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Three-Dimensional Evaluation of Static and Dynamic Effects of Botulinum Toxin A on Glabellar Frown Lines

  • Innovative Techniques
  • Non-Surgical Aesthetic
  • Published:
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Abstract

Background

The use of injectable solutions for aesthetic purposes has increased tremendously, but lacks objective support. We aimed at assessing static and dynamic effects of botulinum toxin A (BoNTA) on glabellar lines by use of an objective three-dimensional methodology.

Methods

We prospectively collected three-dimensional stereographic photographs of two different facial expressions (pretreatment, 30 and 90 days posttreatment) in 21 patients, receiving a total of 20 units of BoNTA in both corrugator supercilii muscles. The primary endpoint was the three-dimensional static and dynamic surface irregularity, and secondary endpoints were the glabellar line scale and overall patient satisfaction. Blinded retrospective data analysis and statistical evaluation were performed with p < 0.05 considered statistically significant.

Results

Static glabellar lines (neutral facial expression) were significantly reduced by − 17% and − 24% on day 30 and 90 posttreatment, respectively (vs. pretreatment; both p < 0.0001). Dynamic glabellar frown lines (firmest possible bilateral eye closure) demonstrated a reduction of surface irregularity by − 26% and − 21% on day 30 and 90 posttreatment, respectively (vs. pretreatment; both p < 0.0001). The subjective dynamic glabellar line scale documented a statistically significant improvement on day 30 posttreatment (mean ± SD: 1.5 ± 0.8; p < 0.05) versus pretreatment (2.8 ± 1.0). Polled patients confirmed a subjective wrinkle improvement 90 days posttreatment.

Conclusion

The presented setup detected even subtle changes of BoNTA treatment for facial wrinkling and is a promising asset for scientific evaluations of clinical studies analyzing the outcome and duration of efficacy of injectable solutions on the face.

Level of Evidence IV

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.

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References

  1. De Boulle K, Fagien S, Sommer B, Glogau R (2010) Treating glabellar lines with botulinum toxin type A-hemagglutinin complex: a review of the science, the clinical data, and patient satisfaction. Clin Interv Aging 5:101–118

    PubMed  PubMed Central  Google Scholar 

  2. Research C for DE and Press Announcements - FDA approves Botox Cosmetic to improve the appearance of crow’s feet lines. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm367662.htm. Accessed 8 Aug 2015

  3. (2015) 2014 Plastic Surgery Statistics In: American Society of Plastic Surgeons http://www.plasticsurgery.org/Documents/news-resources/statistics/2014-statistics/cosmetic-procedure-trends-2014.pdf. Accessed 7 June 2017

  4. Nettar K, Maas C (2012) Facial filler and neurotoxin complications. Facial Plast Surg FPS 28:288–293. https://doi.org/10.1055/s-0032-1312695

    Article  CAS  PubMed  Google Scholar 

  5. Branford OA, Dann SC, Grobbelaar AO (2010) The quantitative assessment of wrinkle depth: turning the microscope on botulinum toxin type A. Ann Plast Surg 65:285–293. https://doi.org/10.1097/SAP.0b013e3181cbfee6

    Article  CAS  PubMed  Google Scholar 

  6. Hexsel D, Soirefmann M, Porto MD et al (2015) Fields of muscular and anhidrotic effects of 2 botulinum toxin-A commercial preparations: a prospective, double-blind, randomized, multicenter study. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 41(Suppl 1):S110–S118. https://doi.org/10.1097/01.DSS.0000452645.76270.88

    Article  CAS  Google Scholar 

  7. Carruthers A, Bruce S, de Coninck A et al (2014) Efficacy and safety of onabotulinumtoxinA for the treatment of crows feet lines: a multicenter, randomized, controlled trial. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 40:1181–1190. https://doi.org/10.1097/DSS.0000000000000128

    Article  CAS  Google Scholar 

  8. Carruthers A, Sadick N, Brandt F et al (2015) Evolution of facial aesthetic treatment over five or more years: a retrospective cross-sectional analysis of continuous onabotulinumtoxinA treatment. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 41:693–701. https://doi.org/10.1097/DSS.0000000000000340

    Article  CAS  Google Scholar 

  9. Flynn TC, Carruthers A, Carruthers J et al (2012) Validated assessment scales for the upper face. Dermatol Surg 38:309–319. https://doi.org/10.1111/j.1524-4725.2011.02248.x

    Article  CAS  PubMed  Google Scholar 

  10. Carruthers JDA, Glogau RG, Blitzer A, Facial Aesthetics Consensus Group Faculty (2008) Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies–consensus recommendations. Plast Reconstr Surg 121:5S–30S. https://doi.org/10.1097/prs.0b013e31816de8d0 (quiz 31S–36S)

    Article  CAS  PubMed  Google Scholar 

  11. Lumenta DB, Selig H, Kitzinger H-B, Kamolz L-P (2012) Objective quantification of wrinkles: three-dimensional analysis of surface irregularity. Plast Reconstr Surg 129:735e–737e. https://doi.org/10.1097/PRS.0b013e318245e74e

    Article  CAS  PubMed  Google Scholar 

  12. Upper face. In: Merz Aesthet. https://www.merzaesthetics.com/services/scales/upper-face/. Accessed 21 Oct 2015

  13. Prager W, Rappl T (2012) Phase IV study comparing incobotulinumtoxinA and onabotulinumtoxinA using a 1:1.5 dose-conversion ratio for the treatment of glabellar frown lines. J Cosmet Dermatol 11:267–271. https://doi.org/10.1111/jocd.12001

    Article  PubMed  Google Scholar 

  14. Bazin R, Lévêque JL (2011) Longitudinal study of skin aging: from microrelief to wrinkles. Skin Res Technol Off J Int Soc Bioeng Skin ISBS Int Soc Digit Imaging Skin ISDIS Int Soc Skin Imaging ISSI 17:135–140. https://doi.org/10.1111/j.1600-0846.2010.00481.x

    Article  Google Scholar 

  15. Lewis C (2002) Botox cosmetic: a look at looking good. FDA Consum 36:11–13

    PubMed  Google Scholar 

  16. Amos N, McCabe MP (2015) Self-perceptions of sexual attractiveness: satisfaction with physical appearance is not of primary importance across gender and sexual orientation. J Sex Res. https://doi.org/10.1080/00224499.2014.1002128

    Article  PubMed  Google Scholar 

  17. Carruthers J, Rivkin A, Donofrio L et al (2015) A multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of repeated onabotulinumtoxinA treatments in subjects with crow’s feet lines and glabellar lines. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 41:702–711. https://doi.org/10.1097/DSS.0000000000000357

    Article  CAS  Google Scholar 

  18. Guo Y, Lu Y, Liu T et al (2015) Efficacy and safety of botulinum toxin type a in the treatment of glabellar lines: a meta-analysis of randomized, placebo-controlled, double-blind trials. Plast Reconstr Surg 136:310e–318e. https://doi.org/10.1097/PRS.0000000000001544

    Article  CAS  PubMed  Google Scholar 

  19. Carruthers A, Carruthers J (2010) A validated facial grading scale: the future of facial ageing measurement tools? J Cosmet Laser Ther Off Publ Eur Soc Laser Dermatol 12:235–241. https://doi.org/10.3109/14764172.2010.514920

    Article  Google Scholar 

  20. Epstein MD, Scheflan M (2015) Three-dimensional imaging and simulation in breast augmentation: what is the current state of the art? Clin Plast Surg 42:437–450. https://doi.org/10.1016/j.cps.2015.06.013

    Article  PubMed  Google Scholar 

  21. Heppt WJ, Godbersen H, Hildebrandt T (2013) An interactive three-dimensional nose model for rhinosurgery. Facial Plast Surg FPS 29:121–126. https://doi.org/10.1055/s-0033-1341586

    Article  CAS  PubMed  Google Scholar 

  22. Verzé L, Bianchi FA, Ramieri G (2014) Three-dimensional laser scanner evaluation of facial soft tissue changes after LeFort I advancement and rhinoplasty surgery: patients with cleft lip and palate vs patients with nonclefted maxillary retrognathic dysplasia (control group). Oral Surg Oral Med Oral Pathol Oral Radiol 117:416–423. https://doi.org/10.1016/j.oooo.2013.12.406

    Article  PubMed  Google Scholar 

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Funding

Dr. Thomas Rappl provided the botulinum toxin for the treatment of the glabellar lines.

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Authors and Affiliations

  1. Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria

    Thomas Rappl, Paul Wurzer, Alexandru Cristian Tuca, Janos Cambiaso-Daniel, Daryousch Parvizi, Lars-P. Kamolz & David B. Lumenta

  2. COREMED – Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria

    Paul Wurzer & Lars-P. Kamolz

  3. Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria

    Simone May

Authors
  1. Thomas Rappl
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  2. Paul Wurzer
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  3. Simone May
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  4. Alexandru Cristian Tuca
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  5. Janos Cambiaso-Daniel
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  6. Daryousch Parvizi
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  7. Lars-P. Kamolz
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  8. David B. Lumenta
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Contributions

All authors made substantial contributions to the conception and design (DBL, TR, PW), data acquisition (DP, PW), analysis (DBL, ACT, PW), interpretation (ACT, DBL, SM, TR, PW, LPK), drafting of the manuscript and its revision for important intellectual content (all authors).

Corresponding author

Correspondence to Paul Wurzer.

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Conflict of interest

Dr. Thomas Rappl is a consultant and investigator to Merz Pharmaceuticals GmbH, Germany. All the other authors have no conflict of interest to declare.

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Rappl, T., Wurzer, P., May, S. et al. Three-Dimensional Evaluation of Static and Dynamic Effects of Botulinum Toxin A on Glabellar Frown Lines. Aesth Plast Surg 43, 206–212 (2019). https://doi.org/10.1007/s00266-018-1230-y

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  • DOI: https://doi.org/10.1007/s00266-018-1230-y

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