An unusual adverse event of botulinum toxin injection in the lower face

Souto, Mariam Patrícia Auada; Souto, Luís Ricardo Martinhão

doi:10.1111/jocd.13869

Cited by 10 publications

(5 citation statements)

References 9 publications

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“…10 Cadaver dissection studies have shown that the DAO overlaps the DLI inferiorly where the muscles arise from the mandibular border. 5,11,12 A potential side effect of DAO injection is therefore inadvertent injection of the DLI, 13 and injection of the DAO should therefore always remain lateral.…”

Section: Discussionmentioning

confidence: 99%

A Novel 3-Point Injection Technique for OnabotulinumtoxinA in the Upper Depressor Anguli Oris

Moradi¹,

Khalifian²,

Alghoul

et al. 2023

Dermatol Surg

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BACKGROUND AND OBJECTIVE To evaluate the efficacy and safety of onabotulinumtoxinA (ONA) injections to the depressor anguli oris (DAO) to improve downturned mouth. PATIENTS AND METHODS/MATERIALS This prospective, placebo-controlled, study enrolled subjects aged 18 to 65 years. Injections were performed using a novel 3-point technique in the upper DAO (1.5 U/injection site). The primary end point was a DAO contraction scale 1-grade improvement. Subjective evaluation was performed using the Global Aesthetic Improvement Scale (GAIS). RESULTS Ten subjects received ONA and 10 placebo (saline) injections. In ONA-treated subjects, DAO scores showed significant improvements at Weeks 4 and 12 (p , .001) compared with baseline. No significant difference between visits was observed for placebo-injected subjects. Global Aesthetic Improvement Scale scores showed that 100% of subjects were improved compared with baseline at Week 4% and 90% at Week 12. By contrast, 90% and 80% of placebo-treated subjects had "no change" in their DAO appearance at Weeks 4 and 12. Subject GAIS assessments matched the live evaluator at Week 4; 60% continued to report improvement at Week 12. Treatment was well tolerated. CONCLUSION OnabotulinumtoxinA injections to the DAO using a 3-point technique provide clinically meaningful improvements in appearance. Treatment was well tolerated and in most individuals lasted at least 12 weeks. IDENTIFIER ClinicalTrials.gov NCT04240535.

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Section: Discussionmentioning

confidence: 99%

A Novel 3-Point Injection Technique for OnabotulinumtoxinA in the Upper Depressor Anguli Oris

Moradi¹,

Khalifian²,

Alghoul

et al. 2023

Dermatol Surg

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“…Adverse smile events may occur during treatment of the hyperactive upper lip of gummy smile, the small vertical wrinkles above the upper lip that run vertically downward into the lip and are known as “barcode” lines, and when trying to induce a depressor anguli oris (DAO) muscle relaxation. 29…”

Section: Botulinum Toxin and The Facial Middle Thirdmentioning

confidence: 99%

Botulinum Toxin Type A: Adverse Events and Management

Cavallini

Papagni²,

Lazzari³

et al. 2022

Facial Plast Surg

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Aesthetic medicine is witnessing an increasing exploitation of all the procedures. The demand has never been higher than it is today. The number of practitioners is also increasing year by year. Consequently complications and other kinds of related troubles and procedures are also rising. Never like today is fundamental, in case of troubles, how to properly manage with the most frequent issues. In aesthetic medicine field, botulinum toxin procedures are the safest. Lot of patients are worried about botulinum toxin despite the available scientific literature. Rare short-term complications are observed. In the most of cases, nothing severe occurs if the international recommendations and the most recent guidelines are closely followed, the majority of them are injection related. This study is a review of rare or common problems that can occur and how to manage or solve the situations.

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“…Other side effects of facial muscles injection include eye dryness [ 8 ], eye weakness [ 9 ], ocular itching [ 10 ], diplopia [ 10 ], blurred vision [ 1 ] and hematoma in the injection site [ 11 ], which seem to be secondary to either upper or lower eyelid injections. Smile asymmetry or mouth droop occur due to injections of the muscles generating the smile function, i.e., the lower eyelid or lower parts of the face [ 12 ]. The decision to treat the lower eyelid with 1-point or 2-points injection is randomly taken and there is no consensus regarding this debate.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Approach to Botulinum Injections for Hemifacial Spasm, Synkinesis and Blepharospasm

Yahalom

Janah

Rajz

et al. 2022

Toxins

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The aim of this study was to show our therapeutic outcome of botulinum injection to the facial muscles and thereby to find the best therapeutic concept which should be embraced. The decision to treat the lower eyelid with 1-point or 2-points injection was randomly taken as there is no consensus regarding this debate. Injections of the lateral end of the upper eyelid were performed more laterally to the conventional injection point, just lateral to the conjunction of the upper and lower eyelids. Twenty-three patients (12 hemifacial spasm, 6 blepharospasm, 5 post facial palsy synkinesis) were enrolled. Data were retrieved from 112 visits between 2019 and 2022. Overall, 84.9% of the treatments had moderate or marked improvement. The most common side effect was facial weakness (11.8%). Neither ptosis nor diplopia were noted. Two-points regimen in the lower eyelid was associated with a lower risk of facial weakness (p = 0.01), compared to 1-point regimen, with a better therapeutic outcome as reflected by more favorable PGI-C scores (p = 0.04). Injection of the pretarsal segment of the upper eyelid, just onto or even lateral to the conjunction of the upper and lower eyelids, lowers the risk of ptosis.

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An unusual adverse event of botulinum toxin injection in the lower face

Cited by 10 publications

References 9 publications

A Novel 3-Point Injection Technique for OnabotulinumtoxinA in the Upper Depressor Anguli Oris

A Novel 3-Point Injection Technique for OnabotulinumtoxinA in the Upper Depressor Anguli Oris

Botulinum Toxin Type A: Adverse Events and Management

Therapeutic Approach to Botulinum Injections for Hemifacial Spasm, Synkinesis and Blepharospasm

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