Microbotulinum: A Quantitative Evaluation of Aesthetic Skin Improvement in 62 Patients

Abstract

Background: Microbotulinum refers to the systematic injection of tiny blebs of diluted botulinum toxin at repeated intervals into the skin. This targets the superficial fibers of the facial muscles, and weakens their insertion into the undersurface of the skin, which is responsible for the fine lines and wrinkles on the face. The authors present a pilot study based on quantitative evaluation, by means of a skin-scanning technology, of the aesthetic improvement of skin texture, microroughness, and enlarged pore size in a patient group treated with microbotulinum injections for cosmetic purposes. Methods: The treatment was performed using a 32-gauge needle to deliver injections on a regular 1-cm grid from the forehead to the cheek and down to the jawline. Results: Sixty of the 62 patients completed the study. All analyzed parameters improved significantly (p < 0.0001) at 90 days with respect to the pretreatment time point (skin texture, −1.93 ± 0.51; microroughness, −2.48 ± 0.79; and pore diameter, 2.1 ± 0.43). Best results have been obtained in patients aged between 42.7 and 46.8 years, and standard deviation calculation allows us to recommend it in patients aged between 36.5 and 53 years. Conclusions: The results of this pilot study suggest that intradermal botulinum toxin injection, or so-called microbotulinum, is a safe and effective method to treat skin flaws. Because of the high satisfaction rate among both physicians and patients, further studies are indeed mandatory to determine the optimal number of units needed for a longer and lasting effect with this particular novel dilution. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism

“…Since nicotinic Ach receptors influence the tissue remodeling activity of dermal fibroblasts [40], a blockade of cholinergic signals by BoNTA may further help diminish prominent facial pores. There are clinical investigations that show the pore improvement efficacy of BoNTA using objective measurements [35,41,42]. However, other factors, such as epidermal regeneration and neocollagenesis after multiple needle pricks, might have contributed to the pore improvement [43].…”

Air‐toxin technique: Introduction and analysis of effect using a photoimaging system

“…There has been much controversy over the effect of BTX on enlarged facial pores. 12,13,[28][29][30] By selective blocking of the parasympathetic system, BTX allows arrector pili muscle contraction which can theoretically reduce pore size. 29 However, our quantitative finding suggests that an overly stretched pore is unlikely to reduce in size with the air-toxin procedure alone.…”

“…There has been much controversy over the effect of BTX on enlarged facial pores 12,13,28‐30 . By selective blocking of the parasympathetic system, BTX allows arrector pili muscle contraction which can theoretically reduce pore size 29 .…”

“…The intradermal injection technique, otherwise known as the “micro‐botulinum” technique, involves serial injection of tiny aliquots of BTX just under the skin surface 13,14 15,16 …”

“…[8][9][10][11][12] The intradermal injection technique, otherwise known as the "micro-botulinum" technique, involves serial injection of tiny aliquots of BTX just under the skin surface. 13,14 The BTX is diluted, where the concentration is lower than the traditional formulation for the intramuscular injection technique. 15,16 The air-toxin technique consists of two phases that in concert, have a dual effect.…”