From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Stony Brook University Hospital; the Department of Materials Science and Chemical Engineering, Stony Brook University; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Nassau University Medical Center.
Plast Reconstr Surg. 2019 Jun;143(6):1614-1618. doi: 10.1097/PRS.0000000000005637.
Historically, physicians have relied on their subjective measures when determining the site and dosages for botulinum toxin type A injections. Digital image speckle correlation is a technology that tracks pore movement from rest to maximal exertion, allowing for the determination of the optimal sites of injection. In this prospective, randomized, crossover trial, the efficacy of using digital image speckle correlation was compared to physician assessment in choosing botulinum toxin type A injection sites.
Ten female patients were analyzed in this blinded crossover study. Subjects were randomized to either injections based on digital image speckle correlation analysis or injections based on the 2004 facial aesthetics consensus recommendations. All patients received 20 U of botulinum toxin type A in the glabellar region and were crossed over and reinjected after 6 months. Follow-up was completed with the Facial Line Outcomes 11-item survey and repeated imaging with digital image speckle correlation, to measure patient satisfaction and degree of paralysis, respectively. Statistical comparison was completed by means of matched sample t test.
On average, the digital image speckle correlation analysis provided 4.8 injection sites, whereas the practitioner chose five injections sites. Patients receiving digital image-directed injections had higher rates of satisfaction on the Facial Line Outcomes instrument (p = 0.0003) and a larger degree of paralysis (p = 0.003). Furthermore, muscle function returned to normal later in patients injected with digital image speckle correlation (17.9 weeks versus 20 weeks; p = 0.03).
This study demonstrates the benefits of using digital image speckle correlation in determining optimal botulinum toxin type A injection location. Digital analysis allows practitioners to better treat facial rhytides by eliminating subjective decisions regarding dose and site of injection.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
历史上，医生在确定肉毒毒素 A 注射部位和剂量时依赖于他们的主观测量。数字图像散斑相关是一种跟踪毛孔从静止到最大运动的技术，可用于确定最佳注射部位。在这项前瞻性、随机、交叉试验中，比较了数字图像散斑相关在选择肉毒毒素 A 注射部位方面的效果与医生评估。
在这项盲法交叉研究中分析了 10 名女性患者。受试者随机分为基于数字图像散斑相关分析的注射组或基于 2004 年面部美学共识建议的注射组。所有患者在前额区域接受 20U 的肉毒毒素 A，并在 6 个月后交叉和重新注射。使用面部线条结局 11 项调查和数字图像散斑相关的重复成像分别完成随访，以衡量患者满意度和麻痹程度。通过匹配样本 t 检验完成统计比较。
平均而言，数字图像散斑相关分析提供了 4.8 个注射部位，而医生选择了 5 个注射部位。接受数字图像引导注射的患者在面部线条结局工具上的满意度更高（p=0.0003），麻痹程度更大（p=0.003）。此外，接受数字图像散斑相关注射的患者肌肉功能恢复正常的时间较晚（17.9 周对 20 周；p=0.03）。
这项研究表明，在确定肉毒毒素 A 注射最佳位置时，使用数字图像散斑相关具有优势。数字分析通过消除剂量和注射部位的主观决策，使医生能够更好地治疗面部皱纹。
临床问题/证据水平： 治疗，II。
