Comparison Between Intramuscular and Perimuscular Injections of Botulinum Toxin Type A

Background Botulinum toxin type A (BTX-A) must be injected in the intramuscular area to exert its paralytic effect. The durability of the BTX-A effect varies in different patients, and this fact can result from different locations of the drug injection, for example, the muscle peripheral area (perimuscular). This study aimed to evaluate whether a difference exists in the effect duration of the muscle paralysis between intramuscular and perimuscular injections of BTX-A. Methods This study used 18 male New Zealand rabbits divided into two groups (A and B) based on the location of the BTX-A injection. The group A animals received 10 units of BTX-A diluted with 0.1 ml of normal saline injected perimuscularly. The group B animals received the same dosage injected in the intramuscular area of the left masseter muscle. An electroneurophysiologic study was performed 1 week before the experiment for all the animals, then repeated 1, 4, and 8 weeks after the toxin injection. Results The amplitude values recorded in the masseter muscle were significantly lower in both groups throughout the study than the physiologic amplitude. The comparison between groups A and B did not show any statistically significant amplitude variations throughout the 8 weeks. Conclusion No significant difference in the neuromuscular blockade induced by botulinum toxin type A was observed between injections into the muscle peripheral area and intramuscular injections.     

Treatment of Hypertrophic Scars With Intralesional Botulinum Toxin Type A Injections: A Preliminary Report

Background  Hypertrophic scar is the abnormal appearance of wound healing that usually causes major physical, psychological, and cosmetic problems. Treatment of the hypertrophic scar still is a dilemma due to the lack of effective and excellent methods and agents. Recent reports show that botulinum toxin type A (BTX-A) improves wound healing. Therefore, the authors hypothesized that BTX-A may be favorable for the improvement of hypertrophic scars. Methods  A total of 19 patients were randomly assigned to a prospective clinical study. At 1-month intervals, BTX-A (2.5 U per cubic centimeter of lesion) was injected in these patients for a total of 3 months. All the patients were followed up for at least half a year. Therapeutic satisfaction was recorded, and the lesions were assessed for erythema, itching sensation, and pliability. Results  The study was completed by 19 patients. At the half-year follow-up visits, all the patients showed acceptable improvement, and the rate of therapeutic satisfaction was very high. The erythema score, itching sensation score, and pliability score after the BTX-A injection all were significantly lower than before the BTX-A injection. The differences all were statistically significant (P < 0.01). Conclusion  For the treatment of hypertrophic scars, doctors and patients both found BTX-A acceptable because of its better therapeutic results. Its effect of eliminating or decreasing hypertrophic scars was promising. Zhibo Xiao and Fengmin Zhang are the primary authors of this article.     

Botulinum Toxin A for Lower Facial Contouring: A Prospective Study

Background A prominent mandibular angle is a common reason for aesthetic treatment among Asian women. Such women usually present with hypertrophic masseteric muscles, and one treatment for this uses botulinum toxin A (BoNTA). Detailed effectiveness and physiologic influences of this therapy are still under investigation. Methods The authors report a prospective study of 10 female volunteers with hypertrophic masseteric muscles who received a single treatment comprising intramuscular injection of BoNTA. The facial change and the discomfort of the injection were self-rated using a visual analog scale, and the patients were regularly inspected up to 1 year. Bite forces also were measured for chronological documentation. Volume changes of masticating muscles were evaluated by three-dimensional computed tomography (CT) scans before and 3 months after injection of BoNTA. Results The serial photographs and patient subjective evaluation showed an obvious facial change 3 to 6 months after injection. Bite forces decreased from the first day after injection, but started to recover during week 3 and were normal 3 months after injection. Three-dimensional CT evaluation showed a statistically significant mean masseter reduction of about 30%, but no change in the volume of other masticating muscles. There were no serious complications during this study. Conclusions Injection of BoNTA is an effective alternative for contouring of the lower facial profile by reducing the bulkiness of masseteric muscles. Its effectiveness was noticed as early as 2 weeks after injection and reached a peak effect in month 3. The facial contour gradually returned 6 months after injection. The reduction in bite force was temporary and caused no daily life interference.     

A Double-Blind,Randomized, Placebo-Controlled,Two-Dose Comparative Study of Botulinum Toxin Type A for Treating Glabellar Lines in Japanese Subjects

BACKGROUND: Systematic, well-controlled clinical trials of botulinum toxin type A (BoNTA) in diverse patient populations are needed. The aim of this study was to characterize the safety and efficacy of 10-U and 20-U BoNTA doses versus placebo for treating glabellar lines in Japanese subjects. METHODS: A 16-week, multicenter, double-blind, randomized, placebo-controlled trial comparing 10 or 20 U of BoNTA versus placebo in 142 Japanese subjects with glabellar lines of at least moderate severity at maximal contraction. The primary efficacy endpoint was physician-rated line severity at maximal contraction 4 weeks after treatment. Secondary efficacy endpoints included physician/subject ratings and estimates of the effect's duration. RESULTS: Response rates by physician-rated line severity at maximal contraction (week 4) were 86.4% (10 U), 88.6% (20 U), and 0% (placebo, p < 0.001). Line severity at maximal contraction in each BoNTA group (p < 0.001) improved significantly from baseline at each visit. BoNTA and placebo differed significantly on all other efficacy measures. Mean duration of effect was 9.4 weeks in the 20-U group and 7.9 weeks in the 10-U BoNTA group. No serious adverse events occurred. CONCLUSION: Doses of BoNTA of 10 and 20 U are effective and safe for treating glabellar lines in Japanese subjects, and the 20-U dose provides greater efficacy and longer duration of effect.     

Nasal Dorsum Augmentation with Botulinum Toxin A: A Pilot Study

BackgroundBotulinum toxin type A (BTxA) is used for cosmetic procedures, but its use for nasal dorsum augmentation has, to our knowledge, never been studied.ObjectiveHere, we describe a method for using BTxA injection for nasal dorsum augmentation.MethodsThis was a pilot study. Participants aged 20 to 60 years were recruited and injected with BTxA in the upper nasal area with either Xeomin^® (Merz Pharmaceuticals GmbH, Frankfurt, Germany) or Dysport^® (Galderma Laboratories, Fort Worth, Texas). The primary outcome measured was the upper nasal area’s volume change from baseline, calculated using a Quantificare camera (San Francisco, California). The volumizing effect was subjectively graded by two blinded dermatologists and participants, and pain scores and adverse events were recorded.ResultsFourteen participants, including two men and 12 women, aged 35.78±9.16 years were recruited. Overall, the volume of the upper nasal area increased after BTxA injection (p<0.001). The volume increase immediately and, at one week after injection, presented a statistically significant difference from baseline, with median (interquartile range) volume differences of 0.095mL (0.010–0.205; p<0.001) and 0.095mL (0.0475–0.155; p<0.001), respectively. Two blinded dermatologists and all participants observed volumizing of the nasal dorsum. The effect appeared to last for one month.ConclusionThis study suggests that injecting BTxA in the upper nasal area is a convenient, minimally invasive technique with minimal side effects for nasal dorsum augmentation.     

微聚焦超声联合肉毒毒素在下面部年轻化的应用

目的 探析微聚焦超声联合肉毒毒素在下面部年轻化中的临床疗效。方法 选择2022年1月-2023年1月 本院医学美容科收治的51例下面部年轻化患者作为研究对象,随机分为对照组（n =25）与观察组（n =26）。 对照组采用微聚焦超声治疗,观察组采用微聚焦超声联合肉毒毒素治疗,比较两组临床疗效、治疗满意度、 面部年轻化指标、面部敏感指标。结果 观察组治疗总有效率为100.00%,高于对照组的84.00%（P ＜0.05）; 观察组治疗满意度为9 6 .15%,高于对照组的7 6 . 0 0%（P ＜0 . 0 5）;观察组治疗后改良FWS评分为 （1.22±0.12）分、WSRS评分为（1.25±0.14）分,低于对照组的（1.74±0.24）分、（1.71±0.16）分 （P ＜0.05）;观察组治疗后瘙痒程度评分为（0.74±0.12）分、24 h灼烧感评分为（0.73±0.14）分、皮 肤检测评分为（22.14±2.51）分,低于对照组的（1.26±0.14）分、（0.99±0.13分）、（26.94±2.67）分 （P＜0.05）。结论 微聚焦超声联合肉毒毒素在下面部年轻化的应用中效果确切,能够提高临床疗效,优 化面部年轻化指标,改善面部敏感问题,取得较高的治疗满意度,值得应用。     

Adverse Events of Intravesical Botulinum Toxin A Injections for Idiopathic Detrusor Overactivity: Risk Factors and Influence on Treatment Outcome

Background

Intravesical injection of botulinum toxin type A (BoNTA) provides effective treatment for detrusor overactivity and overactive bladder (OAB). However, the high rates of treatment-related adverse events (AEs) prevent its more widespread use.

Objective

To investigate the risk factors of increasing AEs after BoNTA injection for idiopathic detrusor overactivity (IDO).

Design, setting, and participants

This study included a total of 217 patients receiving their first intravesical BoNTA injection for refractory IDO in a tertiary university hospital from 2004 to 2009.

Measurements

AE incidence was analyzed according to gender, age, comorbidities, prostate condition in men, OAB subtype, BoNTA dose, injection site, and baseline urodynamic parameters. Successful outcome was determined based on patient perception of improvement of bladder condition at 3 mo.

Results and limitations

Successful outcomes were reported by 144 (66.3%) patients. By multivariable analysis, male gender (p = 0.013) and baseline postvoid residual (PVR) ≥100 ml (p = 0.003) were independent predictors of acute urinary retention (AUR). Baseline PVR ≥100 ml (p = 0.007) and receiving >100 U BoNTA (p = 0.029) were predictors of straining to void. The incidence of large PVR after treatment was associated with comorbidity (p = 0.011). Urinary tract infection occurred more frequently in women (p = 0.003) and in men with retaining prostate (p = 0.008). No AUR developed after bladder base/trigonal injection. Nevertheless, the occurrence of AUR or large PVR did not affect therapeutic outcome. This study is limited by nonconsecutive enrollment of patients.

Conclusions

Male gender, baseline PVR ≥100 ml, comorbidity, and BoNTA dose >100 U are risk factors for increasing incidence of AEs after intravesical BoNTA injection for IDO.     

The Results of Periorbital Rejuvenation with Botulinum Toxin A Using Two Different Protocols

Background: This study was proposed to analyze the changes in shape and position of the eyebrow before and after botulinum toxin A injection using two different protocols for a periorbital rejuvenation. Methods: The botulinum toxin A treatment was performed for brow-lift and effacement of crow’s feet (group A), and for brow-lift and effacement of glabellar frown lines in addition to crow’ feet (group B). To evaluate the change in brow shape and height, measurements of five points around the brow were taken before and after treatment. Results: In groups A and B, the brow positions were elevated, and the interbrow distance was increased. The central brow showed the largest elevation, followed by the lateral brow and the medial brow. The difference in the interbrow distance between groups A and B was statistically significant (p < 0.001). Conclusion: Elevation of the eyebrow with the desired aesthetically pleasing curvature was obtained after botulinum toxin A treatment in both groups using two different protocols for periorbital rejuvenation. The effect on the muscular dynamics after treatment can be changed according to the amount and the injection points. Therefore, in determining the injection protocols for periorbital rejuvenation, consideration should be given to the change in brow position and shape according to the change in the muscular dynamics after treatment.     

A New Technique Applying Botulinum Toxin in Narrow and Wide Foreheads

The use of botulinum toxin is becoming increasingly popular, and application details are being examined in an effort to achieve more satisfactory results with fewer side effects. In the forehead area, the main considerations are the effacement of forehead wrinkles to a desirable extent and the prevention of complications such as ptosis of the eyebrow and upper eyelid. The frontalis muscle necessitates chemodenervation by botulinum toxin at multiple points for the desired effect. The dimensions of foreheads, and thus the frontalis muscle, differ from patient to patient. The effectiveness and side effects change according to whether the forehead is narrow or a wide. Therefore, no single application technique is best for all patients. For this study, the glabella–hairline distance was measured in 90 healthy adults. Patients with a vertical forehead length exceeding 70 mm were regarded as having a wide forehead, and the botulinum toxin was applied in three vertical lines in two split doses. On the other hand, individuals with a vertical forehead length of less than 60 mm were regarded as having a narrow forehead, and the toxin was applied in two split doses in three horizontal lines. The authors have found that in cases of wide or narrow foreheads, the effectiveness of the toxin increased, whereas the side effects such as brow asymmetry and ptosis were not encountered. Thus, they recommend the use of this technique for patients with wide or narrow foreheads.     

Study of Botulinum Toxin A in Neurogenic Bladder Due to Spina Bifida in Children

Background: We report results of a pilot study investigating the safety and efficacy of Botulinum A toxin on urinary incontinence and bladder function in children with neurogenic bladder. Methods: This was a prospective, non‐randomized clinical trial. Seven children with median age of 16 years with spina bifida who had high storage pressures, poor bladder compliance and had failed treatment with anticholinergic medications were offered a single intra‐detrusor injection of Botulinum A toxin. All subjects were on clean intermittent catheterization before and during the study. Follow‐up videourodynamic studies were performed at 1 month, between 3 and 6 months, and at 9 months. Data were collected on safety and on subjective outcomes through validated questionnaires filled out by patients at each visit. Results: In majority of the patients (5/7), the injection produced an increase in bladder compliance (P < 0.05) and an improvement in incontinence (P < 0.05) at 1‐month follow‐up. However, in two patients whose baseline bladder capacity was markedly reduced (<200 mL), the improvement was very minimal. The beneficial effects in bladder compliance and incontinence dissipated by 9 months. The changes in subjective outcomes (incontinence and satisfaction scores) did not parallel the changes in urodynamics through the study period. No side effects of Botulinum toxin were seen. Conclusion: Botulinum A toxin injection produces beneficial urodynamics and clinical effects. These beneficial effects last for approximately 9 months. There is a poor correlation between improvement in the urodynamics and the subjective outcomes. Botulinum A toxin injection is a safe alternative treatment for patients with spina bifida and a neurogenic bladder.     

A型肉毒素在面部除皱中的应用

目的探讨A型肉毒素注射祛除面部皱纹的临床疗效。方法本组56例面部除皱患者,通过设计不同注射点,采用A型肉毒素进行多部位、微剂量局部注射,每次总剂量小于100U。结果经注射后,54例效果显著(96.43%),2例有效(3.57%),总有效率100%。结论 A型肉毒素用于面部除皱,疗效确切,见效快,痛苦小,是一种安全有效的方法。     

Six-Year Follow-Up of Botulinum Toxin A Intradetrusorial Injections in Patients with Refractory Neurogenic Detrusor Overactivity: Clinical and Urodynamic Results

Background

Most reports in the literature on botulinum toxin A (BoNTA) therapy for neurogenic detrusor overactivity (NDO) are based on the results of a single injection. Because most patients may require retreatment, the efficacy and safety of multiple injections must be addressed clearly.

Objective

To investigate the effectiveness and safety of BoNTA intradetrusorial injections in a group of spinal cord–injured (SCI) patients with refractory detrusor overactivity (DO).

Design, setting, and participants

Seventeen SCI patients were prospectively included in the study and followed up to 6 yr.

Intervention

All patients received repeat intradetrusorial injections of BoNTA 300 units (Botox, Allergan, Irvine, CA) under cystoscopic control on an inpatient basis.

Measurements

The preliminary assessment included voiding diary, urodynamics, kidney and bladder ultrasound, and cystourethrography. Patients also completed a standardised quality-of-life (QoL) questionnaire. Clinical evaluation, urodynamics, urinary tract imaging, and QoL assessment were repeated every year throughout the follow-up.

Results and limitations

Before treatment, all patients complained of urinary incontinence and had DO. Bilateral and monolateral renal pelvis dilatation were detected in six and five patients, respectively, and a monolateral and third-grade vesicoureteral reflux was observed in three. At 6-yr follow-up, a significant decrease in the frequency of daily incontinence episodes (p < 0.01), a significant increase in first uninhibited detrusor contraction and in maximum bladder capacity (p < 0.001 for both), and a significant decrease in maximum pressure of these contractions (p < 0.01) were observed. Fifteen patients (88.2%) were completely continent. Renal pelvis dilatation and vesicoureteral reflux resolved in all cases, and the QoL index significantly increased. Limitations of the study are related to the small number of included patients.

Conclusions

In SCI patients with refractory NDO who do not want or are unfit for invasive reconstructive surgery, BoNTA intravesical treatment represents a valid alternative to control DO and urinary incontinence and to preserve upper urinary tract function over a long-term follow-up.     

肉毒杆菌毒素注射在面部美容中的应用效果

探究临床面部美容中注射肉毒杆菌毒素的应用价值。方法 选择2022年5月-2023年2月滕州市中心人民医院收治的90例面部美容患者为研究对象,经随机抽签法分为对照组和观察组,每组45例。对照组采用微针导入富血小板血浆治疗,观察组在对照组基础上注射肉毒杆菌毒素,比较两组临床疗效、皮肤状态、不良反应发生情况以及美容满意度。结果 观察组总有效率为95.56%,高于对照组的80.00%,差异有统计学意义（P＜0.05）;观察组治疗后滋润度与弹性度评分高于对照组,油脂和斑纹评分低于对照组,差异有统计学意义（P ＜0.05）;两组不良反应发生率比较,差异无统计学意义（P ＞0.05）;观察组美容满意度为93.33%,高于对照组的77.78%（P ＜0.05）。结论 临床面部美容患者给予注射肉毒杆菌毒素,能够有效提高美容效果,改善其皮肤滋润、弹性、油脂以及斑纹等皮肤状态,不良反应少,具有较高的患者满意度。     

A型肉毒毒素治疗化脓性汗腺炎的研究进展

化脓性汗腺炎是一种病变首发于毛囊的慢性化脓性炎症,以反复发作的痛性结节、脓肿、窦道、瘢痕形成为主要特点.其发病机制与遗传、免疫、感染、内分泌、吸烟、肥胖等多种因素有关.以往,化脓性汗腺炎的治疗包括抗生素治疗、手术治疗、放射治疗、激光治疗等,但效果都不尽理想.近年来,相关报道显示A型肉毒毒素注射治疗化脓性汗腺炎具有较好的...     

A型肉毒毒素在治疗咬肌肥大中的作用

目的 评价A型肉毒毒素在治疗咬肌肥大中的作用。方法 2005年8月至2014年1月,对15例咬肌肥大患者行A型肉毒毒素治疗,并应用B型超声于术前和术后4、12、24周测量咬肌厚度。结果 本组患者术后随访6个月,咬肌注射A型肉毒毒素后4、12、24周,咬肌厚度萎缩(15.60±4.96)%、(27.72±9.13)%和(24.32±8.86)%。结论 A型肉毒毒素能有效减少咬肌厚度;B型超声测量能有效地反映咬肌萎缩的程度。     

Botulinum Toxin: An Effective Treatment for Flushing and Persistent Erythema in Rosacea

Botulinum toxin has been used to treat persistent erythema and flushing in rosacea for several years. Here, we describe two women and one man, each with rosacea with flushing and permanent erythema refractory to conventional treatment, who achieved satisfactory and lasting results following intradermal application of botulinum toxin. Two different botulinum toxin types were used. Toxin concentrations of 3.75U per 0.1 mL (abobotulinum) and 1.25U per 0.1 mL (incobotulinum) were used for each patient were used for each patient. The outcomes were measured using polarized photography to evaluate the decrease in vascular involvement. In the three cases presented here, botulinum toxin was effective for controlling erythema and flushing associated with rosacea; we also observed a prolonged duration of these improvements without the rebound effect of topical therapies.     

Evaluating Effects of Preservative-Containing Saline Solution on Pain Perception During Botulinum Toxin Type-A Injections at Different Locations: A Prospective, Single-Blinded, Randomized Controlled Trial

Pain is a side effect of botulinum toxin type-A (BTX-A) injections. The efficiency of the preservative-containing saline solution used as the “dilution solution” for controlling the pain felt during multiple injections in different areas has been investigated by a prospective, randomized, single-blinded, controlled study. A total of 93 patients were divided into three groups for the study. All the patients were given BTX-A. Of these 93 patients, 60 received injections in the upper face, 15 in the neck, and 18 in the axillary regions. The visual analog scale (VAS), a single-dimension pain intensity rating scale, was used to evaluate pain perception. The average VAS values for pain sensation experienced by the groups were 1.2 of 10 points for the upper face area in the experimental group (n = 60) and 4.5 point for the control group. In the neck region (n = 15), the respective scores were 0.6 in the experimental group and 3.9 in the control group. Finally, in the axillary region (n = 18), the respective values were 0.9 and 5.1. The authors conclude that the preservative-containing saline solution significantly decreased pain perception during BTX-A injections (p = 0.000).