Durand Paul D, Couto Rafael A, Isakov Raymond, Yoo Donald B, Azizzadeh Babak, Guyuron Bahman, Zins James E
Drs Durand and Couto are Residents, Dr Isakov is an Assistant Professor, and Dr Zins is Chairman, Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH. Drs Yoo and Azizzadeh are facial plastic surgeons in private practice in Beverly Hills, CA. Dr Guyuron is Chairman, Department of Plastic Surgery, Case Western Reserve University, Cleveland, OH.
Aesthet Surg J. 2016 Apr;36(4):482-7. doi: 10.1093/asj/sjv208. Epub 2016 Jan 17.
While the facial rejuvenating effect of botulinum toxin type A is well known and widespread, its use in body and facial contouring is less common. We first describe its use for deliberate muscle volume reduction, and then document instances of unanticipated and undesirable muscle atrophy. Finally, we investigate the potential long-term adverse effects of botulinum toxin-induced muscle atrophy. Although the use of botulinum toxin type A in the cosmetic patient has been extensively studied, there are several questions yet to be addressed. Does prolonged botulinum toxin treatment increase its duration of action? What is the mechanism of muscle atrophy and what is the cause of its reversibility once treatment has stopped? We proceed to examine how prolonged chemodenervation with botulinum toxin can increase its duration of effect and potentially contribute to muscle atrophy. Instances of inadvertent botulinum toxin-induced atrophy are also described. These include the "hourglass deformity" secondary to botulinum toxin type A treatment for migraine headaches, and a patient with atrophy of multiple facial muscles from injections for hemifacial spasm. Numerous reports demonstrate that muscle atrophy after botulinum toxin type A treatment occurs and is both reversible and temporary, with current literature supporting the notion that repeated chemodenervation with botulinum toxin likely responsible for both therapeutic and incidental temporary muscle atrophy. Furthermore, duration of response may be increased with subsequent treatments, thus minimizing frequency of reinjection. Practitioners should be aware of the temporary and reversible effect of botulinum toxin-induced muscle atrophy and be prepared to reassure patients on this matter.
虽然A型肉毒杆菌毒素的面部年轻化效果广为人知且应用广泛，但其在身体塑形和面部轮廓塑造中的应用则不太常见。我们首先描述其用于刻意减少肌肉体积的情况，然后记录意外和不良肌肉萎缩的实例。最后，我们研究肉毒杆菌毒素诱导的肌肉萎缩可能产生的长期不良影响。尽管对A型肉毒杆菌毒素在美容患者中的应用已进行了广泛研究，但仍有几个问题有待解决。延长肉毒杆菌毒素治疗会增加其作用持续时间吗？肌肉萎缩的机制是什么，治疗停止后其可逆性的原因又是什么？我们接着探讨延长肉毒杆菌毒素化学去神经作用如何能增加其作用持续时间并可能导致肌肉萎缩。还描述了肉毒杆菌毒素意外导致萎缩的实例。这些包括因治疗偏头痛而使用A型肉毒杆菌毒素继发的“沙漏畸形”，以及一名因注射治疗半面痉挛而导致多块面部肌肉萎缩的患者。大量报告表明，A型肉毒杆菌毒素治疗后会发生肌肉萎缩，且这种萎缩是可逆和暂时的，当前文献支持这样的观点，即重复使用肉毒杆菌毒素进行化学去神经作用可能是治疗性和偶发性暂时肌肉萎缩的原因。此外，后续治疗可能会增加反应持续时间，从而减少再次注射的频率。从业者应意识到肉毒杆菌毒素诱导的肌肉萎缩具有暂时和可逆的效果，并准备好在这方面安抚患者。
