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de Almeida AT, de Sanctis Pecora C, Marques ER, Contin L, de Almeida CT, da Cunha AL. Assessment of the Efficacy and Durability of IncobotulinumtoxinA in the Treatment of the Upper Face in Adult Women. Dermatol Ther (Heidelb) 2024; 14:2093-2108. [PMID: 38954382 PMCID: PMC11333665 DOI: 10.1007/s13555-024-01216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION IncobotulinumtoxinA (Xeomin®) is used in the treatment of dynamic wrinkles and the aesthetic repositioning of facial structures. The duration of its muscular effect typically extends for around 4 months. However, the residual aesthetic benefit can be observed for a longer period. To date, the long-term aesthetic benefit of incobotulinumtoxinA in facial aesthetics has not been systematically evaluated. This study aimed to evaluate longitudinally the duration and aesthetic benefits of incobotulinumtoxinA in the treatment of the upper face in adult women. METHODS A quasi-experimental, evaluator-blind, clinical trial involving 28 adult women (30-60 years old) with facial movement lines, undergoing treatment of the upper face with incobotulinumtoxinA by two injectors, following an individualized protocol (ONE21 and glabellar contraction patterns) was performed. Participants were evaluated on the day of the intervention (day 0) and days 30, 120, 180, and 240, and subjected to standardized photographs. The following outcomes were evaluated blindly at each visit: Merz Aesthetics Facial Contraction Scale (MAS), GAIS (Global Aesthetic Improvement Scale), and patient satisfaction. Adverse effects were evaluated at each visit. RESULTS Participants ranged in age from 30 to 60 years, 93% were self-declared white, and most of their baseline MAS scores for dynamic lines were moderate and severe. All the parameters presented significative reduction from baseline until day 180. At day 240, the dynamic MAS scores were lower than baseline for forehead lines in 15.4% (95% confidence interval (CI) 0.8-30.0%) of the participants, for glabellar lines in 38.5% (95% CI 18.8-58.1%), and for crow's feet lines in 26.9% (95% CI 9.0-44.8%). Aesthetic improvement compared to baseline was identified in 35% (CI 95% 23‒50%) of the participants at day 240, and 62% (CI 95% 42‒81%) of the sample kept reporting some satisfaction with the procedure. CONCLUSION The aesthetic treatment of the upper face with incobotulinumtoxinA demonstrates enduring clinical benefits, and patient satisfaction lasting up to 180 days in most participants. The length of efficacy, which exceeded those reported in the literature, may be attributed to the use of techniques based on individualized assessment such as ONE21 and glabellar patterns of contraction.
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Affiliation(s)
- Ada Trindade de Almeida
- Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil.
- For Trials Pesquisa Clínica São Paulo, São Paulo, Brazil.
| | | | - Elisa R Marques
- Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
- For Trials Pesquisa Clínica São Paulo, São Paulo, Brazil
| | - Leticia Contin
- Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
- For Trials Pesquisa Clínica São Paulo, São Paulo, Brazil
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Miot HA. Analysis of data with dependent measures in clinical and experimental studies. J Vasc Bras 2023; 22:e20220150. [PMID: 37333755 PMCID: PMC10275643 DOI: 10.1590/1677-5449.202201502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/14/2023] [Indexed: 06/20/2023] Open
Affiliation(s)
- Hélio Amante Miot
- Universidade Estadual Paulista “Júlio de Mesquita Filho” - UNESP, Faculdade de Medicina de Botucatu - FMB, Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Botucatu, SP, Brasil.
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da Cunha ALG, Vasconcelos R, Di Sessa D, Sampaio G, Ramalhoto P, Zampieri BF, Deus BS, Vasconcelos S, Bellote T, Carvalho J, Petrone G, Figueredo V, Limongi Moreira G. IncobotulinumtoxinA for the Treatment of Glabella and Forehead Dynamic Lines: A Real-Life Longitudinal Case Series. Clin Cosmet Investig Dermatol 2023; 16:697-704. [PMID: 36987400 PMCID: PMC10040156 DOI: 10.2147/ccid.s391709] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/11/2023] [Indexed: 03/30/2023]
Abstract
Background There is substantial interpersonal variation in the patterns of muscular contraction that substantiates the use of personalized points of application and dosages in clinical practice to achieve optimal results. Nevertheless, there has been no real-life therapeutic series with botulinum toxin for aesthetic treatment of the face in which the subjects were systematically followed to assess its long-term benefit. Purpose To assess the performance and length of the treatment of glabellar and forehead lines with IncobotulinumtoxinA in a real-life setting. Patients and Methods We enrolled 20 adults with indications for the treatment of upper facial dynamic lines (glabella and forehead) with botulinum toxin. The protocols of injection points were personalized by the injectors. The participants were photographed under maximum facial contraction before the application (D0) and after 15, 90, 120, and 180 days. The photos were randomly assessed by two blinded experienced raters to consensually grade the dynamic lines according to the Merz Aesthetics Scales (MAS). Efficacy was defined as the reduction in the MAS score. Results At D15, 18 (90%; 95% CI: 80%-100%) participants reached the zero score, or a 2-point reduction on the MAS score from the forehead and 16 (80%; 95% CI: 65-90%) reached that reduction for the glabella. These values from D90 were 14 (70%; 95% CI: 55-85%) for both sites. At D120, these values were 11 (55%; 95% CI: 35-75%) and 8 (40%; 95% CI: 25-55%) for the forehead and glabella. At D180, 10 (50%; 95% CI: 30-70%) participants presented a MAS score for forehead or glabella dynamic lines lower than the score assessed at D0. Conclusion As much as 70% of the patients sustained a reduction of scores after 120 days of the treatment for dynamic glabellar and forehead lines. Half of the patients evidenced prolonged benefit at 180 days.
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Affiliation(s)
| | - Rossana Vasconcelos
- Nomina Clinica Médica De Cirurgia Plástica, Dermatologia e Oncologia, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Gustavo Limongi Moreira
- DSL Clínica Médica, São Paulo, SP, Brazil
- Correspondence: Gustavo Limongi Moreira, DSL Clínica Médica, Rua Pamplona 145 / 1717, Jardim Paulista, Sao Paulo, SP, 01405-900, Brazil, Email
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Miola AC, Schmitt JV, Miot HA. Interpretations about gender in the epidemiology of cutaneous melanoma. An Bras Dermatol 2022; 97:406-407. [PMID: 35331601 PMCID: PMC9133297 DOI: 10.1016/j.abd.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Anna Carolina Miola
- Department of Dermatology and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Juliano Vilaverde Schmitt
- Department of Dermatology and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Hélio Amante Miot
- Department of Dermatology and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil.
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Lima PB, Dias JAF, Cassiano DP, Esposito ACC, Miot LDB, Bagatin E, Miot HA. Efficacy and safety of topical isobutylamido thiazolyl resorcinol (Thiamidol) vs. 4% hydroquinone cream for facial melasma: an evaluator-blinded, randomized controlled trial. J Eur Acad Dermatol Venereol 2021; 35:1881-1887. [PMID: 33988887 DOI: 10.1111/jdv.17344] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/12/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Melasma can be refractory to treatment, and relapses are frequent. Thiamidol is a new potent tyrosinase inhibitor that has been found effective as a cosmeceutical for the depigmenting of melasma. OBJECTIVE This study compared the efficacy and tolerability of topical 0.2% Thiamidol vs. 4% hydroquinone for facial melasma. METHODS Fifty women with facial melasma participated in a randomized, evaluator-blinded, controlled study from September through November 2020. Patients were randomly assigned to apply a double layer of 0.2% Thiamidol twice a day or 4% hydroquinone cream at bedtime, for 90 days. Both groups received tinted sunscreen (sun protection factor 60, PPD 20). The primary outcome was the change from the baseline Modified Melasma Area Seve:rity Index (mMASI) score. Secondary outcomes were improvements in the patients' quality of life [Melasma Quality of Life Index (MELASQoL)], colourimetry, and Global Aesthetic Improvement Scale (GAIS) evaluation. RESULTS One participant, from the hydroquinone group, did not complete the study (unrelated to adverse effects). The mean (SD) age of the participants was 43 (6) years, and 86% were phototypes III-IV. Both groups exhibited a reduction in mMASI, MELASQoL, and colour contrast scores (P < 0.01). The mean [95% confidence interval (CI 95%)] reductions of the mMASI scores were 43% (35-50%) for Thiamidol and 33% (23-42%) for hydroquinone. There was no difference between the groups in the reductions in mMASI, MELASQoL, colourimetric contrast and GAIS scores (P ≥ 0.09). The GAIS analysis resulted in an improvement of 84% (CI: 95% 67-97%) for participants in the Thiamidol group and 74% (CI: 95% 61-93%) for those in the hydroquinone group. There were only mild adverse effects in the Thiamidol group, but allergic contact dermatitis was evidenced in two (8%) participants. CONCLUSION The melasma improvement achieved using 0.2% Thiamidol did not differ from that of 4% hydroquinone cream. Thiamidol can be considered a suitable option for melasma patients with poor tolerability or treatment failure with hydroquinone.
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Affiliation(s)
- P B Lima
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Botucatu, Brazil
| | - J A F Dias
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Botucatu, Brazil
| | - D P Cassiano
- Departamento de Dermatologia, UNIFESP, São Paulo, Brazil
| | - A C C Esposito
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Botucatu, Brazil
| | - L D B Miot
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Botucatu, Brazil
| | - E Bagatin
- Departamento de Dermatologia, UNIFESP, São Paulo, Brazil
| | - H A Miot
- Departamento de Dermatologia e Radioterapia, FMB-Unesp, Botucatu, Brazil
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de Sanctis Pecora C, Pinheiro MVB, Ventura Ferreira K, Jacobino de Barros Nunes G, Miot HA. The One21 Technique: An Individualized Treatment for Glabellar Lines Based on Clinical and Anatomical Landmarks. Clin Cosmet Investig Dermatol 2021; 14:97-105. [PMID: 33564254 PMCID: PMC7866909 DOI: 10.2147/ccid.s281901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Botulinum toxin type A is an effective treatment for glabellar dynamic wrinkles. As the muscular group involved in the contraction of the glabella varies among people, individualized treatment can achieve optimal results. This study evaluates a customized assessment for the treatment of glabellar lines with Incobotulinumtoxin-A, leading to an individualized points distribution and dosage. PATIENTS AND METHODS A single-center, evaluator-blinded, therapeutic cohort study enrolled 130 women with moderate or severe glabellar wrinkles. They underwent Incobotulinumtoxin-A injection following the standard 5-point injection at the glabellar muscles (n = 65) or an individualized assessment and scheme treatment based on anatomical references of contraction, the One21 technique (n = 65). All the patients were photographed under maximum contraction before treatment (T0) and after 4 weeks (T28). The photos were randomly assessed by two blinded, experienced raters to consensually grade the severity according to the Merz Aesthetics Scales (MAS). The primary clinical efficacy was defined as a 2-point reduction in the MAS score, on Day 28. RESULTS The groups were homogeneous regarding age, phototype, and baseline MAS scores. On Day 28 (T28), 64 (98.5%) patients from the One21 group and 52 (80%) from the 5-point group reduced the MAS score by at least two points (p < 0.01). When adjusted by age and phototype, both groups reduced the MAS score at T28 (p < 0.01); nevertheless, patients from the One21 group significantly performed better (p < 0.01), with a much higher rate response rate at T28, in comparison to the 5-point group. Of patients enrolled in the 5-point group, 83.1% utilized muscle groups other than the procerus and corrugator in glabellar wrinkle formation, and 17 (24.6%) presented asymmetrical contraction. Patients from the 5-point group with glabellar asymmetry and those who utilized the frontalis and orbicularis presented inferior performance (p < 0.05), reinforcing the importance of an individualized assessment and treatment plan. CONCLUSION The One21 technique yielded better results than the standard 5-point treatment in reducing glabellar dynamic lines with Incobotulinumtoxin-A, especially for asymmetric lines of the glabella or the involvement of muscle groups other than the procerus and corrugator.
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de Freitas VMP, Miot HA, Miot LDB, Nogueira MADS, Yarak S, Ranulfo RT, Nunes GJDB, Sanches JA, Bagatin E. Development of a clinical scale to assess the severity of striae distensae. Skin Res Technol 2020; 27:627-631. [PMID: 33368720 DOI: 10.1111/srt.12995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/31/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE There is no validated instrument to assess the clinical severity of striae distensae. Here, we aimed to develop a striae distensae severity scale. MATERIAL AND METHODS After a Delphi-based consensus, 15 items related to striae severity were assessed in 110 areas (breasts, abdomen, and buttocks) from 45 participants. The items were analyzed through a partial least squares model to select the most important variables. To assess the reliability of the scale, 43 areas were retested. RESULTS Of the 110 areas evaluated, 34 were breasts, 24 abdomens, and 52 buttocks. Striae were considered mild in 30% of the evaluations, moderate in 33%, severe in 21%, and extremely severe in 16%. The final model was composed by: width of the widest striae, width of the striae with the most frequent pattern, atrophy, number of affected quadrants, distribution (multiple or isolated), hypo or hyperchromia and topography. The scores of the scale demonstrated a high correlation with the clinical classification (rho = 0.77). There was a high agreement in the scores from the reassessed areas (intraclass correlation coefficient = 0.90). CONCLUSION An objective and reliable scale to assess the clinical severity of striae distensae on the breasts, abdomen, and buttocks was developed.
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Affiliation(s)
| | | | | | | | - Samira Yarak
- Department of Dermatology, UNIFESP, São Paulo, Brazil
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