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

Min, Peiru MD
Xi, Wenjing MD
Grassetti, Luca MD
Perdanasari, Aurelia Trisliana MD
Torresetti, Matteo MD
Feng, Shaoqing MD
Su, Weijie MD
Pu, Zheming MD
Zhang, Yan MD
Han, Sheng MD
Zhang, Yi Xin MD, PhD
Di Benedetto, Giovanni MD
Lazzeri, Davide MD

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 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

Corresponding Author: Prof Yi Xin Zhang, Professor and Assistant Chief, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. E-mail: [email protected]

Accepted for publication December 8, 2014; online publish-ahead-of-print March 30, 2015.

Aesthetic Surgery Journal (ASJ) 35(5):p 600-610, July 2015. | DOI: 10.1093/asj/sju150

Abstract

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.

Level of Evidence:

2Symbol Therapeutic