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          當前位置:文檔之家 > Complications-of-Botulinum-Toxin-A-use-in-Facial-Rejuvenation

          Complications-of-Botulinum-Toxin-A-use-in-Facial-Rejuvenation

          Complications of botulinum toxin A use in

          facial rejuvenation

          A.John Vartanian,MD a ,Steven H.Dayan,MD b,*

          a

          Lasky Clinic,http://www.ea-motors.com/doc/2de99b08763231126edb1122.htmlsky Drive,Beverly Hills,CA 90212,USA

          b

          Division of Facial Plastic &Reconstructive Surgery,Department of Otolaryngology -Head &Neck Surgery,

          University of Illinois at Chicago,1855West Taylor Street (MC 648),Chicago,IL 60612-7244,USA

          The effacement of hyperkinetic facial lines with botulinum toxin A injections (Botox,Botox Cosmetic,Allergan,Irvine,California)has become an estab-lished part of modern facial rejuvenation.An ever-increasing number of patients are receiving Botox treatments spurred on by word of mouth,the dissemi-nation of information about Botox in the media,and by its excellent safety record.The Federal Food and Drug Administration’s (FDA)approval of Botox for cosmetic indications and Allergan’s remarketing of it as Botox Cosmetic,promises to increase the number of patients who elect to receive Botox injec-tions.With increased demand,greater public accept-ance,and larger numbers of physicians offering Botox injections,it may be timely to review the spectrum of possible complications with esthetic Botox applications.

          Botulinum toxin type A is one of seven botulinum toxin antigenic (A,B,C1,D,E,F,and G)subtypes.It is produced by Clostridium bolutinum bacterial fermen-tation.Several botulinum toxin subtypes are under investigation for clinical use,but only botulinum toxin type A (Botox Cosmetic)is currently approved for cosmetic use.In Europe,botulinum toxin A is marketed under the trademark,Dysport (Ipsen Phar-maceuticals,Dublin,Ireland).The per unit potency of Botox is three to five times that of Dysport [1–4].

          Despite clinical evidence of similar safety profiles,Botox may have a higher efficacy to safety ratio in animal studies [5].Each vial of Botox contains 100units of Botox,0.9mg of sodium chloride,and 0.5mg of human albumin [6].Safety profile

          The excellent safety profile of Botox is illustrated by the paucity of irreversible medical complications that have bee documented over the last 20years (see references [2,7–10]).The reversible,short-term,and localized effects of Botox are reflected in the ob-served complications,which also tend to be localized and reversible.No reports of life-threatening allergic or urticarial reactions have been reported with facial Botox applications [4].Nevertheless,animal or hu-man studies on long-term immunogenic,carcino-genic,and other potential deleterious side effects of Botox have not been performed [11,12].

          Accurate dosing of Botox is important for doc-umentation and standardization of injection sched-ules.The pharmacologically-defined Standard Unit of Botox is based on the lethal dose (LD 50)of botulinum type A toxin in 50%of test mice [6,13].Clinically,the Standard Unit serves as an important unit of measurement and reference.In cases of classic food-borne botulism,flaccid paralysis of motor and autonomic nerves begin with the cranial nerves (in-cluding symptoms of dysphagia,dysarthria,dyspho-nia,blurry vision)and descend to include the rest of the body.Further progression to more severe botu-lism states may lead to flaccid respiratory failure and death.The classic presentation of systemic botulism

          1064-7406/05/$–see front matter D 2004Elsevier Inc.All rights reserved.doi:10.1016/j.fsc.2004.04.008

          http://www.ea-motors.com/doc/2de99b08763231126edb1122.html

          This article was originally published in Facial Plastic Surgery Clinics of North America 11:4,November 2003.The authors have no financial conflict of interests to declare regarding products described in this article.*Corresponding author.

          E-mail address:docdayan@http://www.ea-motors.com/doc/2de99b08763231126edb1122.html (S.H.Dayan).

          Facial Plast Surg Clin N Am 13(2005)1–

          Complications-of-Botulinum-Toxin-A-use-in-Facial-Rejuvenation

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