de Sanctis Pecora Carla, Pinheiro Maria Valéria Bussamara, Ventura Ferreira Karin, Jacobino de Barros Nunes Gisele, Miot Hélio Amante
Dermatologie - Clinica, Cirurgia, Cosmiatria e Laser, São Paulo, SP, Brazil.
Departamento de Dermatologia da FMB-Unesp, Botucatu, SP, Brazil.
Clin Cosmet Investig Dermatol. 2021 Feb 2;14:97-105. doi: 10.2147/CCID.S281901. eCollection 2021.
Botulinum toxin type A is an effective treatment for glabellar dynamic wrinkles. As the muscular group involved in the contraction of the glabella varies among people, individualized treatment can achieve optimal results. This study evaluates a customized assessment for the treatment of glabellar lines with Incobotulinumtoxin-A, leading to an individualized points distribution and dosage.
A single-center, evaluator-blinded, therapeutic cohort study enrolled 130 women with moderate or severe glabellar wrinkles. They underwent Incobotulinumtoxin-A injection following the standard 5-point injection at the glabellar muscles (n = 65) or an individualized assessment and scheme treatment based on anatomical references of contraction, the One21 technique (n = 65). All the patients were photographed under maximum contraction before treatment (T0) and after 4 weeks (T28). The photos were randomly assessed by two blinded, experienced raters to consensually grade the severity according to the Merz Aesthetics Scales (MAS). The primary clinical efficacy was defined as a 2-point reduction in the MAS score, on Day 28.
The groups were homogeneous regarding age, phototype, and baseline MAS scores. On Day 28 (T28), 64 (98.5%) patients from the One21 group and 52 (80%) from the 5-point group reduced the MAS score by at least two points ( < 0.01). When adjusted by age and phototype, both groups reduced the MAS score at T28 ( < 0.01); nevertheless, patients from the One21 group significantly performed better ( < 0.01), with a much higher rate response rate at T28, in comparison to the 5-point group. Of patients enrolled in the 5-point group, 83.1% utilized muscle groups other than the procerus and corrugator in glabellar wrinkle formation, and 17 (24.6%) presented asymmetrical contraction. Patients from the 5-point group with glabellar asymmetry and those who utilized the frontalis and orbicularis presented inferior performance ( < 0.05), reinforcing the importance of an individualized assessment and treatment plan.
The One21 technique yielded better results than the standard 5-point treatment in reducing glabellar dynamic lines with Incobotulinumtoxin-A, especially for asymmetric lines of the glabella or the involvement of muscle groups other than the procerus and corrugator.
A型肉毒杆菌毒素是治疗眉间动态皱纹的有效方法。由于参与眉间收缩的肌肉群因人而异，个体化治疗可取得最佳效果。本研究评估了一种针对用因可必特肉毒毒素A治疗眉间纹的定制评估方法，从而实现个体化的点数分布和剂量。
一项单中心、评估者盲法的治疗队列研究纳入了130名患有中度或重度眉间皱纹的女性。她们接受了因可必特肉毒毒素A注射，其中一组在眉间肌采用标准的5点注射法（n = 65），另一组基于收缩的解剖学参考采用个体化评估和方案治疗，即One21技术（n = 65）。所有患者在治疗前（T0）最大收缩状态下以及4周后（T28）进行拍照。照片由两名盲法、经验丰富的评估者随机评估，以根据默茨美学量表（MAS）达成共识来对严重程度进行分级。主要临床疗效定义为在第28天MAS评分降低2分。
两组在年龄、光型和基线MAS评分方面具有同质性。在第28天（T28），One21组有64名（98.5%）患者，5点组有52名（80%）患者的MAS评分至少降低了2分（P<0.01）。经年龄和光型调整后，两组在T28时MAS评分均降低（P<0.01）；然而，与5点组相比，One21组患者表现明显更好（P<0.01），在T28时的反应率更高。在5点组的患者中，83.1%在眉间皱纹形成中使用了降眉间肌和皱眉肌以外的肌肉群，17名（24.6%）表现出不对称收缩。5点组中眉间不对称的患者以及使用额肌和眼轮匝肌的患者表现较差（P<0.05），这进一步强调了个体化评估和治疗计划的重要性。
在使用因可必特肉毒毒素A减少眉间动态纹方面，One21技术比标准的5点治疗效果更好，尤其是对于眉间不对称纹或降眉间肌和皱眉肌以外肌肉群参与形成的皱纹。
