and differences between onabotulinum toxin A, abobotulinum toxin A, and incobotulinum toxin A are discussed.
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Chagas TF, Almeida NVD, Lisboa CO, Ferreira DMTP, Mattos CT, Mucha JN. Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis. Braz Oral Res 2018; 32:e30. [PMID: 29742231 DOI: 10.1590/1807-3107bor-2018.vol32.0030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 03/08/2018] [Indexed: 11/21/2022] Open
Abstract
Botulinum toxin type A is effective in reducing excessive gingival display caused by hyperfunctional upper lip elevator muscles; however, this effect is transient. This study aimed to determine the duration of the effectiveness of botulinum toxin type A on a gummy smile. A systematic search was conducted using Medline (PubMed), Scopus, and Web of Science electronic databases, from 1970 to March 2017 with no language restriction; the search included studies evaluating adult patients with excessive gingival display who were treated with botulinum toxin and were followed-up for at least 3 months. OpenGrey and Clinical Trial Registry were also consulted. Quality assessment was applied to determine the level of evidence and bias, and a meta-analysis was performed. Of 2181 full texts, 71 were obtained, with 3 prospective studies meeting the selection criteria. The gingival display was significantly reduced to baseline with 2, 4, and 8 weeks of treatment. The gingival display considerably reduced at the baseline-2-week comparison (-4.44 mm using raw data and-4.05 mm using the standard difference) and increased throughout the weeks of follow-up. There is scant evidence to determine the duration of the effectiveness of toxin type A on a gummy smile. The effect tends to be stable until at least 8 weeks of follow-up, and the gingival exposure may not return to baseline within 12 weeks of follow-up. Well-designed randomized clinical trials with a minimum of 6 months of follow-up are necessary to strengthen the evidence.
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Affiliation(s)
| | | | | | | | | | - José Nelson Mucha
- Department of Orthodontics, Universidade Federal Fluminense - UFF, Niterói, RJ, Brazil
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13
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The Use of Botulinum Neurotoxin Type A in Aesthetics: Key Clinical Postulates. Dermatol Surg 2017; 43 Suppl 3:S344-S362. [PMID: 33065958 DOI: 10.1097/dss.0000000000001412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The most common aesthetic procedure performed worldwide is the injection of botulinum neurotoxin Type A (BoNT-A). Aesthetic providers must fully comprehend the objective scientific data, theoretical mechanisms of action, and differences between brands of BoNT-A. OBJECTIVE To determine and review the relevant clinical postulates for the use of botulinum toxin in aesthetics. MATERIALS AND METHODS The BoNT-A clinical postulates presented here discuss how each brand of BoNT-A acts identically, how the molecular potency may vary between the different products, how patient age, gender, genetics, and muscle mass cause variation in toxin receptor number and density, and how both practitioner and patient can affect toxin distribution. RESULTS A total of 8 clinical postulates have been identified that are key to understanding the use of botulinum toxin in aesthetics and to obtaining the best clinical results. CONCLUSION All of these factors affect the potential efficacy of the injected toxin and hence the aesthetic results obtained.
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14
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Giordano CN, Matarasso SL, Ozog DM. Injectable and topical neurotoxins in dermatology: Indications, adverse events, and controversies. J Am Acad Dermatol 2017; 76:1027-1042. [PMID: 28522039 DOI: 10.1016/j.jaad.2016.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022]
Abstract
The use of neuromodulators for therapeutic and cosmetic indications has proven to be remarkably safe. While aesthetic and functional adverse events are uncommon, each anatomic region has its own set of risks of which the physician and patient must be aware before treatment. The therapeutic usages of botulinum toxins now include multiple specialties and multiple indications. New aesthetic indications have also developed, and there has been an increased utilization of combination therapies to combat the effects of global aging. In the second article in this continuing medical education series, we review the prevention and treatment of adverse events, therapeutic and novel aesthetic indications, controversies, and a brief overview of combination therapies.
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Affiliation(s)
| | - Seth L Matarasso
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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15
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Nestor M, Ablon G, Pickett A. Key Parameters for the Use of AbobotulinumtoxinA in Aesthetics: Onset and Duration. Aesthet Surg J 2017; 37:S20-S31. [PMID: 28388717 PMCID: PMC5434495 DOI: 10.1093/asj/sjw282] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Time to onset of response and duration of response are key measures of botulinum toxin efficacy that have a considerable influence on patient satisfaction with aesthetic treatment. However, there is no overall accepted definition of efficacy for aesthetic uses of botulinumtoxinA (BoNT-A). Mechanical methods of assessment do not lend themselves to clinical practice and clinicians rely instead on assessment scales such as the Frontalis Activity Measurement Standard, Frontalis Rating Scale, Wrinkle Severity Scale, and Subject Global Assessment Scale, but not all of these have been fully validated. Onset of activity is typically seen within 5 days of injection, but has also been recorded within 12 hours with abobotulinumtoxinA. Duration of effect is more variable, and is influenced by parameters such as muscle mass (including the effects of age and sex) and type of product used. Even when larger muscles are treated with higher doses of BoNT-A, the duration of effect is still shorter than that for smaller muscles. Muscle injection technique, including dilution of the toxin, the volume of solution injected, and the positioning of the injections, can also have an important influence on onset and duration of activity. Comparison of the efficacy of different forms of BoNT-A must be made with the full understanding that the dosing units are not equivalent. Range of equivalence studies for abobotulinumtoxinA (Azzalure; Ipsen Limited, Slough UK/Galderma, Lausanne CH/Dysport, Ipsen Biopharm Limited, Wrexham UK/Galderma LP, Fort Worth, TX) and onabotulinumtoxinA (Botox; Allergan, Parsippany, NJ) have been conducted, and results indicate that the number of units of abobotulinumtoxinA needs to be approximately twice as high as that of onabotulinumtoxinA to achieve the same effect. An appreciation of the potential influence of all of the parameters that influence onset and duration of activity of BoNT-A, along with a thorough understanding of the anatomy of the face and potency of doses, are essential to tailoring treatment to individual patient needs and expectations.
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Affiliation(s)
- Mark Nestor
- Voluntary Associate Professor, Department of Dermatology and Cutaneous Surgery, Department of Surgery, Division of Plastic Surgery, University of Miami Leonard Miller School of Medicine, Miami, FL, USA
| | - Glynis Ablon
- Associate Clinical Professor of Dermatology, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Andy Pickett
- Director and Founder of Toxin Science Limited, Wrexham, UK
- Adjunct Professor at the Botulinum Research Center, Institute of Advanced Sciences, Dartmouth, MA, USA
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16
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Abstract
Combination of procedures is necessary to obtain better results in facial rejuvenation. We have combined resorcinol chemical peel, topical tretinoin, oral isotretinoin, fat transplantation, GORE-TEX® implants, and Botox injections with good results and optimal patient acceptance.
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Cook BE, Lucarelli MJ, Lemke BN. The Depressor Supercilii Muscle: Anatomy, Histology, and Cosmetic Implications. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/074880680001700402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Briggs E. Cook
- From the Oculoplastics Service, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI (Drs Cook, Lucarelli, and Lemke) and the Davis Duehr Dean Clinic (Drs Cook and Lemke), Madison, Wis
| | - Mark J. Lucarelli
- From the Oculoplastics Service, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI (Drs Cook, Lucarelli, and Lemke) and the Davis Duehr Dean Clinic (Drs Cook and Lemke), Madison, Wis
| | - Bradley N. Lemke
- From the Oculoplastics Service, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI (Drs Cook, Lucarelli, and Lemke) and the Davis Duehr Dean Clinic (Drs Cook and Lemke), Madison, Wis
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Thomas JP, Siupsinskiene N. Frozen versus fresh reconstituted botox for laryngeal dystonia. Otolaryngol Head Neck Surg 2016; 135:204-8. [PMID: 16890068 DOI: 10.1016/j.otohns.2006.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Accepted: 04/04/2006] [Indexed: 10/24/2022]
Abstract
Objectives To compare the efficacy and side effects of frozen versus fresh reconstituted botulinum toxin type A (BTX-A) in the treatment of laryngeal dystonia. Study Design and Setting Prospective open-label crossover study; 43 adult patients with adductor spasmodic dysphonia were randomly treated with fresh or refrozen reconstituted BTX-A at a private voice center. Treatment outcomes were assessed by duration of action and self-rated satisfaction (7 point Likert scale). Side effects of breathiness and dysphagia for liquids were assessed as well. Results There was no statistically significant difference in the duration of action (mean, 16.2 ± 8.5 vs 16.0 ± 7.6 weeks) and self-rated satisfaction of the treatment (median, 6.0 vs 6.0 points). The side effects were similar for both BTX-A injection types. In addition, there were no instances of infection for refrozen injections. Conclusions BTX-A may be safely used after being reconstituted and frozen or refrozen without a significant loss of effectiveness or additional side effects. In our experience, the period of freezing was on 2 occasions for up to 8 weeks. Significance Refrozen BTX-A may be a cost-effective use of an expensive drug. EBM rating: B-2b
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Affiliation(s)
- James P Thomas
- Voice center, 909 NW 18th Avenue, Portland, OR 97209-2324, USA.
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Abstract
Botulinum toxin type A (BTA) can be used for facial aesthetics. The 3 currently available BTA types include onabotulinumtoxinA (Botox; Botox Cosmetic, Allergan, Irvine, CA), abobotulinumtoxinA (Dysport; Ipsen, Ltd, Berkshire, UK), and incobotulinumtoxinA (Xeomin; Merz Pharmaceuticals, Frankfurt, Germany). The mechanism of action and clinical uses for treatment of dynamic lines of the forehead, brow, glabella, lateral orbit, nose, and lips are presented, as well as treatment of masseter hypertrophy, platysmal bands, and improvements of the perioral region. Specific BTA injection sites and suggested doses are presented.
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Effect of intragastric injection of botulinum toxin A for the treatment of obesity: a meta-analysis and meta-regression. Gastrointest Endosc 2015; 81:1141-9.e1-7. [PMID: 25765772 DOI: 10.1016/j.gie.2014.12.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/01/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Controversies persist regarding the effect of intragastric injection of botulinum toxin A for the treatment of obesity. OBJECTIVE To assess the efficacy of intragastric botulinum toxin injection for the treatment of obesity. DESIGN A systematic literature review was conducted by using the core databases. Pre- and posttreatment body weight data were extracted and analyzed by using Hedges' g. A random-effects model was applied. The methodological quality of the enrolled studies was assessed by the risk of bias table and Newcastle-Ottawa Scale. Publication bias was evaluated via the funnel plot, trim and fill method, Egger's test, and rank correlation test. SETTING Meta-analysis of 8 studies. PATIENTS A total of 115 patients (79 treated vs 36 placebo). INTERVENTION Intragastric botulinum toxin A injection. MAIN OUTCOME MEASUREMENTS Hedges' g, calculated from pre- and posttreatment body weight data and comparison of body weight changes between treatment and placebo group. RESULTS The treatment group was associated with weight loss in a pre/post comparative approach and compared with the placebo group (Hedges' g: -0.443; 95% confidence interval, -0.845 to -0.040; P = .031; and Hedges' g: -0.521; 95% confidence interval, -0.956 to -0.085; P = .019). Wide area injection including the fundus or body rather than the antrum only was associated with weight loss. Multiple injections (>10) were associated with weight loss. However, a large amount of botulinum toxin A (500 IU) was not associated with weight loss. Sensitivity analyses showed consistent results. Meta-regression for the botulinum toxin A dose and number of injections showed consistent results. Publication bias was not detected. CONCLUSION In this analysis, intragastric injection of botulinum toxin A is effective for the treatment of obesity.
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Park SY, Park YW, Ji YJ, Park SW, Kim SG. Effects of a botulinum toxin type A injection on the masseter muscle: An animal model study. Maxillofac Plast Reconstr Surg 2015; 37:10. [PMID: 25938091 PMCID: PMC4407284 DOI: 10.1186/s40902-015-0010-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effect of a botulinum toxin type A (BTX-A) injection in the masseter muscle using electromyography (EMG) in an animal model. METHODS Ten male adult (>3 months of age) New Zealand white rabbits were used. Muscle activity was continuously recorded from 8 hours before to 8 hours after BTX-A injection. The rabbits received unilateral BTX-A injections of either 5 units (group 1, n = 5) or 20 units (group 2, n = 5). RESULTS The masseter muscle activity of the rabbits was significantly reduced immediately after BTX-A injection (P < 0.05 for both groups). When the results from group 1 were compared with those from group 2, only the peak voltage was significantly decreased in group 2 (P = 0.013). CONCLUSION Masseter muscle activity measured by EMG was immediately decreased after a BTX-A injection.
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Affiliation(s)
- Si-Yeok Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Young-Wook Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Young-Jun Ji
- Department of Biomedical Engineering, Ulsan University, Ulsan, Republic of Korea
| | - Sung-Wook Park
- Department of Electronic Engineering, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea.,Oral and Maxillofacial Surgery, Gangneung-Wonju National University-College of Dentistry, Gangneung, 210-702 Republic of Korea
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Haenzi S, Stefanics G, Lanaras T, Calcagni M, Ghosh A. Botulinum Toxin-A dose dependent perceptual loss on the hand after its cosmetic use on the face. Cortex 2015; 63:118-20. [DOI: 10.1016/j.cortex.2014.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
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Ramirez-Castaneda J, Jankovic J, Comella C, Dashtipour K, Fernandez HH, Mari Z. Diffusion, spread, and migration of botulinum toxin. Mov Disord 2013; 28:1775-83. [PMID: 23868503 DOI: 10.1002/mds.25582] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 04/17/2013] [Accepted: 05/23/2013] [Indexed: 01/17/2023] Open
Abstract
Botulinum toxin (BoNT) is an acetylcholine release inhibitor and a neuromuscular blocking agent used for the treatment of a variety of neurologic and medical conditions. The efficacy and safety of BoNT depends on accurate selection and identification of intended targets but also may be determined by other factors, including physical spread of the molecule from the injection site, passive diffusion, and migration to distal sites via axonal or hematogenous transport. The passive kinetic dispersion of the toxin away from the injection site in a gradient-dependent manner may also play a role in toxin spread. In addition to unique properties of the various BoNT products, volume and dilution may also influence local and systemic distribution of BoNT. Most of the local and remote complications of BoNT injections are thought to be due to unwanted spread or diffusion of the toxin's biologic activity into adjacent and distal muscles. Despite widespread therapeutic and cosmetic use of BoNT over more than three decades, there is a remarkable paucity of published data on the mechanisms of distribution and its effects on clinical outcomes. The primary aim of this article is to critically review the available experimental and clinical literature and place it in the practical context.
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Affiliation(s)
- Juan Ramirez-Castaneda
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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Park MY, Ahn KY. Effect of the refrigerator storage time on the potency of botox for human extensor digitorum brevis muscle paralysis. J Clin Neurol 2013; 9:157-64. [PMID: 23894239 PMCID: PMC3722467 DOI: 10.3988/jcn.2013.9.3.157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/26/2013] [Accepted: 03/26/2013] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose It is recommended that Botox be used within 5 hours of reconstitution, which results in substantial quantities being discarded. This is not only uneconomic, but also inconvenient for treating patients. The aim of this study was to determine the potencies of Botox used within 2 hours of reconstitution with unpreserved saline, the same Botox refrigerated (at +4℃) 72 hours after reconstitution, and during the next 4 consecutive weeks (weeks 1, 2, 3, and 4). This comparison was used to determine the length of refrigeration time during which reconstituted Botox will maintain the same efficacy as freshly reconstituted toxin. Methods Individual paralysis rates in the extensor digitorum brevis (EDB) compound muscle action potential (CMAP) amplitude and area were measured 1 week after injecting fresh reconstituted 2.5 MU of Botox on one side of the foot, and when the same quantity of Botox that had been refrigerated for a designated time (i.e., 72 h, or 1, 2, 3, or 4 weeks) into the other side of the foot. The EDB CMAP amplitude and area at 12 and 16 weeks postinjection were also measured to compare the efficacy durations in all five comparative groups. Results Ninety-four volunteers were divided into five groups according to the refrigerator storage time of the second Botox injection. The paralysis of the EDBs was significant for each injection of Botox, both fresh and refrigerated, with no statistically significant differences between them, regardless of the refrigeration time. There was a tendency toward increased CMAP amplitude and area at 12 or 16 weeks postinjection (p<0.0001). The duration of effective muscle paralysis did not differ significantly throughout the 16-week follow-up period between all five groups. Conclusions The potency of reconstituted Botox is not degraded by subsequent refrigeration for 4 weeks. However, there are definite concerns regarding its sterility, and hence its safety, since multiple withdrawals from the same vial over long periods can introduce bacterial contamination.
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Affiliation(s)
- Mee Young Park
- Department of Neurology, College of Medicine, Yeungnam University, Daegu, Korea
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Levy LL, Emer JJ. Complications of minimally invasive cosmetic procedures: prevention and management. J Cutan Aesthet Surg 2012; 5:121-32. [PMID: 23060707 PMCID: PMC3461789 DOI: 10.4103/0974-2077.99451] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT), soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care.
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Affiliation(s)
- Lauren L Levy
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
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Ganceviciene R, Liakou AI, Theodoridis A, Makrantonaki E, Zouboulis CC. Skin anti-aging strategies. DERMATO-ENDOCRINOLOGY 2012; 4:308-19. [PMID: 23467476 PMCID: PMC3583892 DOI: 10.4161/derm.22804] [Citation(s) in RCA: 371] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Skin aging is a complex biological process influenced by a combination of endogenous or intrinsic and exogenous or extrinsic factors. Because of the fact that skin health and beauty is considered one of the principal factors representing overall "well-being" and the perception of "health" in humans, several anti-aging strategies have been developed during the last years. It is the intention of this article to review the most important anti-aging strategies that dermatologists have nowadays in hand, including including preventive measurements, cosmetological strategies, topical and systemic therapeutic agents and invasive procedures.
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Affiliation(s)
- Ruta Ganceviciene
- Centre of Dermatovenereology; Vilnius University Hospital Santariskiu Klinikos; Vilnius, Lithuania
| | - Aikaterini I. Liakou
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau, Germany
| | - Athanasios Theodoridis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau, Germany
| | - Evgenia Makrantonaki
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau, Germany
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau, Germany
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Enhancing facial esthetics by other modalities. Int J Dent 2011; 2011:513957. [PMID: 21860623 PMCID: PMC3157159 DOI: 10.1155/2011/513957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 07/02/2011] [Indexed: 11/18/2022] Open
Abstract
Preprosthetic surgeries are generally dealt with surgical procedures performed to facilitate fabrication of prosthesis or improve the prognosis of prosthodontic care. In general the surgical procedures include various soft and hard tissue procedures which are restricted intraorally. Maxillofacial prosthodontics is not restricted to restorations performed intra-orally. Various extraoral surgical procedures have come into light in the recent past which helps to improve the prosthodontic outcome of craniofacial region. The current paper tries to elaborate various minimally invasive cosmetic reconstructive procedures and materials available in recent times.
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HEXSEL DORIS, RUTOWITSCH MARCIOS, DE CASTRO LIACÂNDIDAM, DO PRADO DÉBORAZECHMEISTER, LIMA MARYELLEMOREIRA. Blind Multicenter Study of the Efficacy and Safety of Injections of a Commercial Preparation of Botulinum Toxin Type A Reconstituted up to 15 Days Before Injection. Dermatol Surg 2009; 35:933-9; discussion 940. [DOI: 10.1111/j.1524-4725.2009.01158.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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High Versus Low Concentration Botulinum Toxin A for Benign Essential Blepharospasm: Does Dilution Make a Difference? Ophthalmic Plast Reconstr Surg 2009; 25:81-4. [DOI: 10.1097/iop.0b013e31819946c4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hwang WS, Hur MS, Hu KS, Song WC, Koh KS, Baik HS, Kim ST, Kim HJ, Lee KJ. Surface Anatomy of the Lip Elevator Muscles for the Treatment of Gummy Smile Using Botulinum Toxin. Angle Orthod 2009; 79:70-7. [DOI: 10.2319/091407-437.1] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Accepted: 02/01/2008] [Indexed: 11/23/2022] Open
Abstract
Abstract
Objective: To propose a safe and reproducible injection point for botulinum toxin-A (BTX-A) as a supplementary method for the treatment of gummy smile, as determined by assessment of the morphologic characteristics of three lip elevator muscles.
Materials and Methods: A total of 50 hemi-faces from 25 adult cadavers (male 13, female 12; ages, 47 to 88 years) were used in this study. Topographic relations and the directions of the lip elevator muscles (ie, levator labii superioris [LLS], levator labii superioris alaeque nasi [LLSAN], and zygomaticus minor [ZMi]), were investigated. Possible injection points were examined through the study of predetermined surface landmarks.
Results: The insertion of the LLS was covered partially or entirely by the LLSAN and the ZMi, and the three muscles converged on the area lateral to the ala. The mean angle between the facial midline and each muscle vector was 25.8 ± 4.8 degrees for the LLS, 55.7 ± 6.4 degrees for the ZMi, and −20.2 ± 3.2 degrees for the LLSAN; no significant differences were noted between male and female subjects or between left and right sides. The three vectors passed near a triangular region formed by three surface landmarks. The center of this triangle, named the “Yonsei point”, was suggested as an appropriate injection point for BTX-A. The clinical effectiveness of the injection point was demonstrated in selected cases with or without orthodontic treatment.
Conclusions: Under careful case selection, BTX-A may be an effective treatment alternative for patients with excessive gingival display caused by hyperactive lip elevator muscles.
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Affiliation(s)
- Woo-Sang Hwang
- a Resident, Department of Orthodontics, Yonsei University College of Dentistry, Seoul, Korea
| | - Mi-Sun Hur
- b Postgraduate Student, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea
| | - Kyung-Seok Hu
- c Assistant Professor, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea
| | - Wu-Chul Song
- d Assistant Professor, Department of Anatomy, School of Medicine, Konkuk University, Seoul, Korea
| | - Ki-Seok Koh
- e Professor, Department of Anatomy, School of Medicine, Konkuk University, Seoul, Korea
| | - Hyoung-Seon Baik
- f Professor, Department of Orthodontics, Yonsei University College of Dentistry, Seoul, Korea
| | - Seong-Taek Kim
- g Assistant Professor, Department of Oral Medicine, Yonsei University College of Dentistry, Seoul, Korea
| | - Hee-Jin Kim
- h Associate Professor, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea.*
| | - Kee-Joon Lee
- i Assistant Professor, Department of Orthodontics, Yonsei University College of Dentistry, Oral Science Research Center, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea.*
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Cosmetic Wrinkle Reduction with Botulinum Toxin. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Yang GC, Chiu RJ, Gillman GS. Questioning the Need to Use Botox Within 4 Hours of Reconstitution. ACTA ACUST UNITED AC 2008; 10:273-9. [DOI: 10.1001/archfaci.10.4.273] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- George C. Yang
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Robert J. Chiu
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Grant S. Gillman
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
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Mittermair R, Keller C, Geibel J. Intragastric injection of botulinum toxin A for the treatment of obesity. Obes Surg 2007; 17:732-6. [PMID: 17879570 DOI: 10.1007/s11695-007-9135-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Botulinum toxin A (BTX-A) is a powerful and long-acting inhibitor of muscular contractions in both striated and smooth muscles. Hypothetically, BTX-A should inhibit the acetylcholine-mediated peristalsis, which is mainly responsible for gastric motility, and thereby induce slowed gastric emptying, earlier satiety and weight loss. The aim of this study was to observe the effects of endoscopic intragastric injections of BTX-A in obese patients. METHODS After approval by the University Ethics Committee, 10 female patients with class I obesity (body mass index 30-35) were double-blind randomized into 2 groups (BTX-A and 0.9% Saline). In Group 1, 200 U BTX-A were injected endoscopically into the antrum and the distal gastric body. In Group 2, 0.9% saline was injected endoscopically into the antrum and the distal gastric body. Body weight and feeling of satiety were recorded monthly over a period of 6 months. RESULTS Both groups (BTX-A and 0.9% Saline) showed no significant weight reduction (P>0.05). One patient in Group 1 and two patients in Group 2 reported a feeling of early satiety. No adverse effects related to BTX-A or complications resulting from the endoscopic procedure were observed. CONCLUSION Intragastric injection of BTX-A for the treatment of obesity does not seem to reduce body weight.
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Affiliation(s)
- Reinhard Mittermair
- Department of General and Transplant Surgery, University Hospital, Medical University Innsbruck, Austria.
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Elmas C, Ayhan S, Tuncer S, Erdogan D, Calguner E, Basterzï Y, Gozil R, Bahcelioglu M. Effect of Fresh and Stored Botulinum Toxin A on Muscle and Nerve Ultrastructure. Ann Plast Surg 2007; 59:316-22. [PMID: 17721223 DOI: 10.1097/sap.0b013e31802e0912] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to compare the ultrastructural alterations of the muscle and nerve that appear following injection of freshly reconstituted and stored botulinum toxin A. Fifteen New Zealand white rabbits were assigned to 6 groups, and anterior auricular muscle was used for injections. Group 1 did not receive any injection and group 2 received saline injection. Groups 3 and 5 received fresh botulinum; muscles and motor nerves were harvested at 5 days and 12 weeks, respectively. Groups 4 and 6 received stored botulinum; muscles and motor nerves were harvested at 5 days and 12 weeks, respectively. Alterations in muscle and nerve ultrastructure were evaluated with electron microscopy. Degeneration findings in muscle after botulinum toxin injection revealed no significant difference between freshly reconstituted and stored toxin in the early period. When stored toxin was used, atrophic changes in the muscle were less severe than the fresh toxin at 3 months. On nerve evaluation, fresh toxin displays significant acute changes on nerve ultrastructure; however, fresh and stored toxin shows similar degeneration at 12 weeks.
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Affiliation(s)
- Cigdem Elmas
- Department of Histology, Gazi University, Faculty of Medicine, Ankara, Turkey
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Schwemmle C, Ptok M. [Treatment of laryngeal movement disorders with botulinum toxins: part 1: History and mode of action]. HNO 2007; 55:399-402. [PMID: 17431567 DOI: 10.1007/s00106-007-1553-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Laryngeal dystonia (spasmodic dysphonia) is a movement disorder characterised by involuntary contractions of the laryngeal muscles involved in vocalisation. The introduction of botulinum toxin (BTX) in the treatment of laryngeal dystonia had a major clinical impact due to the striking improvement of symptoms. Most patients with severe types of spasmodic dysphonia are treated with injections of botulinum toxin type A. For patients with a resistance against type A toxin there is a new hypercleaned type A toxin or type B available. Research on type F toxin is also underway. In this article, the history of botulinum toxin, its therapeutic activity and possibilities for its use are described.
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Affiliation(s)
- C Schwemmle
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover.
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Carruthers A, Carruthers J. Single-Center, Double-Blind, Randomized Study to Evaluate the Efficacy of 4% Lidocaine Cream versus Vehicle Cream During Botulinum Toxin Type A Treatments. Dermatol Surg 2006; 31:1655-9. [PMID: 16336883 DOI: 10.2310/6350.2005.31304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Botulinum toxin type A (BTX-A) injections are overwhelmingly safe and effective treatment in cosmetic treatment, but some patients are apprehensive about pain associated with injection. OBJECTIVE To determine whether preprocedural application of lidocaine 4% topical anesthetic cream to the injection site will reduce pain on injection of BTX-A for the treatment of crow's feet. METHODS Twenty-four participants receiving bilateral injections for crow's feet were enrolled. Subjects were randomized to one of four study groups. Prior to BTX-A injection, group 1 (n = 6) received lidocaine 4% cream on the right side of the face and vehicle cream on the left side of the face; group 2 (n = 6) received vehicle cream on the right side and lidocaine 4% on the left side; group 3 (n = 6) received lidocaine 4% on both sides; and group 4 (n = 6) received vehicle cream on both sides. RESULTS We observed a statistically significant reduction in subject-reported procedural pain in participants pretreated with lidocaine 4% on both sides of the face compared with controls. CONCLUSION Lidocaine 4% cream is effective in reducing the pain associated with BTX-A injection for crow's feet. We encourage further study to clarify the optimal use of topical anesthetics in the practice of cosmetic dermatology.
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Abstract
BACKGROUND Nasal wrinkles on the dorsum of the nose can frequently be treated with botulinum toxin type A by injecting a few units into the nasalis muscle. Between 2 and 5 U of botulinum toxin have commonly been used. However, clinicians have observed that some nasal wrinkles persist following nasalis treatment. OBJECTIVE To detail remaining nasal and perinasal rhytids and further injection sites, which can lead to improvement. METHODS Two hundred fifty patients with nasal rhytids were treated between 1997 and 2004. Three units of botulinum toxin type A were injected bilaterally into the nasalis muscle. Patients were seen at 1 month for follow-up, and the remaining rhytids were documented. RESULTS Forty percent of patients had satisfactory treatment of nasal wrinkles with the initial bilateral 3 U injections. Sixty percent of subjects had remaining nasal rhytids following the nasalis muscle injections. Thirty percent o f subjects hadpersistent wrinkles at the root of the nose (nasal orbicular wrinkles), and 30% had wrinkles at the nasal root and between the eyes (nasociliary wrinkles). The injection of botulinum toxin into additional locations according to the anatomic differences of each person showed excellent resolution of the rhytids without complications. CONCLUSION Understanding nasal wrinkle patterns allows for complete wrinkle treatment of the nose beyond simple bilateral treatment of the nasalis. New points of botulinum toxin application improve not only wrinkles at the root of the nose but also wrinkles in the nasoalar area.
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Affiliation(s)
- Bhertha M Tamura
- Dermatology Department, Santo Amaro University, São Paulo, Brazil.
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Snir M, Weinberger D, Bourla D, Kristal-Shalit O, Dotan G, Axer-Siegel R. Quantitative changes in botulinum toxin a treatment over time in patients with essential blepharospasm and idiopathic hemifacial spasm. Am J Ophthalmol 2003; 136:99-105. [PMID: 12834676 DOI: 10.1016/s0002-9394(03)00075-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the quantitative changes in botulinum toxin A (BTA) treatment required over time to achieve relief for 3 to 4 months in patients with essential blepharospasm (EBS) and idiopathic hemifacial spasm (IHFS). DESIGN Interventional case series. METHODS In this retrospective longitudinal study in an institutional ophthalmologic outpatient clinic, data were retrieved from patient files and a comparison between patients with EBS and IHFS was performed. The patient population consisted of 27 patients, 17 with EBS and 10 with IHFS, who were treated for the first time with BTA injections and were followed up for 4 to 6 consecutive years. All patients initially received 12 or more courses of treatment with a lower dose (<or=20 U) and were then switched to a higher dose (>20 U). The main outcome measures were the shift in the dose-response relationship between the lower and higher doses and were analyzed with respect to four variables: average number of treatments, dosage, duration of therapy, and interval of symptomatic relief. RESULTS In the EBS group the mean dose for each patient changed from 16.0 +/- 1.4 U (lower dose) to 24.2 +/- 1.4 U (higher dose). The shift occurred after a mean of 8.8 +/- 2.9 treatments per patient given for a mean of 33.5 +/- 13.3 months. The mean interval of relief was longer with the lower dose than with the higher dose (4.0 +/- 1.4 months vs 3.2 +/- 1.0 months, respectively). In the IHFS group, the mean dose / patient changed from 16.8 +/- 1.2 U to 25.0 +/- 1.8 U, and the switch occurred after a mean of 6.5 +/- 2.3 treatments given over a mean period of 23.8 +/- 6.6 months. The mean duration of treatment with the lower dose was shorter than with the higher dose. The interval of relief was similar for both dose ranges (3.8 +/- 10 months and 4.1 +/- 1.3 months, respectively). The IHFS group switched to the higher dose earlier, by both number and duration of treatments, than the EBS group. Only minor and transient side effects of treatment were observed in both groups. CONCLUSIONS Botulinum toxin A is an effective and safe treatment for EBS and IHFS. The dose in our study was increased over time by 50% to achieve 3 to 4 months of symptomatic relief with minimal complications.
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Affiliation(s)
- Moshe Snir
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Tel Aviv, Israel.
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Nicolau PJ, Chaouat M, Mimoun M. [Skin, wrinkles and botulinum toxin]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2003; 46:361-74. [PMID: 12928144 DOI: 10.1016/s0168-6054(03)00129-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To present an up-to-date analysis about the use of botulinum toxin for treating facial lines and wrinkles.Method. - A systematic search of the literature was conducted to select the most recent or relevant publications on this topic, through Medline. RESULTS Out of the 583 articles retrieved, 90 were finally selected for the study. DISCUSSION Validity of using botulinum toxin for cosmetic use is demonstrated, together with contra-indications and different methods to objectivate the results. The different available types of toxin are presented and compared. Modalities of preparation, conservation, and waste disposal are detailed. Anatomical bases of muscular facial balance are reviewed, with techniques of injection presented for each site, and also with adjunctive procedures. Complications and side effects are described and analysed. Most complications can be prevented through: perfect knowledge of local anatomy;use of small volumes;orientation of the needle bevel towards the muscle body, injection within the muscle body if thick, more superficial if thin;application of ice on the skin pre- and post-injecting. Adding epinephrin or diluting with xylocaïne and epinephrin is not commonly used. CONCLUSION Botulinum toxin has found its way as a major component of the therapeutic armamentarium. Its efficacy for facial rejuvenation has made it extremely popular, but its use does follow strict rules, and should be restricted to soundly trained practitioners.
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Affiliation(s)
- P J Nicolau
- Service de chirurgie plastique, reconstructrice et esthétique et des brûlés, hôpital Rothschild, 33, boulevard de Picpus, 75571 Paris cedex 12, France.
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Connor MS, Karlis V, Ghali GE. Management of the aging forehead: a review. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:642-8. [PMID: 12789141 DOI: 10.1067/moe.2003.240] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aging in the upper third of the face manifests as rhytids and ptosis of the frontal, glabellar, and brow regions. Frown lines may occur even in younger individuals as a result of habitual or dynamic forehead muscular hyperactivity. Multiple treatment options have been advocated to address forehead rhytids and brow ptosis. This article reviews 3 of the more commonly used treatment options: collagen, botulinum toxin, and surgical forehead lifting. Additionally, an algorithm is proposed as a guideline for selecting the most appropriate option for a given condition.
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Affiliation(s)
- M Scott Connor
- Louisiana State University, Shreveport, LA 71130-3932, USA
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Abstract
This article reviews the cosmetic use of botulinum toxin in upper face from both the historic and clinical viewpoints. The published literature and our current experience are outlined. Botulinum toxin type A in the upper face has become an extremely popular cosmetic procedure and is outstandingly safe.
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Abstract
Botulinum toxins are the causative agents of the severe food-borne illness botulism. With lethal doses approximating 10(-9) g/kg body weight, these neurotoxins represent some of the most toxic naturally occurring substances. Regardless, botulinum toxin is considered a safe therapy for inappropriate muscle spasms with adverse effects being typically self-limited. This article deals with some of the complications that have occurred with these treatments. The greatest concern with the use of BOTOX is probably the formation of blocking antibodies leading to nonresponse of subsequent treatment. Prevalence of resistance is less than 5%. Most complications associated with its aesthetic use are few and anecdotal. Nevertheless, the common problems and pitfalls associated with aesthetic treatment of the various areas of the face and neck with botulinum toxin are discussed. Also included are recommendations as to how to avoid these very undesirable, yet common, problems.
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Fagien S, Brandt FS. Primary and Adjunctive Use of Botulinum Toxin Type A (BOTOX) in Facial Aesthetic Surgery. Clin Plast Surg 2001. [DOI: 10.1016/s0094-1298(20)32345-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fulton JE, Saylan Z, Helton P, Rahimi AD, Golshani M. The S-Lift Facelift Featuring the U-Suture and O-Suture Combined with Skin Resurfacing. Dermatol Surg 2001. [DOI: 10.1111/j.1524-4725.2001.00162.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Botulinum toxin has a well-defined role among dermatologists for the treatment of facial wrinkling, brow position, and palmar and axillary hyperhidrosis. OBJECTIVE The purpose of this study is to educate dermatologists on the pharmacology of botulinum toxin. METHODS A retrospective review of the literature on botulinum toxin from 1962 to the present was conducted. We examined the clinical applications of botulinum toxin, cholinergic neuromuscular transmission, the toxin's structure and molecular actions, drug and disease interactions at the neuromuscular junction, toxin assays, determinants of clinical response, and adverse side effects. RESULTS Botulinum toxin blocks the release of acetylcholine from the presynaptic terminal of the neuromuscular junction. Several drugs and diseases interfere with the neuromuscular junction and the effects of botulinum toxin. The mouse bioassay, the most sensitive and specific measurement of toxin activity, is the gold standard for botulinum toxin detection and standardization. The major determinants of clinical response to treatment are the toxin preparation, individual patient's anatomy, dose and response relationships, length of toxin storage after reconstitution, and immunogenicity. To minimize potential antibody resistance, one should use the smallest effective dose, utilize treatment intervals of more than 3 months, and avoid booster injections. Uncommon adverse effects include ptosis, ectropion, diplopia, bruising, eyelid drooping, hematoma formation, and temporary headaches. CONCLUSION Botulinum toxin is a safe and effective treatment. Knowledge of the pharmacologic basis of therapy will be useful for standardizing techniques and achieving consistent therapeutic results in the future.
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Affiliation(s)
- W Huang
- Departments of Dermatology and Ophthalmology, Cleveland Clinic Foundation, USA
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