Wanitphakdeedecha Rungsima, Kaewkes Arisa, Ungaksornpairote Chanida, Limsaengurai Saowalak, Panich Uraiwan, Manuskiatti Woraphong
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Cosmet Dermatol. 2019 Oct;18(5):1215-1223. doi: 10.1111/jocd.13058. Epub 2019 Jul 22.
Botulinum toxin type A (BoNT-A) may directly remodel dermal tissues or induce a loss of normal morphology and cytoplasmic retraction and spread. Intradermal injection was claimed to produce a dermo-lifting effect, including midface lifting by using low concentration with variable dilution.
To understand how intradermal BoNT-A achieves tissue lifting, we examined different type of BoNT-A and their effects on dermal fibroblast contraction.
Normal human dermal fibroblasts were treated with onabotulinumtoxin (ONA), abobotulinumtoxin (ABO), prabotulinumtoxinA (PRABO), incobotulinumtoxinA (INCO), and letibotulinumtoxin A (LETI) in dilutions used in real-world practice. Fifty fibroblasts per dilution were photographed and measured the length to demonstrate their contraction every 2 hours from baseline (0 hours) to 12 hours post-treatment.
ONA did not significantly decrease fibroblast lengths, at any timepoint or dilution. At 1:7 dilution ratios, ABO decreased fibroblast lengths after 2 hours and significantly after 10-12 hours. At 1:7, 1:8, 1:9, and 1:10 dilution, PRABO decreased length, and most rapidly at 1:7 and 1:8. At 1:6, 1:8, 1:9, and 1:10 dilution, INCO decreased lengths almost immediately. At 1:6 dilution, INCO decreased lengths almost immediately. At 1:7 dilution, INCO decreased lengths after 2-4 hours, while at 1:8, 1:9, and 1:10 dilution, INCO decreased lenghts nearly imediately. LETI decreased lengths at all dilutions except 1:9, with near-immediate effects at 1:6, 1:7, 1:8, and 1:10. At 1:4 dilution, LETI decreased lengths from 1 hour.
Different commercial preparations of BoNT-A toxins cause different fibroblast contractions in vitro. Product selection and dilution used may affect the clinical outcome of intradermal injection of BoNT-A for face lifting.
A型肉毒毒素（BoNT-A）可能直接重塑真皮组织，或导致正常形态丧失、细胞质收缩和扩散。皮内注射据称可产生皮肤提升效果，包括使用不同稀释度的低浓度药物进行中面部提升。
为了解皮内注射BoNT-A如何实现组织提升，我们研究了不同类型的BoNT-A及其对真皮成纤维细胞收缩的影响。
用实际应用中的稀释度，将普通型肉毒毒素（ONA）、阿伯型肉毒毒素（ABO）、普拉博型肉毒毒素A（PRABO）、因可型肉毒毒素A（INCO）和乐提葆型肉毒毒素A（LETI）作用于正常人真皮成纤维细胞。每个稀释度取50个成纤维细胞进行拍照，并测量其长度，从基线（0小时）到治疗后12小时，每2小时记录一次，以显示其收缩情况。
在任何时间点或稀释度下，ONA均未显著缩短成纤维细胞长度。在1:7的稀释比例下，ABO在2小时后可使成纤维细胞长度缩短，在10 - 12小时后显著缩短。在1:7、1:8、1:9和1:10的稀释度下，PRABO可使成纤维细胞长度缩短，在1:7和1:8时缩短速度最快。在1:6、1:8、1:9和1:10的稀释度下，INCO几乎可立即使成纤维细胞长度缩短。在1:6的稀释度下，INCO几乎可立即使成纤维细胞长度缩短。在1:7的稀释度下，INCO在2 - 4小时后可使成纤维细胞长度缩短，而在1:8、1:9和1:10的稀释度下，INCO几乎可立即使成纤维细胞长度缩短。除1:9外，LETI在所有稀释度下均可使成纤维细胞长度缩短，在1:6、1:7、1:8和1:10时几乎可立即起效。在1:4的稀释度下，LETI在1小时后可使成纤维细胞长度缩短。
不同商业制剂的BoNT-A毒素在体外可引起不同的成纤维细胞收缩。产品选择和使用的稀释度可能会影响皮内注射BoNT-A进行面部提升的临床效果。
