Intradermal Micro-Dosing of AbobotulinumtoxinA for Face-Lifting: How Long Does It Last?

Abstract

Introduction Intradermal injection of botulinum toxin type A (BoNT/A) has been used off-label by many clinicians for face-lifting. Previous studies on abobotulinumtoxinA (ABO) (Dysport®; Ipsen Biopharm Ltd.) have demonstrated clinical efficacy in face-lifting when compared to normal saline solution (NSS). However, few clinical studies have evaluated ABO in terms of duration of sustained effects for face-lifting. Methods Thirty subjects were enrolled, and their face was injected with ABO at a dilution of 1 vial:7 mL (500 U in 7 mL of NSS) using an intradermal injection technique. Standardized photographic documentation was obtained using a two-, and three-dimensional imaging system (Vectra H1, Canfield Scientific, Inc, Fairfield, NJ) at baseline, immediately after injection, 2 weeks after injection and at 1 , 2 , 3 , 4 , 5 and 6 months of follow-up after treatment. The face-lifting effects were graded by both the subjects and two blinded dermatologists who compared photographs taken at the different time points. Side effects were also recorded at the end of the study. Results Of the 30 subjects, 28 completed treatment and attended every follow-up visit. All subjects were female with Fitzpatrick skin type II to IV. The average age of the subjects was 27.6 ± 3.4 (range 22–34) years. The total number of ABO units used varied for each subject (range 200–250 U), with the average (± standard deviation) dose being 237 ± 19 units. Most of the subjects reported significant face-lifting up to 3 months post-procedure. However, face-lifting assessed by blinded dermatologists was notably lower than that of each patient’s evaluation. The difference in the facial contouring volume of the nasolabial fold and jawline, as measured by the Vectra H1 imaging system, was statistically significant from baseline up until 3 months after injection ( p = 0.001 and p = 0.001, respectively). The only side effect found in this study was minimal bruising, which was seen in 13.8% of subjects. None of the subjects reported facial asymmetry, either at rest or during facial expression. Conclusion The results of this study demonstrate the face-lifting effect of ABO intradermal injection. The results show sustained effects up to 3 months after injection.

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.…”

“…Vectra) to evaluate changes in facial volume as a surrogate measure for a face-lifting effect. 12,13 Follow-up was from as early as 1 week and averaged up to 10.5 (range, 1-24) weeks after treatment. Overall, in general, patients tended to self-report a more positive face-lifting effect as compared with that by a blinded physician (Figure 1).…”

Air‐toxin technique: Introduction and analysis of effect using a photoimaging system

“…The intradermal injection technique, otherwise known as the “micro‐botulinum” technique, involves serial injection of tiny aliquots of BTX just under the skin surface 13,14 15,16 …”

A Novel Technique to Reduce Pain from Intradermal Injection of Botulinum Toxin Type A

“… 2 Blocking the secretion of calcitonin gene-related peptide and vasoactive interstitial peptides has been shown to reduce flushing, induce collagen synthesis, and improve skin texture. 3 …”

“…BTX-A manufacturers recommend sterile physiological saline as a standard dilution solution, but more recent studies have shown that dilution with lidocaine is an effective way to reduce pain. 3 However, because the pH of lidocaine solution is about 6, it is weakly acidic and inevitably causes pain during injection. Therefore, mixing lidocaine with sodium bicarbonate increases the pH to 7.2, reducing the pain.…”