Modifications of eyebrow position with botulinum exotoxin A.

OBJECTIVE: To determine if clinically used botulinum exotoxin A (Botox) injections to the forehead and glabellar and crow\u27s-feet regions result in modifications of eyebrow position. DESIGN: Prospective study. SETTING: Academic medical center in St Louis, Mo. SUBJECTS: Twenty-nine adult patients treated with botulinum exotoxin A injections for rhytids. INTERVENTION: The eyebrow position at 13 different sites was measured before injection and 2 weeks after treatment. The areas injected were based on patient preference and physician assessment. Of the 29 patients, 14 received injections into the glabella only and 15 received injections into the glabella and forehead, with or without treatment of the crow\u27s-feet. RESULTS: In 29 patients at rest, we found no significant (P value range,.17 to.97) change in eyebrow position, except for a point depression at the right lateral eyebrow. The 15 patients who received injections into the forehead and glabella, with or without treatment of the crow\u27s-feet, had no significant (P value range,.11 to.84) change in eyebrow position, except for a point of depression at the left medial eyebrow. Both groups exhibited eyebrow depression in the active state (eyebrow maximally elevated). CONCLUSIONS: Botulinum exotoxin A injections into the forehead and glabellar, and crow\u27s-feet regions did not significantly change the resting eyebrow position. However, forehead injections contributed to eyebrow depression in the active state

A Double-Blind, Placebo-Controlled, Phase 3b Study of ATX-101 for Reduction of Mild or Extreme Submental Fat

BACKGROUND ATX-101 (deoxycholic acid injection) is approved for reduction of moderate or severe submental fat (SMF).OBJECTIVETo evaluate the efficacy and safety of ATX-101 in subjects with mild or extreme SMF.PATIENTS AND METHODSAdults with mild or extreme SMF (based on clinician assessment) were randomized to receive ≤6 treatments with ATX-101 or placebo. Efficacy end points, evaluated at 12 weeks after last treatment, included percentage of subjects who achieved ≥1-grade improvement in SMF from baseline based on both clinician and patient assessment (composite CR-1/PR-1 response) as well as multiple subject-reported outcomes. Safety end points included change in skin laxity and incidence of adverse events.RESULTSOverall, 61.3% of ATX-101-treated subjects versus 6.7% of placebo-treated subjects with mild SMF and 89.3% versus 13.3% of subjects, respectively, with extreme SMF achieved a composite CR-1/PR-1 response (p \u3c.001 for both). ATX-101-treated subjects also reported higher levels of satisfaction and greater reductions in the psychological impact of SMF versus placebo-treated subjects regardless of baseline SMF severity. Skin laxity was unchanged or improved in most of the subjects. Adverse events were mainly mild/moderate, transient, and associated with the injection site.CONCLUSIONATX-101 was efficacious and well tolerated for reduction of mild or extreme SMF

Effect of botulinum toxin pretreatment on laser resurfacing results: a prospective, randomized, blinded trial.

BACKGROUND: Facial laser resurfacing and chemodenervation with botulinum toxin type A are used independently as means of nonsurgical facial rejuvenation. Recent reports in the literature have described combining these 2 therapies, claiming improved and longer-lasting laser resurfacing results. To date, no scientific investigation has been undertaken to prove or disprove this theory. DESIGN: Institutional review board-approved, prospective, randomized, blinded study at university-affiliated outpatient cosmetic surgery offices. INTERVENTION: Patients had one side of their face injected, at specific anatomic subsites (crow\u27s feet, horizontal forehead furrows, and glabellar frown lines), with botulinum toxin 1 week before laser resurfacing. After receiving an injection, patients underwent cutaneous laser exfoliation on both sides of the face with either a carbon dioxide or an erbium dual-mode laser. MAIN OUTCOME MEASURES: Patients\u27 injected (experimental) and noninjected (control) sides were compared after laser resurfacing. Follow-up was documented at 6 weeks, 3 months, and 6 months after laser resurfacing. Subjective evaluation, based on a visual analog scale, was performed in person by a blinded observer. Furthermore, a blinded panel of 3 expert judges (1 facial plastic surgeon, 1 oculoplastic surgeon, and 1 cosmetic dermatologist) graded 35-mm photographs taken during postoperative follow-up visits. RESULTS: Ten female patients were enrolled in the study. A 2-tailed t test showed that all sites that were pretreated with botulinum toxin showed statistically significant improvement (P\u3c or =.05) over the nontreated side, with the crow\u27s feet region showing the greatest improvement. Comparing results between the carbon dioxide and erbium lasers did not result in any statistically significant differences. CONCLUSIONS: Hyperdynamic facial lines, pretreated with botulinum toxin before laser resurfacing, heal in a smoother rhytid-diminished fashion. These results were clinically most significant in the crow\u27s feet region. We recommend pretreatment of movement-associated rhytides with botulinum toxin before laser resurfacing. For optimum results, we further recommend continued maintenance therapy with botulinum toxin postoperatively