Subjective and Objective Measurements of the Facial Effects of Microdoses of Botulinum Toxin

Abstract

Introduction: Studies have suggested that botulinum toxin A may improve skin quality, and application protocols using hyper-diluted doses of botulinum toxin (microdosing) have been studied as a way to achieve therapeutic goals without fully paralyzing the targeted muscles. Objectives: To evaluate the effects of a combined protocol utilizing both the standard dosing and the microdosing of AbobotulinumtoxinA for the improvement of skin quality, measured by objective and subjective measurements. Methods: Thirty patients were treated with botulinum toxin using both the standard technique and the microdosing technique. Objective (Sebumeter®, Mexameter® and digital dermoscopy pictures) and subjective (Global Aesthetic Improvement Scale and a clinical scale for evaluating the quality of facial skin) measurements of the effects in the treated areas were taken to assess the efficacy of the treatment. Results: Digital dermoscopy showed a marked reduction of erythema and telangiectasias. Erythema and telangiectasias improved both on objective and subjective measurements. Skin oleosity, static rhytids, papules and pustules and enlarged pores improved on subjective measurements. Patient satisfaction was high (93%) despite the high rate of adverse events (56%). Conclusions: The combined application of standard doses and microdoses of AbobotulinumtoxinA is effective in improving the overall quality of facial skin. The effects on erythema and telangiectasias suggest that it is an effective treatment option for patients with erythematotelangiectatic rosacea. When applying microdoses of botulinum toxin in the lower and mid-face, the doses and pattern of injection should be customized for each patient to reduce the occurrence of adverse events.

Mild Allergic Reactions after Botulinum Toxin Injection: A Case Series and Literature Review

“…11,12 Simultaneously, a clinical survey focusing on BTA adverse reactions in clinical practice proved the adverse reaction of BTA is actually not rare but usually inconspicuous, thus almost having no influence on subsequent treatment procedure and patients' satisfaction. 6 We suspected that most clinicians and patients might ignore some early and inconspicuous BTA hypersensitive reactions in the first place, but the subsequent injection without protective measures could lead to a severe and unexpected consequence and invoke serious medical accidents. According to the literature review, we noticed that the BTA allergic symptoms reported so far all occurred around the injection sites or primarily occurred in the injection sites before spreading to other sites.…”

“…[3][4][5] The BTA allergic symptoms reported so far all occurred around the injection sites or primarily occurred in the injection sites before spreading to other sites. 6 We have noticed several patients in our clinical practice who experienced inconspicuous and nonpruritic erythema on the chest after BTA injection into the upper face, but the injection sites showed no anomaly. We speculate that some of the BTA we injected may have diffused into the blood and invoked some kind of hypersensitive reaction…”

Incobotulinumtoxin A and Yoga-like Isometric Exercise in Adolescent Idiopathic Lumbar Scoliosis—A Randomized Pilot Study

“…(1) Although inactive after two months, longer-term reduction in muscle tension is seen in botulinum toxin's cosmetic and dental uses [35][36][37][38][39]. (2) The botulinum weakens the strong (concave) side of the lumbar curve, enabling the actin and myosin fibers of the weak (convex) side to slide further together, increasing the number of cross bridges, and proportionately increasing their power to contract [40], in addition to the continual strengthening the yoga pose provides during the latter part of the three-month period.…”