Sibar Serhat, Findikcioglu Kemal, Zinnuroglu Murat, Cenetoglu Seyhan
From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Duzce Ataturk State Hospital, Duzce; †Department of Plastic, Reconstructive and Aesthetic Surgery, and ‡Department of Physical Therapy and Rehabilitation, Gazi University Hospital, Ankara, Turkey.
Ann Plast Surg. 2017 Apr;78(4):436-442. doi: 10.1097/SAP.0000000000000957.
Today, botulinum toxin is commonly used for cosmetic purposes throughout the world. Despite various agents reducing the efficiency of toxin are well defined, the studies related to increasing the bioavailability are limited. The purpose of our study is to assess the effect of the preparation of toxin by diluting with platelet-poor plasma (PPP) and/or albumin instead of standard dilution (saline) on bioavailability in cosmetic-purpose botulinum toxin applications.In the study, 24 New Zealand rabbits were used. Right anterior auricular muscle was preferred for toxin injections. Subjects were divided in 4 groups and in every group; botulinum A toxin (BTxA) that was prepared by different dilution methods was injected. 2.5 U saline-diluted BTxA was injected to the subjects in group 1, 2.5 U ready-to-use rabbit albumin-diluted BTxA was injected to group 2 and 2.5 U autologous PPP-diluted BTxA was injected to group 3 and pure saline was injected to group 4.Before the injection (0th week) and in the second, sixth, and 12th weeks after the injection, visual and electroneuromyographic evaluations of the ears of the subjects were performed.In the second week, median amplitude levels in group 2 were significantly found lower than other groups.In the sixth week, median amplitude levels in group 1 were significantly found lower than other groups.In 12th week, no significant difference was found among all the groups in terms of median amplitude levels.Visual findings were also correlated with electroneuromyographic findings.It was observed that the dilution of BTxA with albumin had caused a stronger paralysis when compared to dilution with saline or PPP at the beginning (second week); however, in the following weeks (sixth week), it was seen that dilution with saline had maintained paralysis better when compared with other dilution methods.In cosmetic BTxA applications, dilution of the toxin with albumin or PPP instead of standard dilution has no positive effect on bioavailability and such modifications regarding this kind of dilution are found unsuitable. Further studies are needed to directly relate the results with clinical applications.
如今，肉毒杆菌毒素在全球范围内广泛用于美容目的。尽管各种降低毒素效力的因素已明确，但关于提高生物利用度的研究却很有限。我们研究的目的是评估用贫血小板血浆（PPP）和/或白蛋白稀释而非标准稀释（生理盐水）制备毒素对美容用途肉毒杆菌毒素应用中生物利用度的影响。
在该研究中，使用了24只新西兰兔。选择右耳前肌进行毒素注射。将实验对象分为4组，每组注射通过不同稀释方法制备的A型肉毒杆菌毒素（BTxA）。第1组向实验对象注射2.5 U生理盐水稀释的BTxA，第2组注射2.5 U即用型兔白蛋白稀释的BTxA，第3组注射2.5 U自体PPP稀释的BTxA，第4组注射纯生理盐水。
在注射前（第0周）以及注射后的第2、6和12周，对实验对象的耳部进行视觉和神经电生理评估。
在第2周，发现第2组的中位振幅水平显著低于其他组。
在第6周，发现第1组的中位振幅水平显著低于其他组。
在第12周，所有组之间的中位振幅水平未发现显著差异。
视觉结果也与神经电生理结果相关。
观察到，与生理盐水或PPP稀释相比，开始时（第2周）白蛋白稀释的BTxA导致更强的麻痹；然而，在接下来的几周（第6周），与其他稀释方法相比，生理盐水稀释在维持麻痹方面效果更好。
在美容用BTxA应用中，用白蛋白或PPP而非标准稀释来稀释毒素对生物利用度没有积极影响，并且发现这种关于稀释的改变不合适。需要进一步研究将结果直接与临床应用相关联。
