An Update on the Cosmetic Use of Botulinum Toxin: The Pattern of Practice among Korean Dermatologists

Abstract

The efficacy and safety of botulinum toxin injection have made it a popular aesthetic procedure worldwide. A cross-sectional survey was performed in order to determine the pattern of type A botulinum toxin injections in cosmetic practice, for which an 18-item questionnaire was distributed to dermatologists. A total of 469 Korean board-certified dermatologists participated in the survey, with the following results: the main candidates for type A botulinum toxin injection were individuals in their 40–50 years (46.1%), followed by those in their 20–30 years (33.4%), and people over 60 years of age (20.5%). Overall, the upper face (the glabella, forehead, and crow’s line, in decreasing order) was the most favored area of injection (51%). In contrast, body contouring (i.e., shoulder, calf) and treatment for benign masseter hypertrophy were significantly more popular in the 20–30 years age group than their older counterparts. For wrinkle effacement, the most preferred dilution was 100 units/2.5 mL with isotonic sodium chloride injection (51.2%), and the most often used interval was six months (43.6%). About half (46.3%) of the dermatologists reported the experience of clinical cases which were suspicious of botulinum toxin resistance. Despite this, regarding the choice of the product, type A botulinum toxin products with greater cost-effectiveness were favored over products with a lower risk of antibody formation. Other than its cosmetic usage, botulinum toxin is applied for a variety of skin conditions. Further studies are suggested in order to identify the practice pattern of type A botulinum toxin for therapeutic uses in dermatology, such as hyperhidrosis and rosacea.

Botulinum toxin for cosmetic treatments in young adults: An evidence‐based review and survey on current practice among aesthetic practitioners

“…In the study, on onaBoNTA for the treatment of moderate to severe horizontal forehead lines, treatment‐related AEs were comparable in both groups and consistent with the know safety profile of onaBoNTA used for facial rhytids 15 . Interestingly, 46.3% of the survey responders of Korean practices reported having experienced possible cases of clinical resistance to BoNTA 14 …”

“…One study assessed the overall prevalence of possible clinical resistance to BoNTA in a questionnaire delivered to Korean dermatologists (Table 2). 14–16 The overall incidence of AEs was related to injections and higher in millennials (16.4%) versus nonmillennials (13.3%), the most common being headache and uncommon AEs like lid ptosis were similar in both groups 16 . The higher overall incidence of AEs in millennials could be due to sampling bias, the sample size of millennials being smaller ( n = 67) compared to nonmillennials ( n = 670).…”

“…Three papers were excluded, being commentary or letter to the editor, one paper was on combined treatment modalities, and another paper did not meet inclusion criteria, excluding data on millennials. Four studies remained, meeting the criteria for inclusion (two observational studies 9,14 and post hoc analyses of two randomized controlled trials (RCTs)) 15,16 . In the included studies, the sample size ranged from 144 to 1178 participants.…”

“…Four studies remained, meeting the criteria for inclusion (two observational studies 9,14 and post hoc analyses of two randomized controlled trials (RCTs)). 15,16 In the included studies, the sample size ranged from 144 to 1178 participants.…”

“…16 In the study on onaBoNTA, at day 30, 100% of millennials achieved at least a one-grade improvement on the FWS at maximum contractions, and 78.4% at rest. 15 In his survey on the pattern of practice on the cosmetic use of BoNT, Rho et al 14 omitted to evaluate the dosing of BoNTA by Korean dermatologists. The last paper included in our review retrospectively analyzed the dosing of onaBoNTA in millennials (between 20 and 38 years of age at the time of the study) versus older patients (51 years of age and older at the time of the study) by performing a chart review of a single-center and single-injector.…”