Evaluation of Botulinum Toxin Applications in a Tertiary Cosmetic Department

Öz

Aim: Botulinum toxin type A (BTX-A) treatment for facial rejuvenation has been started to used widely and become the most common aesthetic procedure. The aim in this study to evaluate the patients features and outcomes who had Onabotulinumtoxin A. Material and Method: The data of the BTX-A patient’s gender, age, occupation, history of cosmetic procedures, history of disease, doses of the first and control injections, complications and expectations from the therapy collected from the medical records. The patients were divided into two groups as under the age of 45 and age of 45 and older. These groups were compared with each other in terms of mentioned variables. Results: A total of 200 patients included in this study. The mean botulinum toxin dose was 33.7 units and the mean control dose was 4.5 units. Three (1.5%) of the patients developed a complication, all of them were eyelid ptosis. Most common expectation from the toxin injection was to look more young (69%) and vigorous (75.5%). There were no significant difference between the under the age of 45 and 45 and older group in terms of total BTX-A dose and control dose and complication rate (p=0.8, p=0.5, p=0.6). Expectation of looking less angry and less saggy were significantly higher in the 45 year and older group (p=0.02, p=0.02). Conclusion: It is important to evaluate the patient’s gender, age and expectations from the botulinum toxin injection to get the highest efficiency from BTX-A injection.

Anahtar Kelimeler

• botox, wrinkles, face rejunevation

Bir Eğitim Araştırma Hastanesinde Kozmetik Amaçlı Botulinum Toksin Uygulamalarının Değerlendirilmesi

Öz

GİRİŞ-AMAÇ: Botulinum toksini, Gram negatif bir bakteri olan Clostridium botulinum tarafından sentezlenen bir nörotoksindir. Kozmetik amaçlı ilk kez 1992 yılında glabella kırışıklıkları tedavisinde kullanılmıştır. Fasiyal kırışıklık tedavisinde giderek artan sıklıklarla uygulanmaya başlanmıştır. Bu çalışmada, eğitim araştırma hastanesinde kozmetik amaçlı uygulanan botulinum toksin uygulamalarının değerlendirilmesini amaçladık. YÖNTEM: Çalışmaya, 2018-2019 yıllarında hastanemizin kozmetoloji ünitesine kozmetik amaçlı botulinum toksin uygulaması için başvurmuş 200 hasta dahil edilmiştir. Hastaların dosyaları taranarak; demografik bulguları, kozmetik işlem geçmişleri, uygulanan botoks dozları, kontrol dozu uygulamaları, komplikasyonlar ve botokstan beklentileri kaydedildi. Ayrıca hastalar 45 yaş altı ve 45 yaş ve üstü olarak iki gruba ayrılarak, iki grubun kozmetik işlem geçmişleri, uygulanan botoks dozları, kontrol dozu uygulamaları, komplikasyonlar ve botokstan beklentileri karşılaştırılmıştır. BULGULAR: Çalışmaya dahil edilen 200 hastanın 195’i kadın (%97,5) ve 5’i erkek (%2,5) hastaydı. Hastaların yaş ortalaması 44,8 idi. Daha önce hastaların 107’si (%53,5) botoks yaptırmış, 40’ı (%20) ise dolgu işlemi yaptırmıştır. Hastaların hepsine üst yüz botoksu uygulanırken, alt yüz botoksu 55 (%27,5) hastaya uygulandı. Hastalara uygulanan total botoks dozu 33,7 Ü idi. Hastaların 131’ine (%65,5) kontrol doz uygulandı. Uygulanan kontrol doz ortalaması 4,5 Ü idi. Hastaların 3’ünde (%1,5) komplikasyon olarak pitozis gözlendi. Hastalar dinç görünme, mutlu görünme, çekici görünme, zarif görünme, feminen görünme, genç görünme, az öfkeli görünme ve az sarkık görünme seçenekleri arasından, en çok dinç görünmek için botoks yaptırdığını belirtmiştir. Kırkbeş yaş altı hasta grubunda 101 kadın ve 3 erkek (total:104), 45 yaş ve üstü grubunda 94 kadın ve 2 erkek (total:96) vardı. Hastalar 45 yaş altı ve 45 yaş ve üstü olarak karşılaştırıldığında; botoks ve dolgu geçmişi, alt yüz botoks işlemi, total ve kontrol doz ortalaması, komplikasyon gelişimi açısından istatiksel olarak anlamlı fark saptanmamıştır. Hastaların botoks işleminden beklentisine bakıldığında ise 45 yaş ve üstü grubun, 45 yaş altı gruba göre daha az öfkeli ve daha az sarkık görünme isteği anlamlı yüksek bulunmuştur (p=0,018, p=0,029). SONUÇ: Botoks tedavisi hastaların farklı amaçlarla başvurduğu, kişi bazlı değerlendirme gerektiren etkili ve komplikasyon oranı düşük bir tedavi yöntemidir.

Anahtar Kelimeler

• botoks
• kırışıklıklar
• rejuvenasyon

Kaynakça

1. 1.Jia Z, Lu H, Yang X, Jin X, Wu R, Zhao J, et al. Adverse Events of Botulinum Toxin Type A in Facial Rejuvenation: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg. 2016;40(5):769-77.
2. 2.Charles FJ, Cox SE, Earl ML. Social implications of hyperfunctional facial lines. Dermatol Surg. 2003;29(5):450-5.
3. 3.Gart MS, Gutowski KA. Overview of Botulinum Toxins for Aesthetic Uses. Clin Plast Surg. 2016;43(3):459-71.
4. 4.American Society of Plastic Surgeons. 2018 National PlasticSurgery Statistics; 2018. www.plast icsur gery.org/documents/News/Statistics/ 2018/plastic-surge ry-stati stics-report-2018.pdf.Accessed June 28, 2019.
5. 5.Niamtu J 3rd. Complications in fillers and Botox. Oral Maxillofac Surg Clin North Am. 2009;21(1):13-21, v. doi: 10.1016/j.coms.2008.11.001. PMID: 19185791.
6. 6.Casabona G, Kaye K, Barreto Marchese P, Boggio R, Cotofana S. Six years of experience using an advanced algorithm for botulinum toxin application. J Cosmet Dermatol. 2019;18(1):21-35.
7. 7.Carruthers A, Bogle M, Carruthers JD, Dover JS, Arndt KA, Hsu TS, et al. A randomized, evaluator-blinded, two-center study of the safety and effect of volume on the diffusion and efficacy of botulinum toxin type A in the treatment of lateral orbital rhytides. Dermatol Surg. 2007;33(5):567-71.
8. 8.Carruthers A, Bruce S, Cox SE, Kane MA, Lee E, Gallagher CJ. OnabotulinumtoxinA for Treatment of Moderate to Severe Crow’s Feet Lines: A Review. Aesthet Surg J. 2016;36(5):591-7.

9. 9.Gangigatti R, Bennani V, Aarts J, Choi J, Brunton P. Efficacy and safety of Botulinum toxin A for improving esthetics in facial complex: A systematic review. Braz Dent J. 2021;32(4):31-44.
10. 10.American Society for Aesthetic Plastic Surgery. 15th AnnualCosmetic Surgery National Data Bank Statistics. 2011 Statistics
11. 11.D’Emilio R, Rosati G. Full-face treatment with onabotulinumtoxinA: Results from a single-center study. J Cosmet Dermatol. 2020;19(4):809-816.
12. 12.Sepehr A, Chauhan N, Alexander AJ, Adamson PA. Botulinum toxin type a for facial rejuvenation: treatment evolution and patient satisfaction. Aesthetic Plast Surg. 2010;34(5):583-6.
13. 13.Carruthers J, Fagien S, Matarasso SL; Botox Consensus Group. Consensus recommendations on the use of botulinum toxin type a in facial aesthetics. Plast Reconstr Surg. 2004;114(6 Suppl):1S-22S.
14. 14.Carruthers JDA, Glogau RG, Blitzer A; Facial Aesthetics Consensus Group Faculty. Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies--consensus recommendations. Plast Reconstr Surg. 2008;121(5 Suppl):5S-30S.
15. 15.Ahn BK, Kim YS, Kim HJ, Rho NK, Kim HS. Consensus recommendations on the aesthetic usage of botulinum toxin type A in Asians. Dermatol Surg. 2013;39(12):1843-60.
16. 16.Sommer B, Bergfeld D, Sattler G. Consensus recommendations on the use of botulinum toxin type A in aesthetic medicine. J Dtsch Dermatol Ges. 2007;5(1):S1-S29.
17. 17.Carruthers A, Carruthers J. Prospective, double-blind, randomized, parallel-group, dose-ranging study of botulinum toxin type A in men with glabellar rhytids. Dermatol Surg. 2005;31(10):1297-303.
18. 18.Sharova AA. Comparison of different consensuses of BTXA in different countries. J Cosmet Dermatol. 2016;15(4):540-548.
19. 19.D’Emilio R, Rosati G. Full-face treatment with onabotulinumtoxinA: Results from a single-center study. J Cosmet Dermatol. 2020;19(4):809-816.
20. 20.Kim BW, Park GH, Yun WJ, Rho NK, Jang KA, Won CH, et al. Adverse events associated with botulinum toxin injection: a multidepartment, retrospective study of 5310 treatments administered to 1819 patients. J Dermatolog Treat. 2014;25(4):331-6.
21. 21.Zargaran D, Zoller F, Zargaran A, Rahman E, Woollard A, Weyrich T, et al. Complications of Cosmetic Botulinum Toxin A Injections to the 159 Upper Face: A Systematic Review and Meta-Analysis. Aesthet Surg J. 2022;42(5):NP327-NP336.
22. 22.Sethi N, Singh S, DeBoulle K, Rahman E. A Review of Complications Due to the Use of Botulinum Toxin A for Cosmetic Indications. Aesthetic Plast Surg. 2021;45(3):1210-1220.
23. 23.Ascher B, Zakine B, Kestemont P, Baspeyras M, Bougara A, Santini J. A multicenter, randomized, double-blind, placebo-controlled study of efficacy and safety of 3 doses of botulinum toxin A in the treatment of glabellar lines. J Am Acad Dermatol. 2004;51(2):223- 33.
24. 24.Lowe NJ, Lask G, Yamauchi P, Moore D. Bilateral, double-blind, randomized comparison of 3 doses of botulinum toxin type A and placebo in patients with crow’s feet. J Am Acad Dermatol. 2002;47(6):834-40.
25. 25.Solish N, Rivers JK, Humphrey S, Muhn C, Somogyi C, Lei X, et al. Efficacy and Safety of OnabotulinumtoxinA Treatment of Forehead Lines: A Multicenter, Randomized, Dose-Ranging Controlled Trial. Dermatol Surg. 2016;42(3):410-9.
26. 26.Sundaram H, Signorini M, Liew S, Trindade de Almeida AR, Wu Y, Vieira Braz A, et al; Global Aesthetics Consensus Group. Global Aesthetics Consensus: Botulinum Toxin Type A--Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications. Plast Reconstr Surg. 2016;137(3):518e-529e.
27. 27.Carruthers JD, Lowe NJ, Menter MA, Gibson J, Eadie N; Botox Glabellar Lines II Study Group. Double-blind, placebo-controlled study of the safety and efficacy of botulinum toxin type A for patients with glabellar lines. Plast Reconstr Surg. 2003;112(4):1089-98.
28. 28.Yeslev M, Gupta V, Winocour J, Shack RB, Grotting JC, Higdon KK. Safety of Cosmetic Procedures in Elderly and Octogenarian Patients. Aesthet Surg J. 2015;35(7):864-73.