Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Scientific review of the aesthetic uses of botulinum toxin type A

  • Park, Mee Young (Department of Neurology, Yeungnam University Medical Center) ;
  • Ahn, Ki Young (Dr. Ahn's Aesthetic and Plastic Surgical Clinic and Botulinum Center)
  • Received : 2021.02.02
  • Accepted : 2021.02.05
  • Published : 2021.02.20
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Abstract

Botulinum toxin type A (BoNT-A), onabotulinumtoxinA (Botox) was approved by the United States Food and Drug Administration for temporary improvement of glabellar lines in patients 65 years and younger in 2002, and has also been used widely for aesthetic purposes such as hyperhidrosis, body shape contouring, and other noninvasive facial procedures. BoNT-A inhibits presynaptic exocytosis of acetylcholine (ACh)-containing vesicles into the neuromuscular junction at cholinergic nerve endings of the peripheral nervous system, thereby paralyzing skeletal muscles. ACh is the most broadly used neurotransmitter in the somatic nervous system, preganglionic and postganglionic fibers of parasympathetic nerves, and preganglionic fibers or postganglionic sudomotor nerves of sympathetic nerves. The scientific basis for using BoNT-A in various cosmetic procedures is that its function goes beyond the dual role of muscle paralysis and neuromodulation by inhibiting the secretion of ACh. Although the major target organs for aesthetic procedures are facial expression muscles, skeletal body muscles, salivary glands, and sweat glands, which are innervated by the somatic or autonomic nerves of the peripheral cholinergic nerve system, few studies have attempted to directly explain the anatomy of the areas targeted for injection by addressing the neural physiology and rationale for specific aesthetic applications of BoNT-A therapy. In this article, we classify the various cosmetic uses of BoNT-A according to the relevant component of the peripheral nervous system, and describe scientific theories regarding the anatomy and physiology of the cholinergic nervous system. We also review critical physiological factors and conditions influencing the efficacy of BoNT-A for the rational aesthetic use of BoNT-A. We hope that this comprehensive review helps promote management policies to support long-term, safe, successful practice. Furthermore, based on this, we look forward to developing and expanding new advanced indications for the aesthetic use of BoNT-A in the future.

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References

  1. Botox (OnabotulinumtoxinA) [package insert]. Irvine (Botox) [package insert]. Irvine: Allergan; 2011.
  2. Aurora SK, Dodick DW, Turkel CC, DeGryse RE, Silberstein SD, Lipton RB, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia 2010;30:793-803. https://doi.org/10.1177/0333102410364676
  3. Diener HC, Dodick DW, Aurora SK, Turkel CC, DeGryse RE, Lipton RB, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia 2010;30: 804-14. https://doi.org/10.1177/0333102410364677
  4. Wei J, Zhu X, Yang G, Shen J, Xie P, Zuo X, et al. The efficacy and safety of botulinum toxin type A in treatment of trigeminal neuralgia and peripheral neuropathic pain: a meta-analysis of randomized controlled trials. Brain Behav 2019;9:e01409.
  5. Calvani F, Santini S, Bartoletti E, Alhadeff A. Personal technique of microinfiltration with botulin toxin: the SINB technique (superficial injection needling botulinum). Plast Surg (Oakv) 2019;27:156-61. https://doi.org/10.1177/2292550318800330
  6. Carruthers A, Carruthers J. History of botulinum toxin for medical and aesthetic use. In: Cohen JL, Ozog DM, Porto DA, editors. Botulinum toxins: cosmetic and clinical applications. Hoboken: John Wiley & Sons Inc.; 2017. p. 1-12.
  7. Burgen AS, Dickens F, Zatman LJ. The action of botulinum toxin on the neuro-muscular junction. J Physiol 1949;109:10-24. https://doi.org/10.1113/jphysiol.1949.sp004364
  8. Brooks VB. The action of botulinum toxin on motor-nerve filaments. J Physiol 1954;123:501-15. https://doi.org/10.1113/jphysiol.1954.sp005067
  9. Scott AB. Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Ophthalmology 1980; 87:1044-9. https://doi.org/10.1016/s0161-6420(80)35127-0
  10. Lipham WJ. A brief history of the clinical applications of botulinum toxin. In: Lipham WJ, editor. Cosmetic and clinical applications of botulinum toxin. Thorofare: SLACK; 2004. p. 1-3.
  11. Carruthers JD, Carruthers JA. Treatment of glabellar frown lines with C. botulinum: a exotoxin. J Dermatol Surg Oncol 1992;18:17-21. https://doi.org/10.1111/j.1524-4725.1992.tb03295.x
  12. Ahn KY, Park MY, Park DH, Han DG. Botulinum toxin A for the treatment of facial hyperkinetic wrinkle lines in Koreans. Plast Reconstr Surg 2000;105:778-84. https://doi.org/10.1097/00006534-200002000-00050
  13. Kane M, Donofrio L, Ascher B, Hexsel D, Monheit G, Rzany B, et al. Expanding the use of neurotoxins in facial aesthetics: a consensus panel's assessment and recommendations. J Drugs Dermatol 2010;9(1 Suppl):s7-22.
  14. Ahmed NY, Knowles R, Dehorter N. New insights into cholinergic neuron diversity. Front Mol Neurosci 2019;12:204. https://doi.org/10.3389/fnmol.2019.00204
  15. Sine SM. End-plate acetylcholine receptor: structure, mechanism, pharmacology, and disease. Physiol Rev 2012;92:1189-234. https://doi.org/10.1152/physrev.00015.2011
  16. Shone CC. Clostridium botulinum neurotoxins, their structures and modes of action. In: Watson DH, editor. Natural toxicants in foods. Chichester: Ellis Harwood Ltd; 1986. p. 11-57.
  17. Jankovic J. Botulinum toxin in clinical practice. J Neurol Neurosurg Psychiatry 2004;75:951-7. https://doi.org/10.1136/jnnp.2003.034702
  18. Simpson LL. Molecular pharmacology of botulinum toxin and tetanus toxin. Annu Rev Pharmacol Toxicol 1986;26:427-53. https://doi.org/10.1146/annurev.pa.26.040186.002235
  19. Black JD, Dolly JO. Interaction of 125I-labeled botulinum neurotoxins with nerve terminals. II. Autoradiographic evidence for its uptake into motor nerves by acceptor-mediated endocytosis. J Cell Biol 1986;103:535-44. https://doi.org/10.1083/jcb.103.2.535
  20. Pijning AE, Chiu J, Yeo RX, Wong JW, Hogg PJ. Identification of allosteric disulfides from labile bonds in X-ray structures. R Soc Open Sci 2018;5:171058. https://doi.org/10.1098/rsos.171058
  21. Pearce LB, First ER, MacCallum RD, Gupta A. Pharmacologic characterization of botulinum toxin for basic science and medicine. Toxicon 1997;35:1373-412. https://doi.org/10.1016/S0041-0101(96)00180-8
  22. Brin MF, Dressler D, Aoki KR. Pharmacology of botulinum toxin therapy. In: Brin MF, Comella C, Jankovic J, editors. Dystonia: etiology, clinical feature, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 93-108.
  23. Jung GS, Cho IK, Sung HM. Submandibular gland reduction using botulinum toxin type A for a smooth jawline. Plast Reconstr Surg Glob Open 2019;7:e2192. https://doi.org/10.1097/gox.0000000000002192
  24. Park MY, Ahn KY, Jung DS. Botulinum toxin type A treatment for contouring of the lower face. Dermatol Surg 2003;29:477-83. https://doi.org/10.1097/00042728-200305000-00007
  25. Park MY, Ahn KY. The comparison of long-term effect of botox(R) injection on lower face contouring after single injection and long-term repeated injections by standardized photograph analysis. J Korean Soc Plast Reconstr Surg 2009;36:654-9.
  26. Park MY, Porto DA, Ahn KY. Contouring of the lower face and the lower leg and calf. In: Cohen JL, Ozog DM, Porto DA, editors. Botulinum toxins: cosmetic and clinical applications. Hoboken: John Wiley & Sons Inc.; 2017. p. 177-90.
  27. Lee JH, Lee KY, Kim JY, Son WH, Jeong JH, Gil Jeong Y, et al. Botulinum toxin injection-site selection for a smooth shoulder line: an anatomical study. Biomed Res Int 2017;2017:3092720. https://doi.org/10.1155/2017/3092720
  28. Al-Fouzan AF, Mokeem LS, Al-Saqat RT, Alfalah MA, Alharbi MA, Al-Samary AE. Botulinum toxin for the treatment of Gummv smile. J Contemp Dent Pract 2017;18:474-8. https://doi.org/10.5005/jp-journals-10024-2068
  29. Matarasso A, Matarasso SL, Brandt FS, Bellman B. Botulinum A exotoxin for the management of platysma bands. Plast Reconstr Surg 1999;103:645-52. https://doi.org/10.1097/00006534-199902000-00043
  30. Bi M, Sun P, Li D, Dong Z, Chen Z. Intralesional injection of botulinum toxin type A compared with intralesional injection of corticosteroid for the treatment of hypertrophic scar and keloid: a systematic review and meta-analysis. Med Sci Monit 2019;25:2950-8. https://doi.org/10.12659/msm.916305
  31. Kandhari R, Kaur I, Sharma D. Mesococktails and mesoproducts in aesthetic dermatology. Dermatol Ther 2020;33:e14218. https://doi.org/10.1111/dth.14218
  32. Childers MK. Targeting the neuromuscular junction in skeletal muscles. Am J Phys Med Rehabil 2004;83(10 Suppl):S38-44. https://doi.org/10.1097/01.PHM.0000141129.23219.42
  33. Ramirez-Castaneda J, Jankovic J, Comella C, Dashtipour K, Fernandez HH, Mari Z. Diffusion, spread, and migration of botulinum toxin. Mov Disord 2013;28:1775-83. https://doi.org/10.1002/mds.25582
  34. Carli L, Montecucco C, Rossetto O. Assay of diffusion of different botulinum neurotoxin type a formulations injected in the mouse leg. Muscle Nerve 2009;40:374-80. https://doi.org/10.1002/mus.21343
  35. Stone HF, Zhu Z, Thach TQ, Ruegg CL. Characterization of diffusion and duration of action of a new botulinum toxin type A formulation. Toxicon 2011;58:159-67. https://doi.org/10.1016/j.toxicon.2011.05.012
  36. Borodic GE, Ferrante R, Pearce LB, Smith K. Histologic assessment of dose-related diffusion and muscle fiber response after therapeutic botulinum A toxin injections. Mov Disord 1994;9: 31-9. https://doi.org/10.1002/mds.870090106
  37. Restani L, Antonucci F, Gianfranceschi L, Rossi C, Rossetto O, Caleo M. Evidence for anterograde transport and transcytosis of botulinum neurotoxin A (BoNT/A). J Neurosci 2011;31:15650-9. https://doi.org/10.1523/JNEUROSCI.2618-11.2011
  38. Aoki KR. Botulinum toxin: a successful therapeutic protein. Curr Med Chem 2004;11:3085-92. https://doi.org/10.2174/0929867043363802
  39. Francisco GE, Tan H, Green M. Do botulinum toxins have a role in the management of neuropathic pain? A focused review. Am J Phys Med Rehabil 2012;91:899-909. https://doi.org/10.1097/PHM.0b013e31825a134b
  40. Dressler D, Benecke R. Autonomic side effects of botulinum toxin type B treatment of cervical dystonia and hyperhidrosis. Eur Neurol 2003;49:34-8. https://doi.org/10.1159/000067023
  41. Tintner R, Gross R, Winzer UF, Smalky KA, Jankovic J. Autonomic function after botulinum toxin type A or B: a doubleblind, randomized trial. Neurology 2005;65:765-7. https://doi.org/10.1212/01.wnl.0000174433.76707.8c
  42. Huang W, Foster JA, Rogachefsky AS. Pharmacology of botulinum toxin. J Am Acad Dermatol 2000;43(2 Pt 1):249-59. https://doi.org/10.1067/mjd.2000.105567
  43. Kim SH, Lee SJ, Kim HJ, Lee JH, Jeong HS, Suh IS. Aging-related changes in the mid-face skin elasticity in East Asian women. Arch Craniofac Surg 2019;20:158-63. https://doi.org/10.7181/acfs.2019.00213

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