Sebum Production Alteration after Botulinum Toxin Type A Injections for the Treatment of Forehead Rhytides: A Prospective Randomized Double-Blind Dose-Comparative Clinical Investigation

Aesthetic Surgery Journal, Jul 2015

Min, Peiru, Xi, Wenjing, Grassetti, Luca, Trisliana Perdanasari, Aurelia, Torresetti, Matteo, Feng, Shaoqing, Su, Weijie, Pu, Zheming, Zhang, Yan, Han, Sheng, et al.

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Sebum Production Alteration after Botulinum Toxin Type A Injections for the Treatment of Forehead Rhytides: A Prospective Randomized Double-Blind Dose-Comparative Clinical Investigation

Aesthetic Surgery Journal Sebum Production Alteration after Botulinum Toxin Type A Injections for the Treatment of Forehead Rhytides: A Prospective Randomized Double-Blind Dose-Comparative Clinical Investigation Peiru Min 0 1 Wenjing Xi 0 1 Luca Grassetti 0 1 Aurelia Trisliana Perdanasari 0 1 Matteo Torresetti 0 1 Shaoqing Feng 0 1 Weijie Su 0 1 Zheming Pu 0 1 Yan Zhang 0 1 Sheng Han 0 1 Yi Xin Zhang 0 1 Giovanni Di Benedetto 0 1 Davide Lazzeri 0 1 0 Medical School, University Hospital of Ancona , Ancona , Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic , Rome , Italy 1 Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Background: Research has investigated the decrease in human skin sebum after the application of botulinum toxin. Few studies of the mechanism and objective assessments of this phenomenon have been conducted and the correlation between the sebum production and injection dosages or techniques remains unclear. Objectives: We prospectively investigated the sebum regulation and its gradient around the injection site in patients who received intramuscular injections of botulinum toxin A (BTX-A) for forehead rhytides, comparing two injection doses. Methods: Forty-two female volunteers with rhytides on the forehead region were randomly assigned to receive 10 or 20 units of BTX-A, which was administered in five standard injection sites. The baseline and post-treatment sebum production was measured using a Sebumeter. Results: Treatment with BTX-A exhibited significant sebum alteration at the injection site of both groups, with a sebum gradient surrounding the injection point. The efficacy did not improve at higher injection doses, with the four-unit regimen generally not being more potent than the two-unit regimen. The sebum production recovered to normal levels at the 16 week follow-up for both treatment groups, indicating that a higher dosage (four units) did not result in a longer duration until relapse compared with the two-unit dose. Conclusions: We determined that the sebum production has a positive correlation with the distance away from the injection point. Intramuscular injection of BTX-A significantly reduces sebum production at the injection site but increases the sebum production of the surrounding skin at a radius of 2.5 cm at the 2, 4, and 8 week follow-ups. Therapeutic Botulinum toxin was first reported for glabellar folds associated with corrugators and/or procerus muscle dynamics in 1992.1,2 The high efficacy and patient satisfaction3,4 quickly moved the indications from glabellar wrinkles to more global and sophisticated indications, such as crow’s feet, lower eyelid wrinkles, nasolabial lines, horizontal lines, and masseter hypertrophy.5-7 A lack of studies and experiments in vitro or in vivo results in physicians’ applying botulinum toxin type A (BTX-A; Botox, Allergan, Irvine, CA) empirically, which causes adverse events, such as injection pain, erythema, hematoma, headache, and asymmetry.4,8,9 Recent studies have demonstrated that botulinum toxin will affect skin texture and sebum production at the injection site, leading to local skin dryness.10-13 Sebum contributes to the delivery of fat-soluble antioxidants to the skin surface and has antimicrobial activity, which represents the ultimate barrier of the human body against exogenous insults.14 Undesirable sebum blocks the pores, provides nourishment to bacteria, and results in acne. Patients who suffer from forehead lines are suggested to obtain a standard treatment of botulinum toxin injection in the forehead region. As part of the so-called “T-zone” (forehead, nose and chin), the forehead region normally has higher sebum production than other regions because of a higher density of sebaceous follicles in the face (300–900/ cm2).15 Alterations in sebum production will appear obvious in this region compared with other regions. Because the majority of female patients regularly use makeup to prevent their skin from drying, few reports or studies have been conducted regarding this issue. Recently, insights into the effect of botulinum toxin on sebum production have been published.11,12 The results indicated a significant reduction in sebum production and demonstrated a correlation between sebum production and injection techniques, although the dosage(s (...truncated)


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Min, Peiru, Xi, Wenjing, Grassetti, Luca, Trisliana Perdanasari, Aurelia, Torresetti, Matteo, Feng, Shaoqing, Su, Weijie, Pu, Zheming, Zhang, Yan, Han, Sheng, Zhang, Yi Xin, Di Benedetto, Giovanni, Lazzeri, Davide. Sebum Production Alteration after Botulinum Toxin Type A Injections for the Treatment of Forehead Rhytides: A Prospective Randomized Double-Blind Dose-Comparative Clinical Investigation, Aesthetic Surgery Journal, 2015, pp. 600-610, Volume 35, Issue 5, DOI: 10.1093/asj/sju150