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IMCAS World Congress 2020
Program

FOCUS ON S030

Contributed talks - Botulinum toxins

Room: Room Passy - level 1
Date: Thursday 30 January 2020 at 15:00 to 16:00
Format: CONTRIBUTED TALKS > session made up of abstract submissions that were carefully reviewed and selected by the Scientific Board

Chairs

Dr Elena RUMYANTSEVA MATHEY

Dermatologist

France

Dr Sergio TALARICO

Dermatologist

Brazil

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
15:00	Dr Grasiela Cassia MONTEIRO	Efficacy of botulinum toxin type A for treating facial hyperhidrosis	View	86935
15:08	Dr Nino KOBALADZE	Volumizing and devolumizing effects of botulinum toxin type A - Clinical cases	View	93157
15:16	Prof Seong Taek KIM	How can we prevent the paradoxical masseteric bulging and asymmetric lip smile?	View	99092
15:24	Dr Haidar ALQUSOUS	Botulinum toxins treatment for gummy smile	View	99545
15:32	Dr Adam RISH	Less is more: sub-maximal dosing of botulinum toxin to increase cost effectiveness and patient satisfaction and retention rates	View	99714
15:40	Prof Elena GUBANOVA	Patient satisfaction according to age and gender following treatment of glabellar lines with abobotulinumtoxinA: results from the APPEAL study	View	99519
15:48	Dr Iryna SMOLANKA	Botulinum toxin in accessing symmetry of the face in a patient with a facial nerve palsy	View	100196
15:56		Q&A		100354

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Botulinum toxins

Anatomy

Anatomy for injections

Midface (non-surgical)

Patient communication & psychology

Dr Grasiela Cassia MONTEIRO

Dermatologist

Brazil

Other author(s) :

Efficacy of botulinum toxin type A for treating facial hyperhidrosis

Objectives: - Describes facial hiperhidrosis
- Describes the use of botulinum toxin A for treatment of facial hiperidrosis
- Describes dilution, syringe selection and best technique
- Facial anatomy

Introduction: Facial hyperhidrosis (FH) is a disorder that consists in excessive sweating and involves hyperactivity of the sympathetic nervous system. Patients usually report blurred vision from sweating and feel distressed with their appearance. This condition has the potential to affect the mental status of an individual and social environments, impairing their quality of life. Some cases are resistant to topical treatment and oral anticholinergic medications. In this severe cases botulinum toxin A (BTX-A) injections may be performed.

Materials / method: In this paper we present two Case Reports of FH successfully treated with BTX-A in the whole face. In a systematic review in Pub med in the past ten years there have been a few reports of pharmacological treatment with BTX-A in single parts of the face as the forehead and nasal region but just one paper reported a treatment including the full face, the middle and lower face. The use of BTX-A for treating the whole face in patients affected by FH is underexplored.

Results: This article offers suggestions about dilution, syringe selection, dose and best injection technique to avoid adverse effects such as facial asymmetry or brow ptosis to treat this condition successfully.

Conclusion: The use of BTX-A for treating the whole face in patients affected by FH is underexplored.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Nino KOBALADZE

Plastic Surgeon

Russia

Other author(s) : Kobaladze Nino

Volumizing and devolumizing effects of botulinum toxin type A - Clinical cases

Objectives: Botulinum toxin is one of the most frequently requested cosmetic procedures.
In the hands of hi level injectors, the focus has shifted from the treatment of individual dynamic rhytides to ,contouring, shaping, and sculpting.r
In combination with other cosmetic procedures we see better aesthetic appearance of the face.

Introduction: Nowadays patients most common request is soft and natural result. Also they want to have more skinny shape of the face and rested look.
The aim of volumizing and devolumizing botulinum toxin injections is to relax the muscle and not paralyze it. Also due to the redistribution of muscle activity, we see in some places a clinical decrease in muscle volume and somewhere in a turn a clinically increase in volume due to relaxation.

Materials / method: Patients were injected all over full face and neck. Injected muscles were m.procerus, m.corrugator supercilii, m.frontalis, m.orbicularis oculi, m.nasalis, m.depressor anguli oris, m.mentalis, m.masseter, m.platizma.
All muscles except m.masseter were treated in low or standard doses of botulinum toxin.

Results: Global improvement in skin texture, face shape and tightness was noted in the post-treatment photographs.
Patients satisfaction was very high.
The changes of the face are natural and attractive.

Conclusion: philosophy of volumizing and devolumizing Botulinum Toxin Tipe-A provides not only rejuvenation but also harmonization and beautification results.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Prof Seong Taek KIM

Dental Surgeon

South Korea

Other author(s) : Hee-Jin KIM, Jung-Hee BAE, Kyle SEO

How can we prevent the paradoxical masseteric bulging and asymmetric lip smile?

Objectives: The aim of this study was to determine the detailed anatomical structures of the superficial part of the masseter and to clarify the location and boundaries of the risorius muscle and its topographical relationship with the surrounding structures.

Introduction: The botulinum toxin (BoNT) injection into the masseter muscle often causes the paradoxical masseteric bulging and the change in the facial expression. There is as yet no precise anatomic evidence to support this etiologic factor of these two side effects.

Materials / method: Forty-four hemifaces from Korean and Thai embalmed cadavers were used in this study. The deep tendon structure was located deep in the lower third of the superficial part of the masseter. It was observed in all specimens and was designated as a deep inferior tendon (DIT). The relationship between the masseter and DIT could be classified into three types according to the coverage pattern. And also the locations of origin and insertion points of the risorius muscle were measured, and the masseter muscle was divided into 6 equally sized rectangular areas.

Results: In the DIT location study, we could find the superficial part of the masseter
consists of not only the muscle belly but also the deep tendon structure. When we clarified the location and boundaries of the risorius muscle and the masseter muscles, the cases where the masseter muscle was covered by the risorius muscle were classified into followings: in Type A, Area III was partially covered by the risorius (17.8%); in Type B, Area VI was partially covered (20.0%); in Type C, Areas III and VI were partially covered (53.3%). Almost 91% of risorius muscles attached anterior 1/3 of masseter muscles

Conclusion: To prevent the paradoxical masseteric bulging, we recommend performing layer-by-layer retrograde injections into the superficial and deep muscle bellies of the masseter. And also we could find that the medial part of the masseter muscle represents a hazard zone into which the injection of BoNT may affect the risorius muscle, potentially resulting in iatrogenic unnatural facial expressions.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Haidar ALQUSOUS

Dental Surgeon

Jordan

Other author(s) : dr. haider alqusous

Botulinum toxins treatment for gummy smile

Objectives: new technique for injecting botulinum toxins for gummy smile.

Introduction: A smile is considered to be the most attractive facial feature.
gingival display more than 3mm is considered to be unattracive according to golden smile analysis.
new non surgical technique of treating the gingival display with botulinum toxins which is considered to be safe and reversible.

Materials / method: new technique, my own technique of giving botulinum toxins for gummy smile.
and reveling some of my interesiting cases.

Results: less complication, and faster results have been shown

Conclusion: botutinum toxins is the new era for treatment of the gummy smile, with less complication, faster result and non traditional method.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Adam RISH

Australia

Other author(s) : nil

Less is more: sub-maximal dosing of botulinum toxin to increase cost effectiveness and patient satisfaction and retention rates

Objectives: Patients often prefer smaller improvements in wrinkling but retention of movement i.e. paresis rather than paralysis. Strategic placement of toxin may achieve this at lower doses with reduced cost.

Introduction: Meta-analysis of papers in Dermatological Surgery over a 10 year period advise a total dose of up to 140U toxin for three upper facial areas. The author uses 20U for these areas. To be more cost effective the higher dosage would need to be five times better to offer the same cost efficiency. This paper shows this is not the case.

Materials / method: Meta-analysis of comparative dosing recommendations in papers in Dermatological Surgery over a decade for botulinum type A toxin usage in the upper face.

Clinical audit of Laserase patients attending for botulinum treatments with low dose toxin type A in June 2012.

Results: Laserase audit June 2012: 134 patients treated in nine sites. Mean dosage 15 units (Botox). Total dosage 1835U, total top ups 7 (6%), mean top up dosage 3U (0.02% total dose). Audit past visits between 2007 and 2012: mean 10 treatments over 3 years. Top up doses 7.7% patients. Patient retention at 3 years 76%. Patient growth over 5 years 2

Conclusion: Low dose botulinum may not be low dose due to studies not making cut off dose low enough. There was a high level of satisfaction, low top-up incidence and high patient retention rates at Laserase with low dose treatments of botulinum toxin type A.

It is desirable to titrate toxin dose for individual patients, dependent upon muscle mass, wrinkle severity, desired outcome and finances in order to maximize “cost to satisfaction” ratios.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Prof Elena GUBANOVA

Dermatologist

Russia

Other author(s) : Inna Prygova, Pascal Maisonobe

Patient satisfaction according to age and gender following treatment of glabellar lines with abobotulinumtoxinA: results from the APPEAL study

Objectives: In this post-hoc analysis of the APPEAL study, we aimed to compare patient satisfaction, stratified by age and gender, after 3 injection cycles of abobotulinumtoxinA (aboBoNT-A) for the treatment of glabellar lines (GL).

Introduction: AboBoNT-A is a botulinum toxin type A (BoNT-A) that can be used to weaken muscle contraction to a therapeutic advantage. The short- and long-term efficacy of aboBoNT-A for treating GL is well established in clinical development studies. However, real-world data regarding patient beliefs and attitudes following long-term aboBoNT-A treatment, and whether they vary depending on age and gender, are limited.

Materials / method: The APPEAL study (NCT02353897) was a multicentre non-interventional, prospective, longitudinal study in patients with moderate-to-severe GL. Patients received 3 cycles of aboBoNT-A injections. The decision to receive aboBoNT-A must have been made prior to the decision to participate in the study. Overall satisfaction and factors associated with patient satisfaction (aesthetic outcome, self-perceived age, natural looks, self-esteem or desire to receive further injections) were assessed at 3 weeks (±7 days) after each cycle using a satisfaction questionnaire.

Results: Of 150 patients enrolled, 91.3% were women; the proportion for each age group (years) was: 18-30, 8.7%; 31-40, 21.3%; 41-50, 38.7%; 51-60, 22.7%; >60, 8.7%. After Cycle 3 (n=135), all except 1 patient, reported overall satisfaction with treatment. The proportion of ‘very satisfied’ patients was similar in 31-60 year-olds (73.7-76.0%), but higher in 18-30 year-olds and lower in >60 year-olds (80.0% versus 66.7%). All patients felt the results looked natural, and a greater proportion of women than men felt they looked ‘a little’ or ‘much’ younger than their age (92.9% vs 77.8% after Cycle 3).

Conclusion: This post-hoc analysis shows that regardless of patient sex and age at baseline, high levels of patient satisfaction can be achieved with aboBoNT-A injections for the treatment of GL. Interestingly, some differences were identified in factors affecting satisfaction between women and men, which supports an individualised treatment approach that should respect patients expectations and preferences.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Ipsen

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Ipsen

Dr Iryna SMOLANKA

Dermatologist

Ukraine

Other author(s) : Herasymenko Olga

Botulinum toxin in accessing symmetry of the face in a patient with a facial nerve palsy

Objectives: Rehabilitation after facial nerve palsy is extremely important for patients in both aesthetic and psychological aspects.
Because of aberrant reinnervation of facial nerve patients may suffer from mimic muscle contracture, pathologic synkinesis, spontaneous muscle twitching, hemifacial sweating, lacrimation, salivation on the affected side and controlateral hypertonus of non-affected side.
Facial asymmetry and impairment of functionality could lead the patient to severe psychological problems, including low self-esteem, social isolation, anxiety, and depression.

Introduction: We would like to report a case of botulinum therapy in a patient with facial nerve palsy after the neurosurgical operation because of acoustic neurinoma.

Materials / method: The abobulotoxin type A was injected using an insulin syringe with a 27-gauge needle. Before and after the procedure, the electroneuromyography was performed. Two treatments in 7 months were done. Both paralyzed and non-paralyzed side were treated.
On the healthy side, we injected all the muscles, which take part in the mimic activity.
The injection on the affected side was done only to synkinetic muscles : m. frontalis, m.orbicularis oculi, m. depressor anguli oris, m.platysma, m. zygomaticus major.
Functional efficacy was assessed using the Sunnybrook Facial Grading scale.

Results: Significant improvement in facial symmetry has been reported. The patient admitted the relief of tension on the non-paralyzed side and increase motor strength on paralyzed.
We obtained a better median SFG score (symmetry of voluntary movement, synkinesis, composite score)after the BTX-A injections.

Conclusion: BTX injection is a good therapeutic option for the rehabilitation of patients after facial nerve palsy.
The injection on the healthy side helps to correct the compensatory hypertonus of the non-affected side and access the symmetry of the face at rest. Also, the relaxation on the non-paralyzed side could create conditions for the paralyzed side to improve functional activity and become stronger.
By the injection to synkinetic muscle on the affected side, we can decrease «theft» syndrome of nerve impulses to the muscles and improve overall face motility.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

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IMCAS World Congress 2020 Program

FOCUS ON S030

Contributed talks - Botulinum toxins

Chairs

Lectures of the session

Recommended sessions

IMCAS World Congress 2020
Program