Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of Botulinum Toxin (Type-A) Administered by the Fixed-Site Dosing Approach Versus the Muscle Area Identification

  • Original Article
  • Non-Surgical Aesthetic
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Introduction

Botulinum toxin is widely used in glabellar musculature. The authors express the need to individualize the approach by means of muscular identification to improve effectiveness. Despite these guidelines, the fixed-point technique is still used.

Objective

Comparison of effectiveness of botulinum toxin administration in the glabellar zone by using fixed-site application versus objective-muscle-identification.

Materials and Methods

Prolective dynamic cohort study. Patients (after previous informed consent) were assessed on their facial expressions, level of satisfaction, re-interventions, adverse effects, dosage, dilution, and number of injections. All patients who experienced either of both techniques of botulinum toxin administration (fixed-site or objective-muscle-identification) were subjected to followup by the following parameters: statistical analysis: student’s t Test (inter-group mean comparisons), paired student’s t test (intra-group mean comparisons), χ 2 with Fisher exact text.

Results

Sixty-two patients were evaluated (31 fixed-site approach, 31 objective-muscle-identification). No patient abandoned the trial during followup. Fixed-site injections required larger doses (16 vs 12 U, p = 0.001), greater volume (0.48 vs. 0.37 ml, p = 0.001), and more application sites (4 vs 2, p = 0.001), compared to the objective-muscle-identification approach. Under the objective-muscle-identification technique, facial expressions were better attenuated (52 vs 65 %, p = 0.001), with a higher initial satisfaction level (6 vs 9, p = 0.001) and final satisfaction level (9 vs 9.9, p = 0.001).

Conclusions

Botulinum toxin application is more effective when administered through the objective-muscle-identification approach (less frowning, lower doses, less fixed sites injected, and patients more satisfied at the end).

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Carruthers A, Carruthers J (2004) Botulinum toxin type A for the treatment of glabelar rhytides. Dermatol Clin 22:137–144. doi:10.1016/S0733-86:35(03)00071-8

    Article  CAS  PubMed  Google Scholar 

  2. Özsoy Zafer, Genc Bulent, Gözü Aydýn (2005) A new technique applying botulinum toxin in narrow and wide foreheads. Aesthet Plast Surg 29:368–372. doi:10.1007/s00266-004-063-z

    Article  Google Scholar 

  3. Carruthers A, Carruthers J, Coleman WP III et al (2013) Multicenter, randomized, phase III study of a single dose of incobotulinumtoxinA, free from complexing proteins, in the treatment of glabellar frown lines. Dermatol Surg 39:551–558. doi:10.1111/dsu.12100

    Article  CAS  PubMed  Google Scholar 

  4. Prager W, Bee EK, Havermann I et al (2013) Onset, longevity and patient satisfaction with incobotulinumtoxinA for the treatment of glabellar frown lines. Clin Interv Aging 8:449–456

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. D LA, Fallico Nefer, Mazzocchi M et al (2011) Botulinum toxin for glabellar lines: a review of the efficacy and safety of currently available products. Am J Clin Dermatol 12(6):377–388

    Google Scholar 

  6. Techniques Allergan Inc. (2011) Botox® (onabotulinum toxin A) US prescribing information [online]. http://www.allergan.com/assets/pdf/botox_cosmetic_pi.pdf. Accessed Jul 22

  7. Psillakis JM (1994) Deep face-lifting techniques. Medical Publishers, New York, p 44

    Google Scholar 

  8. Treu D, Ploch LE, Lupo MP (2012) Neurotoxin treatment of the upper face. Cosmet Dermatol 25:427–432

    Google Scholar 

  9. Allergan Inc. (2011) Botox® cosmetic (package insert). Allergan Inc., Irvine

    Google Scholar 

  10. Glogau R, Kane M, Beddingfield F et al (2012) OnabotulinumA: meta-analysis of duration of effect in the treatment of glabellar lines. Dermatol Surg 38:1794–1803. doi:10.1111/j.1524-4725.2012.02582.x

    Article  CAS  PubMed  Google Scholar 

  11. Rzany B, Carruthers A, Carruthers J et al (2012) Validated composite assessment scales for the global face. Dermatol Surg 38:294–308. doi:10.1111/j.1524-4725.2011.02252.x

    Article  CAS  PubMed  Google Scholar 

  12. Flynn TC, Carruthers A, Carruthers J et al (2012) Validated assessment scales for the upper face. Dermatol Surg 38(2S):309–319. doi:10.1111/j1524-4725.2011.02248.x

    Article  CAS  PubMed  Google Scholar 

  13. Carruthers A, Carruthers J (2004) Botulinum toxin type A for the treatment of glabelar rhytides. Dermatol Clin 22(2004):137–144. doi:10.1016/S0733-86:35(03)00071-8

    Article  CAS  PubMed  Google Scholar 

  14. Salti G, Ghersetich I (2008) Advanced botulinum toxin techniques against wrinkles in the upper face. Clin Dermatol 26(2):182–191. doi:10.1016/j.clindermatol.2007.09.008

    Article  PubMed  Google Scholar 

  15. Alfredo RL, Michel L (2010) Human anatomy, 4th edn. Edit. Medica Panamericana, Buenos Aires, pp 326–328

    Google Scholar 

  16. Isee NG, Elahi MM (2001) The corrugator supercilii muscle revisited. Aesthet Surg J 21:209–215

    Article  Google Scholar 

  17. Carruthers A, Carruthers J, Said S (2002) Dose-ranging study of botulinum type A in the treatment of glabellar lines. Presented at the 20th world congress of dermatology, Paris, July 1–5

  18. Carruthers J, Fagien S, Matarasso SL, Botox Consensus group (2004) Consensus recommendations on the use of botulinum toxin type A in facial aesthetics. Plast Reconstr Surg 112:1089–1098

    Google Scholar 

  19. Tremaine AM, McCullough JL (2010) Botulinum toxin type A, for the management of glabelar rhytids. Clin Cosmet Investing Dermatol 3:15–23

    Article  CAS  Google Scholar 

  20. Nigan PK, Nigam A (2010) Botulinum toxin. Indian J Dermatol 55(1):8–14

    Article  Google Scholar 

  21. Hsu TS, Dover JS, Arndt KA (2004) Effect of volume and concentration on the diffusion of botulinum exotoxin A. Arch Dermatol 140(11):1351–1354

    Article  CAS  PubMed  Google Scholar 

  22. Bolognia JL, Rapini R, Jorizzo JL (2008) Dermatology, 2nd edn. Mosby, London

    Google Scholar 

  23. Carruthers A, Carruthers J (2001) Botulinum toxin type A history and current cosmetic use in the upper face. Semin Cutan Med Surg 20:71–84

    Article  CAS  PubMed  Google Scholar 

  24. Öszoy Z, Gosu A, Genc B (2004) Two-plane injection of botulinum exotoxin A in glabellar frown lines. Aesthet Surg Plast 28(2):114–115. doi:10.1007/s00266-004-2105-y

    Google Scholar 

  25. Knize MD (2000) Muscles that act on glabellar skin a closer look. Plast Reconstr Surg 105:350–361

    Article  CAS  PubMed  Google Scholar 

  26. Le Louarn C (2001) Botulinum toxin A and facial lines: the variable concentration. Aesthet Plast Surg 25:73–84

    Article  CAS  Google Scholar 

  27. Rollin KD, Landon B (1997) Endoscopic forehead lift: anatomic basis. Aesthet Surg J 17:97

    Article  Google Scholar 

  28. Weider JM, Moy LR (1998) Understanding botulinum toxin surgical anatomy of the frown, forehead and peroocular región. Dermatol Surg 24:1172–1174

    Google Scholar 

  29. Öszoy Z, Gosu A, Genc B (2004) Two-plane injection of botulinum exotoxin A in glabellar frown lines. Aesthetic Surg Plast 28(2):114–115. doi:10.1007/s00266-004-2105-y

    Google Scholar 

  30. Finn G (2009) Histology biomolecular bases, 3rd edn. Edit. Medica Panamericana, Buenos Aires, p 223

    Google Scholar 

  31. Ross P (2009) Histology, 5th edn. Edit. Medica Panamericana, Buenos Aires, pp 163–165

    Google Scholar 

  32. Klein AW, Carruthers A, Fagien S, Lowe NJ (2008) Comparisons among botulinum toxins: an evidence-based review. Plast Reconstr Surg 12(6):413E–422E

    Article  Google Scholar 

  33. Carruthers J, Glogau R, Blitzer A, Facial Aesthetics Consensus Group Faculty (2010) Advances in facial rejuvenation: botulinum toxin type A, hyaluronic AC dermal fillers and combination therapies—consensus recommendations. Plast Surg 121(5 Suppl):5S–30S

    Google Scholar 

  34. Krystkowiak P (2009) Long-term effects of botulinum toxin treatment. Venereol Ann Dermatol 136(Suppl. 4):S86–S88

    Article  Google Scholar 

Download references

Compliance with Ethical Requirements

This research paper is considered as a minimum risk Class II trial, therefore informed signed consent was required. All information was guaranteed confidentiality and to use only for scientific research purposes.

Conflict of interest

This paper did not rely on any financing or support by any pharmaceutical company or institution. This paper was totally financed by the participating researchers: therefore authors here in declare not having any commercial interest based on the subject matter in this paper.

Author information

Authors and Affiliations

  1. Plastic Surgery Division of University of Guadalajara, Medical School, Calzada Federalismo 2022, Guadalajara, Jalisco, Mexico

    Jose Guerrrerosantos

  2. University of Guadalajara, Avenida Pablo Neruda 3265 Interior 25, CP 44638, Guadalajara, Jalisco, Mexico

    Pulido Galaviz Carlos Eduardo

  3. University of Guadalajara, Medical School, Avenida Pablo Neruda 3265 Interior 25, CP 44638, Guadalajara, Jalisco, Mexico

    Josefina Mateos Arriola

  4. University of Guadalajara, Medical School, Leonardo Da Vinci 5015, Zapopan, Jalisco, Mexico

    Alberto I. Villa Manzano

  5. Casita Montaña Medspa, Ajijic Mexico, Av. Agustin Yañez 2457, Guadalajara, Jalisco, Mexico

    Benjamin Villarán-Muñoz

  6. University of Guadalajara, Sierra Mojada 950, Col. Independencia, CP 44340, Guadalajara, Jalisco, Mexico

    Leonel García Benavides

  7. University of Guadalajara, José Vasconcelos 550 Street, Guadalajara, Jalisco, Mexico

    Ma Guadalupe Vazquez

Authors
  1. Jose Guerrrerosantos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pulido Galaviz Carlos Eduardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Josefina Mateos Arriola
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alberto I. Villa Manzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benjamin Villarán-Muñoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leonel García Benavides
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ma Guadalupe Vazquez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jose Guerrrerosantos.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guerrrerosantos, J., Eduardo, P.G.C., Arriola, J.M. et al. Effectiveness of Botulinum Toxin (Type-A) Administered by the Fixed-Site Dosing Approach Versus the Muscle Area Identification. Aesth Plast Surg 39, 243–251 (2015). https://doi.org/10.1007/s00266-014-0445-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-014-0445-9

Keywords

Search

Navigation