A Randomized, Evaluator-Blinded, Two-Center Study of the Safety and Effect of Volume on the Diffusion and Efficacy of Botulinum Toxin Type A in the Treatment of Lateral Orbital Rhytides

Abstract

This is a small study and it may be that dilution does affect BTX result. We were, however, unable to detect any difference in this study, which suggests that the degree of dilution, at least within a fivefold margin, has only a small effect on the results of BTX injection in the lateral orbital area.

High Versus Low Concentration Botulinum Toxin A for Benign Essential Blepharospasm: Does Dilution Make a Difference?

“…Work in humans by Francisco et al,22 found no difference in the efficacy of 2 different volume preparations for the relief of wrist and finger spasticity after an acquired brain injury. These findings were consistent with the studies of rhytids by Carruthers et al 7,8 and Hankins et al, 5 which suggested that the dilution of BTX-A did not affect its longevity or degree of action.…”

“…Subsequent work by Hsu et al 6 examined concentrations ranging from 20 to 100 U/ml and showed that a lower concentration and higher volume resulted in greater diffusion of the toxin and a larger affected area. In studies by Carruthers et al, 7,8 concentrations were varied from 10 to 100 U/ml, and no difference was observed in efficacy or side effects.…”

Field effect of two commercial preparations of botulinum toxin type A: A prospective, double-blind, randomized clinical trial

“…13,[17][18][19][20][21] Some of these terms are misleading and incorrectly used, as described by Pickett. 22 ''Spread'' is the physical movement caused by the injection of the toxin and ''diffusion'' is the passive movement of the product away from the injection site, taking several days to fully conclude.…”

The Use of Botulinum Toxin Type A in the Upper Face

“…Evidence indicates that higher doses of BTX-A delivered in smaller volumes keep the effects more localized and allow for the precise placement of the toxin with little diffusion [19], whereas injection of BTX-A in low concentration and higher volume contributes to a wider diffusion and area of effect, a shorter duration of effect, and a possible increase in side effects [20][21][22]. The few studies that have specifically compared dilutions in facial rejuvenation show no statistical significance in efficacy or side effects [23][24][25]. Indeed, only one study found a noticeable difference, with an almost 50% greater area of effect (as measured visually) associated with a larger volume [22].…”