Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK.
Department of Plastic Surgery, Chelsea and Westminster Hospital, London, UK.
Aesthet Surg J. 2022 Apr 12;42(5):NP327-NP336. doi: 10.1093/asj/sjac036.
Botulinum toxin A (BoNT-A) injections are a popular non-surgical procedure for facial rejuvenation. Its increase in popularity and utilization is met with limited regulations, potentially posing a significant risk to patient safety and public health.
The authors sought to assess the safety profile of cosmetic glabellar and forehead BoNT-A injections and evaluate BoNT-A type on complication rate.
A systematic search of MEDLINE and EMBASE was performed for studies reporting complications after cosmetic BoNT-A in the glabellar or in the forehead region in the glabellar or in the forehead region. A random effects meta-analysis was carried out to assess complication rate. Where there were sufficient randomized-controlled trials, a network meta-analysis was performed.
Of 556 identified articles, 24 were included in the final quantitative analysis, with 4268 BoNT-A injection sessions and 1234 placebos. Frequently observed treatment-related complications in the BoNT-A intervention group included headache, local skin reactions, and facial neuromuscular symptoms. The overall BoNT-A complication rate was 16%. The odds ratio of developing complications from abobotulinum toxin injections compared with placebo was 1.62 (1.15, 2.27; P > 0.05) and that from onabotulinum toxin injections compared with placebo was 1.34 (0.52, 3.48; P > 0.05). In 30% of the studies, the injectors were doctors, whereas the training status of the practitioner was not reported in the remaining 70%.
Cosmetic BoNT-A injections in the glabellar and forehead region appear to be safe, and most complications are mild and transient. Nevertheless, the literature demonstrates heterogeneous reporting of complications and a lack of consistency of the definition of treatment-related complications.
肉毒杆菌毒素 A（BoNT-A）注射是一种流行的非手术面部年轻化方法。其受欢迎程度和使用率的增加伴随着有限的监管，这可能对患者安全和公共健康构成重大风险。
作者旨在评估美容眉间和额部 BoNT-A 注射的安全性概况，并评估 BoNT-A 类型对并发症发生率的影响。
对 MEDLINE 和 EMBASE 进行系统检索，以查找报告眉间或额部美容 BoNT-A 后并发症的研究。采用随机效应荟萃分析评估并发症发生率。在有足够随机对照试验的情况下，进行网络荟萃分析。
在 556 篇确定的文章中，有 24 篇被纳入最终的定量分析，其中包括 4268 次 BoNT-A 注射和 1234 次安慰剂。BoNT-A 干预组中经常观察到与治疗相关的并发症包括头痛、局部皮肤反应和面部神经肌肉症状。BoNT-A 总体并发症发生率为 16%。与安慰剂相比，接受 abobotulinumtoxin 注射的患者发生并发症的优势比为 1.62（1.15，2.27；P>0.05），接受 onabotulinumtoxin 注射的患者发生并发症的优势比为 1.34（0.52，3.48；P>0.05）。在 30%的研究中，注射者为医生，而在其余 70%的研究中，未报告从业者的培训状况。
眉间和额部美容 BoNT-A 注射似乎是安全的，大多数并发症是轻微且短暂的。然而，文献显示并发症报告存在异质性，且治疗相关并发症的定义缺乏一致性。
