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Ebrahimi B, Jamzad S, Naseh Z, Moezzi I, Kargar Jahromi H, Naseh M. The efficacy of various interventions as good strategies to reduce pain in botulinum neurotoxin A for wrinkles. A systematic review of the randomized controlled trials (RCTs). J COSMET LASER THER 2024:1-8. [PMID: 39023097 DOI: 10.1080/14764172.2024.2374812] [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: 01/07/2023] [Accepted: 06/27/2024] [Indexed: 07/20/2024]
Abstract
Various topical interventions have been described to minimize botulinum neurotoxin-A (BoNT)-induced pain. The purpose of this study is to conduct a systematic review of relevant randomized controlled trials (RCTs) to compare the efficacy of pain relief methods during BoNT injection. PubMed, Scopus, and Web of Science were searched using "Botox," "Botulinum," or "BTX." We identified RCTs in which BoNT were injected to eliminate wrinkles. The pain score was the study outcome, and pain reduction method was compared with routine one. The meta-analysis was reported using the PRISMA checklist. The Higgins I(I2) statistical model assessed results heterogeneity. Two thousand one hundred and twenty-three articles were identified, thirteen articles eligible. Two hundred and sixty-two healthy volunteers were performed on these RCTs. Meta-analysis evaluated different methods to ease BoNT injection pain, and these methods significantly improved outcomes by 0.23% (95%CI, 0.11-0.46, p = .000). Subgroup analysis based on injection area showed no significant heterogeneity, but heterogeneity decreased when subgroup analysis based on other methods was done (Cochran's Q test = 115.52, p = .0001, I2 = 87.9%). This meta-analysis confirms the effectiveness of pain relief methods during BoNT injection. Evaluation of different methods showed their effectiveness, but finding the best method requires comparative studies, although the role of pH and EMLA has been proven.
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Affiliation(s)
- Bahareh Ebrahimi
- Shiraz Geriatric Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Sina Jamzad
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zahra Naseh
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Iman Moezzi
- Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Kargar Jahromi
- Research center for non-Communicable Disease, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Maryam Naseh
- Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Guo P, Huang C, Yang Q, Zhong G, Zhang J, Qiu M, Zeng R, Gou K, Zhang C, Qu Y. Advances in Formulations of Microneedle System for Rheumatoid Arthritis Treatment. Int J Nanomedicine 2023; 18:7759-7784. [PMID: 38144510 PMCID: PMC10743780 DOI: 10.2147/ijn.s435251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023] Open
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic joint inflammation, eventually leading to severe disability and premature death. At present, the treatment of RA is mainly to reduce inflammation, swelling, and pain. Commonly used drugs are non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and disease-modifying anti-rheumatic drugs (DMARDs). These drugs lack specificity and require long-term, high-dose administration, which can cause serious adverse effects. In addition, the oral, intravenous, and intra-articular injections will reduce patient compliance, resulting in high cost and low bioavailability. Due to these limitations, microneedles (MNs) have emerged as a new strategy to efficiently localize the drugs in inflamed joints for the treatment of RA. MNs can overcome the cuticle barrier of the skin without stimulating nerves and blood vessels. Which can increase patient compliance, improve bioavailability, and avoid systemic circulation. This review summarizes and evaluates the application of MNs in RA, especially dissolving MNs (DMNs). We encourage the use of MNs to treat RA, by describing the general properties of MNs, materials, preparation technology, drug release mechanism, and advantages. Furthermore, we discussed the biological safety, development prospects, and future challenges of MNs, hoping to provide a new strategy for the treatment of RA.
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Affiliation(s)
- Peng Guo
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, People’s Republic of China
| | - Chi Huang
- Department of Pharmacy, Jiang’an Hospital of Traditional Chinese Medicine, Yibin, 644200, People’s Republic of China
| | - Qin Yang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, People’s Republic of China
| | - Guofeng Zhong
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, People’s Republic of China
| | - Junbo Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, People’s Republic of China
| | - Mengyu Qiu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, People’s Republic of China
| | - Rui Zeng
- Institute of Tibetan Plateau, Southwest Minzu University, Chengdu, 610225, People’s Republic of China
| | - Kaijun Gou
- Institute of Tibetan Plateau, Southwest Minzu University, Chengdu, 610225, People’s Republic of China
| | - Chen Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, People’s Republic of China
| | - Yan Qu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, People’s Republic of China
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Nguyen HX, Nguyen CN. Microneedle-Mediated Transdermal Delivery of Biopharmaceuticals. Pharmaceutics 2023; 15:pharmaceutics15010277. [PMID: 36678906 PMCID: PMC9864466 DOI: 10.3390/pharmaceutics15010277] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Transdermal delivery provides numerous benefits over conventional routes of administration. However, this strategy is generally limited to a few molecules with specific physicochemical properties (low molecular weight, high potency, and moderate lipophilicity) due to the barrier function of the stratum corneum layer. Researchers have developed several physical enhancement techniques to expand the applications of the transdermal field; among these, microneedle technology has recently emerged as a promising platform to deliver therapeutic agents of any size into and across the skin. Typically, hydrophilic biomolecules cannot penetrate the skin by passive diffusion. Microneedle insertion disrupts skin integrity and compromises its protective function, thus creating pathways (microchannels) for enhanced permeation of macromolecules. Microneedles not only improve stability but also enhance skin delivery of various biomolecules. Academic institutions and industrial companies have invested substantial resources in the development of microneedle systems for biopharmaceutical delivery. This review article summarizes the most recent research to provide a comprehensive discussion about microneedle-mediated delivery of macromolecules, covering various topics from the introduction of the skin, transdermal delivery, microneedles, and biopharmaceuticals (current status, conventional administration, and stability issues), to different microneedle types, clinical trials, safety and acceptability of microneedles, manufacturing and regulatory issues, and the future of microneedle technology.
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Affiliation(s)
- Hiep X. Nguyen
- Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University, Atlanta, GA 30341, USA
- Correspondence: ; Tel.: +1-404-820-4015
| | - Chien N. Nguyen
- National Institute of Pharmaceutical Technology, Hanoi University of Pharmacy, Hanoi 100000, Vietnam
- Faculty of Pharmaceutics and Pharmaceutical Technology, Hanoi University of Pharmacy, Hanoi 100000, Vietnam
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Li Y, He G, Fu LH, Younis MR, He T, Chen Y, Lin J, Li Z, Huang P. A Microneedle Patch with Self-Oxygenation and Glutathione Depletion for Repeatable Photodynamic Therapy. ACS NANO 2022; 16:17298-17312. [PMID: 36166667 DOI: 10.1021/acsnano.2c08098] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Photodynamic therapy (PDT) has attained extensive attention as a noninvasive tumor treatment modality. However, the hypoxia in solid tumors, skin phototoxicity of "always on" photosensitizers (PSs), and abundant supply of glutathione (GSH) in cancer cells severely hampered the clinical applications of PDT. Herein, a self-oxygenation nanoplatform (denoted as CZCH) with GSH depletion ability was encapsulated into the hyaluronic acid microneedle patch (MN-CZCH) to simultaneously improve the biosafety and therapeutic efficacy of PDT. The Cu2+-doped porous zeolitic imidazolate framework incorporated with catalase (CAT) is capable of efficiently loading PS 2-(1-hexyloxyethyl)-2-divinylpyropheophorbic-a (HPPH). The CZCH intermingled MN patch (MN-CZCH) could effectively penetrate the stratum corneum, topically transport HPPH to the target tumor site, achieve a long tumor retention time, and enhance the efficacy of PDT via the simultaneously synergistic effect of CAT-catalyzed self-supplying O2 and Cu2+-mediated GSH depletion. Using traceable fluorescence (FL) imaging of the released HPPH from CZCH, the FL imaging-guided repeatable PDT can be achieved for enhanced antitumor efficacy. As a result, the MN-CZCH patch exhibited excellent therapeutic efficacy against melanoma with minimal toxicity, which has promising potential for cancer theranostics.
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Affiliation(s)
- Yashi Li
- Department of Dermatology and Venereology, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
- Marshall Laboratory of Biomedical Engineering, International Cancer Center, Laboratory of Evolutionary Theranostics (LET), School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Gang He
- Marshall Laboratory of Biomedical Engineering, International Cancer Center, Laboratory of Evolutionary Theranostics (LET), School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Lian-Hua Fu
- Marshall Laboratory of Biomedical Engineering, International Cancer Center, Laboratory of Evolutionary Theranostics (LET), School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Muhammad Rizwan Younis
- Marshall Laboratory of Biomedical Engineering, International Cancer Center, Laboratory of Evolutionary Theranostics (LET), School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Ting He
- Marshall Laboratory of Biomedical Engineering, International Cancer Center, Laboratory of Evolutionary Theranostics (LET), School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Yunzhi Chen
- Department of Dermatology and Venereology, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jing Lin
- Department of Dermatology and Venereology, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
- Marshall Laboratory of Biomedical Engineering, International Cancer Center, Laboratory of Evolutionary Theranostics (LET), School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Zhiming Li
- Department of Dermatology and Venereology, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Peng Huang
- Department of Dermatology and Venereology, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
- Marshall Laboratory of Biomedical Engineering, International Cancer Center, Laboratory of Evolutionary Theranostics (LET), School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
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Signorini M, Piero Fundarò S, Bertossi D, Cavallini M, Cirillo P, Natuzzi G, Quartucci S, Sciuto C, Patalano M, Trocchi G. OnabotulinumtoxinA from lines to facial reshaping: A new Italian consensus report. J Cosmet Dermatol 2022; 21:550-563. [DOI: 10.1111/jocd.14728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Dario Bertossi
- Section of Oral and Maxillofacial Surgery Department of Surgical Sciences University of Verona Verona Italy
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Zhao J, Xu G, Yao X, Zhou H, Lyu B, Pei S, Wen P. Microneedle-based insulin transdermal delivery system: current status and translation challenges. Drug Deliv Transl Res 2021; 12:2403-2427. [PMID: 34671948 PMCID: PMC8528479 DOI: 10.1007/s13346-021-01077-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 01/27/2023]
Abstract
Diabetes mellitus is a metabolic disease manifested by hyperglycemia. For patients with type 1 and advanced type 2 diabetes mellitus, insulin therapy is essential. Subcutaneous injection remains the most common administration method. Non-invasive insulin delivery technologies are pursued because of their benefits of decreasing patients' pain, anxiety, and stress. Transdermal delivery systems have gained extensive attention due to the ease of administration and absence of hepatic first-pass metabolism. Microneedle (MN) technology is one of the most promising tactics, which can effectively deliver insulin through skin stratum corneum in a minimally invasive and painless way. This article will review the research progress of MNs in insulin transdermal delivery, including hollow MNs, dissolving MNs, hydrogel MNs, and glucose-responsive MN patches, in which insulin dosage can be strictly controlled. The clinical studies about insulin delivery with MN devices have also been summarized and grouped based on the study phase. There are still several challenges to achieve successful translation of MNs-based insulin therapy. In this review, we also discussed these challenges including safety, efficacy, patient/prescriber acceptability, manufacturing and scale-up, and regulatory authority acceptability.
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Affiliation(s)
- Jing Zhao
- Prinbury Biopharm Co, 538 Cailun Road Zhangjiang Hi-Tech Park Shanghai, Ltd, 200120 No China
| | - Genying Xu
- Department of Pharmacy, Zhongshan Hospital Fudan University, No. 180 Fenglin Road, Shanghai, 200032 China
| | - Xin Yao
- Prinbury Biopharm Co, 538 Cailun Road Zhangjiang Hi-Tech Park Shanghai, Ltd, 200120 No China
| | - Huirui Zhou
- Prinbury Biopharm Co, 538 Cailun Road Zhangjiang Hi-Tech Park Shanghai, Ltd, 200120 No China
| | - Boyang Lyu
- Prinbury Biopharm Co, 538 Cailun Road Zhangjiang Hi-Tech Park Shanghai, Ltd, 200120 No China
| | - Shuangshuang Pei
- Prinbury Biopharm Co, 538 Cailun Road Zhangjiang Hi-Tech Park Shanghai, Ltd, 200120 No China
| | - Ping Wen
- School of Pharmacy, Fudan University, No. 826 Zhangheng Road Zhangjiang Hi-Tech Park , Shanghai, 200120 China
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Makvandi P, Kirkby M, Hutton ARJ, Shabani M, Yiu CKY, Baghbantaraghdari Z, Jamaledin R, Carlotti M, Mazzolai B, Mattoli V, Donnelly RF. Engineering Microneedle Patches for Improved Penetration: Analysis, Skin Models and Factors Affecting Needle Insertion. NANO-MICRO LETTERS 2021; 13:93. [PMID: 34138349 PMCID: PMC8006208 DOI: 10.1007/s40820-021-00611-9] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/05/2021] [Indexed: 05/14/2023]
Abstract
Transdermal microneedle (MN) patches are a promising tool used to transport a wide variety of active compounds into the skin. To serve as a substitute for common hypodermic needles, MNs must pierce the human stratum corneum (~ 10 to 20 µm), without rupturing or bending during penetration. This ensures that the cargo is released at the predetermined place and time. Therefore, the ability of MN patches to sufficiently pierce the skin is a crucial requirement. In the current review, the pain signal and its management during application of MNs and typical hypodermic needles are presented and compared. This is followed by a discussion on mechanical analysis and skin models used for insertion tests before application to clinical practice. Factors that affect insertion (e.g., geometry, material composition and cross-linking of MNs), along with recent advancements in developed strategies (e.g., insertion responsive patches and 3D printed biomimetic MNs using two-photon lithography) to improve the skin penetration are highlighted to provide a backdrop for future research.
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Affiliation(s)
- Pooyan Makvandi
- Istituto Italiano Di Tecnologia, Centre for Materials Interface, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy.
| | - Melissa Kirkby
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Aaron R J Hutton
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Majid Shabani
- Istituto Italiano Di Tecnologia, Centre for Materials Interface, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
| | - Cynthia K Y Yiu
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | - Zahra Baghbantaraghdari
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, 80125, Naples, Italy
| | - Rezvan Jamaledin
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, 80125, Naples, Italy
- Center for Advanced Biomaterials for Health Care (iit@CRIB), Italian Institute of Technology, 80125, Naples, Italy
| | - Marco Carlotti
- Istituto Italiano Di Tecnologia, Centre for Materials Interface, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
| | - Barbara Mazzolai
- Istituto Italiano Di Tecnologia, Centre for Materials Interface, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
| | - Virgilio Mattoli
- Istituto Italiano Di Tecnologia, Centre for Materials Interface, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy.
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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Comparison of Two Anticoagulants for Pain Associated with Platelet-Rich Plasma Injections. Aesthetic Plast Surg 2020; 44:955-961. [PMID: 31722064 DOI: 10.1007/s00266-019-01541-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/03/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Platelet-rich plasma (PRP) has long been used in skin rejuvenation and hair loss treatment. Some patients require multiple intradermal injections into the face and scalp, and the way in which these patients process and experience pain differs, depending on the patient. Minimizing pain and discomfort during nonsurgical procedures is essential for patient satisfaction. In our experience, the use of acid citrate dextrose-A (ACD-A) as an anticoagulant caused more patient discomfort than did sodium citrate (Na-citrate) among patients who underwent facial rejuvenation with PRP. The aim of the present study was to evaluate patient-related discomfort in PRP sessions using two different anticoagulants. MATERIALS AND METHODS This clinical trial included 10 patients who received facial PRP injections for facial rejuvenation and 10 patients who received PRP injections in their scalps for hair loss. On the application area, half the surface was treated with Na-citrate PRP injections, and the other half was treated with the same amount of ACD-A PRP injections. Neither the doctors who applied the treatment nor the patients were given information about which anticoagulant was used in each area. Immediately after the procedure, the patients were asked to score their pain on each side of the application area on a scale of 1-10 using a visual analog scale (VAS). RESULTS PRP injections using Na-citrate as an anticoagulant caused less discomfort on both the face and scalp as compared with that of ACD-A. The outcome was statistically significant. CONCLUSION Anticoagulants used in PRP preparation affected patients' pain perceptions during the injections. The sensation of pain with PRP prepared with Na-citrate as an anticoagulant was lower than that of PRP prepared with ACD-A. Further studies are required to evaluate the correlation between anticoagulants used for PRP preparation and pain feelings during injections. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Fallahi HR, Keyhan SO, Zandian D, Sabzian R. A mini review on the common methods of pain reduction before filler and botulinum toxin injection. J Cosmet Dermatol 2019; 19:566-569. [PMID: 31490624 DOI: 10.1111/jocd.13138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/19/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the desire for beauty and youthful appearance has increased in recent years, cosmetic injections are getting more attention. However, patients discomfort during these injections is a challenging issue. AIM This review explores common approaches to reduce pain and discomfort during cosmetic injections through the available literature. METHODS The eligible studies through searching in PubMed have been entered to evaluate the common methods of pain reduction for cosmetic injections. RESULTS According to reviewed studies, vibration, local anesthesia, and vapocoolant anesthesia are common methods applied in order to reduce pain and discomfort in patients. All of these methods are able to reduce pain through their affects on neuron fibers. CONCLUSION It seems that all common approaches can result in some amount of pain reduction. Using a combination of these methods during injections, practitioners can successfully reduce the pain of injection.
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Affiliation(s)
- Hamid Reza Fallahi
- School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Dental Research Center, Research institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seied Omid Keyhan
- National Advance center for craniomaxillofacial reconstruction, Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Regenerative medicine and stem cell research network, Shahaid Beheshti University of Medical Sciences and Health Services, Tehran, Iran
| | - Dana Zandian
- School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Dental Research Center, Research institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Sabzian
- Dental Students Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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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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Finer Needles Reduce Pain Associated With Injection of Local Anesthetic Using a Minimal Insertion Injection Technique. Dermatol Surg 2017; 44:204-208. [PMID: 29016543 DOI: 10.1097/dss.0000000000001279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The injection of local anesthetic into the skin is often the only memorable event described by the patient after dermatologic procedures. OBJECTIVE The authors compared the pain felt during injection of local anesthetic using a minimal needle insertion technique with a 30- or 33-gauge needle. MATERIALS AND METHODS Three hundred eighteen patients with tumors on the head and neck were injected with lidocaine using a previously described technique with either a 30- or 33-gauge needle. After injection, patients were surveyed using the visual assessment scale for pain. RESULTS Seventy-seven percent of patients felt no pain with injection on the face using a 33-gauge needle compared with 64% with a 30 gauge, whereas 94% of patients felt no pain on the scalp with a 33-gauge needle compared with 54% with a 30 gauge. Visual analog scale scores were also significantly decreased on the face and scalp using the smaller needle. There was no difference in pain between the 2 needles with injection on the neck. CONCLUSION This study further validates the use of this technique for the injection of lidocaine and the preference of a 33 gauge over a 30-gauge needle for the initial injection on the face and scalp.
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Guney K, Sezgin B, Yavuzer R. The Efficacy of Vibration Anesthesia on Reducing Pain Levels During Lip Augmentation: Worth the Buzz? Aesthet Surg J 2017; 37:1044-1048. [PMID: 29025227 DOI: 10.1093/asj/sjx073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Lip augmentation procedures have increased drastically in the last years as patients seek to enhance the shape and size of their lips with dermal fillers. One of the main concerns faced with these procedures is the pain inflicted through injections. On the other hand, many different techniques have been introduced for the reduction of pain while performing office-based minimal invasive procedures. Objectives This study aims to determine the analgesic effect of vibration anesthesia during lip augmentation procedures and to evaluate its overall effect on the comfort of patients. Methods A split-lip study was designed in a randomized fashion for 25 lip augmentation patients who received hyaluronic acid fillers with or without with a concurrent vibration stimulus on either half of their lips. Patients were asked to score the pain that they felt during lip injections on a scale from 0 to 10 (0 being no pain and 10 being the worst pain ever felt) for either lip half. The pain scores were then analyzed for significance. Results The overall pain score on the vibration-assisted side was 3.82 ± 1.73 while the pain score for the side with no vibration was 5.6 ± 1.76 (P < 0.001). Twenty-three patients (92%) felt less pain with the addition of vibration while, interestingly, 2 patients (8%) stated that they felt an increase in pain levels on the vibration-treated side. Conclusions Vibration devices can be a safe and effective tool for lowering pain levels in patients undergoing lip augmentation with hyaluronic acid fillers. Level of Evidence 2.
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Affiliation(s)
- Kirdar Guney
- Dr Guney is a plastic surgeon in private practice in Istanbul, Turkey. Dr Sezgin is a Plastic Surgeon and Clinical Specialist, and Full Faculty Member; and Dr Yavuzer is a Visiting Professor, Koç University School of Medicine, Istanbul, Turkey
| | - Billur Sezgin
- Dr Guney is a plastic surgeon in private practice in Istanbul, Turkey. Dr Sezgin is a Plastic Surgeon and Clinical Specialist, and Full Faculty Member; and Dr Yavuzer is a Visiting Professor, Koç University School of Medicine, Istanbul, Turkey
| | - Reha Yavuzer
- Dr Guney is a plastic surgeon in private practice in Istanbul, Turkey. Dr Sezgin is a Plastic Surgeon and Clinical Specialist, and Full Faculty Member; and Dr Yavuzer is a Visiting Professor, Koç University School of Medicine, Istanbul, Turkey
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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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Ma G, Wu C. Microneedle, bio-microneedle and bio-inspired microneedle: A review. J Control Release 2017; 251:11-23. [DOI: 10.1016/j.jconrel.2017.02.011] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/11/2017] [Accepted: 02/13/2017] [Indexed: 12/29/2022]
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Prevention and Management of Injection-Related Adverse Effects in Facial Aesthetics: Considerations for ATX-101 (Deoxycholic Acid Injection) Treatment. Dermatol Surg 2016; 42 Suppl 1:S300-S304. [DOI: 10.1097/dss.0000000000000898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jeong HR, Lee HS, Choi IJ, Park JH. Considerations in the use of microneedles: pain, convenience, anxiety and safety. J Drug Target 2016; 25:29-40. [DOI: 10.1080/1061186x.2016.1200589] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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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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Abstract
BACKGROUND The introduction of neuromodulators for aesthetic facial improvements greatly expanded the limits of nonsurgical facial rejuvenation. Although many current uses are considered "off-label," the widespread acceptance and favorable safety profile of properly used botulinum toxins have made them one of the most common aesthetic treatments available. METHODS A literature review of current facial aesthetic uses of various botulinum toxin preparations was done, and general concepts were identified. RESULTS Currently, Food and Drug Administration-approved botulinum toxin preparations onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), and incobotulinumtoxinA (Xeomin) have similar off-label indications and clinical uses. CONCLUSIONS Although not considered interchangeable, administration and clinical outcomes are not much different between the 3 commonly used botulinum products. The impact of botulinum products currently in development has yet to be determined.
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Abstract
Eyebrow and upper eyelid aging occurs in all tissue planes, and manifests most commonly in skin quality, tissue volume loss (soft tissue and bone), and tissue descent. All these involutional changes are amenable to less-invasive (nonsurgical) interventions with natural and aesthetically pleasing results. It is critical for aesthetic facial surgeons to familiarize themselves with these procedures because they are in high demand by patients. This article outlines current concepts of nonsurgical management options for brow and upper eyelid aging. The anatomy and age-related changes in these structures are reviewed, and minimally invasive techniques to address these changes are detailed.
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