Botulinum toxin for the treatment of hyperfunctional lines of the face
A. Blitzer, M. F. Brin, M. S. Keen and J. E. Aviv
Department of Otolaryngology, Columbia-Presbyterian Medical Center, New York, NY.
OBJECTIVE: To determine the effectiveness of botulinum toxin injections for
the management of hyperfunctional facial lines in patients with dystonia.
DESIGN: Twenty-six patients were included in the study: 24 patients had
dystonic movement of the face as either a primary or secondary component,
and two patients were treated for purely hyperfunctional lines. Botulinum
toxin type A was injected via a monopolar hollow-bore Teflon-coated
electromyography needle into the facial muscles associated with the
hyperfunctional lines. Doses were divided into 1.25- to 10-U aliquots.
Qualitative assessments by the patient and physician were made before
injection and 2 to 3 weeks after injection. PATIENTS: Twenty-six patients
(two male and 24 female) with hyperfunctional lines were included. The ages
were from 32 to 84 years with an average age of 59 years. Twenty had
dystonia, four had hemifacial spasm, and two had pure hyperfunction without
neuromuscular disease. RESULTS: All of the patients had an effect of toxin
within the first 24 to 72 hours. All of the patients experienced benefit
from the toxin injections with partial or total resolution of painful
contractions or unsightly hyperfunctional lines and spasms. The effects of
the injection lasted 3 to 6 months. No systemic side effects were noted.
Adverse effects included mild, temporary eyelid or lip weakness.
CONCLUSION: Based on this initial pilot study, botulinum toxin may be an
important new option for the treatment of patients with hyperfunctional
facial lines.
