Exaggeration of Wrinkles after Botulinum Toxin Injection for Forehead Horizontal Lines

Abstract

There have been no long-term complications or lifethreatening adverse effects related to botulinum toxin treatment for any cosmetic indications. Nevertheless, there are well-known, mild side effects of botulinum toxin treatment on the upper face, though most of them are self limited with time. However, excluding brow ptosis, reports about site specific side effects are few and anecdotal. We experienced cases of exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines, and report them here. In our cases, new appearance of a noticeable glabellar protrusion following botulinum toxin injection on the forehead was observed in 2 patients. Also, a new deep wrinkle on one side of the forehead just above the eyebrow appeared in another 2 patients. The exaggerated wrinkles nearly disappeared without treatment by week 4 in all subjects. These exaggerations of wrinkles may be caused by hyperactivity and overcompensation of untreated muscles. With the increasing availability of diverse botulinum toxin for cosmetic purposes, physicians and patients should be aware of this temporary change after therapeutic injections. We recommend explaining this possible effect prior to injection, for better understanding of treatment for cosmetic indications. (Ann Dermatol 23(2) 217∼221, 2011)

Complications associated with cutaneous aesthetic procedures

“…In one study, 3.8 % of patients reported sensation of localized skin dryness . Exaggeration of wrinkles after the treatment of forehead horizontal lines is caused by hyperactivity and overcompensation of untreated muscles and can be eliminated by subsequent injection of BoNTA into the mimic muscle responsible for the newly formed wrinkles . Temporary blepharoptosis (in 6.5 % cases ), eyebrow ptosis (Figure ) due to weakening of the Musculus (M.) frontalis, lid ptosis due to attenuated fibres of the M. levator palpebrae superioris, diplopia and ectropion are technique‐dependent, caused by improper placement of injections or by localized diffusion of injected material .…”

Botulinum toxin complications in registered and off‐label aesthetic indications

“…Sometimes patients complain on worsening of wrinkles in areas close or related to a treated area. It is caused by hyperactivity and overcompensation of untreated muscles 41 …”

Nebenwirkungen ästhetischer Eingriffe an der Haut

“…In einer Studie gaben 3,8 % der Patienten lokalisierte Hauttrockenheit an . Vermehrte Faltenbildung nach der Behandlung horizontaler Stirnfalten wird durch die Hyperaktivität und Überkompensation der unbehandelten Muskeln hervorgerufen und kann durch anschließende Injektion von BoNTA in die mimische Muskulatur, die für die neuen Falten verantwortlich ist, beseitigt werden . Temporäre Blepharoptosis (in 6,5 % der Fälle ), Augenbrauen‐Ptosis (Abbildung ) aufgrund einer Schwächung des Musculus (M.) frontalis, Augenlid‐Ptosis aufgrund von abgeschwächten Fasern des M. levator palpebrae superioris, Diplopie und Ektropium sind methodenabhängig, verursacht durch ungenaue Platzierung der Injektionen oder durch lokalisierte Verbreitung des injizierten Stoffes .…”