Intradermal injection of incobotulinumtoxinA for face lifting

Abstract

Intradermal injection of botulinumtoxinA (BoNT/A) has been used off-label by many clinicians for the purpose of face-lifting effect. Some studies on AbobotulinumtoxinA (AboA) demonstrated clinical efficacy on face-lifting effect when comparing to normal saline solution (NSS). So far, there is no split-face comparison study on facelifting effect of IncobotulinumtoxinA (IncoA). The objective of this study was to compare the face-lifting effect of IncoA intradermal injection and NSS. Twenty-two subjects were enrolled and randomly injected with IncoA at 1:6 cc dilution (100 unit or 1 vial in 6 cc of NSS) on one side, and NSS on the other side by using intradermal injection technique. Standardized photographic documentation with 2-, and 3-dimentional imaging system (Vectra H1, Canfield Scientific, Inc., Fairfield, NJ) were obtained at baseline, and at 2 weeks after treatment. The face-lifting effect was graded by the subjects and two blinded dermatologists, using photographic comparison. Side effects were also recorded at the end of the study. Immediate face-lifting was identified on the side that was treated with IncoA by blinded injectors in 63.6%

Use of Micro Botulinum Toxin for a Face-lifting Effect: A Systematic Review

“…24 Indeed, when injections were performed along the hair and jawlines, this somewhat created face-lift–like vectors, which probably accounts for some semblance of the face-lifting effect observed. 11–13,15 Finally, while the dilution, concentration, type, and total dose of botulinum toxin used were all highly varied in this study, analysis of results suggest that an average of 20 to 30 BU (or equivalent) would produce a face-lifting effect, provided the injection patterns were designed to recreate face-lift vectors, sort of, as mentioned. It does seem, however, that injecting with 30-G needles resulted unanimously in procedure-related pain, 9,15 whereas studies that utilized 32-G needles only reported minimal bruising in 13.8% of patients, 13 so this may be worth bearing in mind.…”

“…The immediacy of a face-lifting effect was investigated through direct assessment by the blinded treating physician, which was seen 50%, 11 55.2%, 13 and 63.6% 12 of the time when DYS, DYS, and XEO were used, respectively, in 3 separate studies; this represents an overall efficacy of only 10.8% (40/372) in achieving an immediate face-lifting effect. It was also shown objectively through three-dimensional imaging analysis that overall, such face-lifting effects from micro-btx, if any, can last for up to 3 months.…”

“…As detailed in the PRISMA flowchart, 8 studies were included for final analysis (See Supplemental Digital Content, Figure S1, http://links.lww.com/DSS/B83). This included one Level III (retrospective cohort 7 ), 5 Level II (split face, prospective cohort 6,9,[11][12][13] ), and 2 Level I (split face, randomized control trials 14,15 ) studies. In total, there were 372 patients of which 56 (15%) were men.…”

“…7 Although there were blinded assessments by nontreating physicians, 6,9,14 they may or may not be familiar with the subtleties of facial aesthetics and may not have been trained to identify such differences (see next paragraph). When patient self-assessments were thrown into the mix, 11–13,15 highly discordant results with that of blinded physicians' assessments suggest that most likely, there is both an element of the Hawthorne effect from the patients, due to a change in behavior and/or responses because of their awareness of being assessed, as well as the above. Moreover, the various injection patterns described do not quite make sense with the postulated mechanism of action of micro-btx as described by Wu.…”

“…Assessment methods of the effect of face-lifting were highly varied including (1) retrospective, nonblinded assessment of pre-and posttreatment patient photographs by the treating physician, 7 (2) blinded assessment of pre-and posttreatment patient photographs by physician(s) blinded to the study, 6,9,14 (3) same as (2) but with additional selfassessment by the treated patients, [11][12][13]15 and (4) quantitative, 2-and 3-dimensional imaging analysis (e.g. Vectra) to evaluate changes in facial volume as a surrogate measure for a face-lifting effect.…”