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Effect of Botulinum Toxin Pretreatment on Laser Resurfacing Results
A Prospective, Randomized, Blinded Trial
Marc S. Zimbler, MD;
John B. Holds, MD;
Mimi S. Kokoska, MD;
Dee Anna Glaser, MD;
Stephen Prendiville, MD;
Christopher S. Hollenbeak, PhD;
J. Regan Thomas, MD
Arch Facial Plast Surg. 2001;3:165-169.
Background Facial laser resurfacing and chemodenervation with botulinum toxin type
A are used independently as means of nonsurgical facial rejuvenation. Recent
reports in the literature have described combining these 2 therapies, claiming
improved and longer-lasting laser resurfacing results. To date, no scientific
investigation has been undertaken to prove or disprove this theory.
Design Institutional review board–approved, prospective, randomized,
blinded study at university-affiliated outpatient cosmetic surgery offices.
Intervention Patients had one side of their face injected, at specific anatomic subsites
(crow's feet, horizontal forehead furrows, and glabellar frown lines), with
botulinum toxin 1 week before laser resurfacing. After receiving an injection,
patients underwent cutaneous laser exfoliation on both sides of the face with
either a carbon dioxide or an erbium dual-mode laser.
Main Outcome Measures Patients' injected (experimental) and noninjected (control) sides were
compared after laser resurfacing. Follow-up was documented at 6 weeks, 3 months,
and 6 months after laser resurfacing. Subjective evaluation, based on a visual
analog scale, was performed in person by a blinded observer. Furthermore,
a blinded panel of 3 expert judges (1 facial plastic surgeon, 1 oculoplastic
surgeon, and 1 cosmetic dermatologist) graded 35-mm photographs taken during
postoperative follow-up visits.
Results Ten female patients were enrolled in the study. A 2-tailed t test showed that all sites that were pretreated with botulinum toxin
showed statistically significant improvement (P .05)
over the nontreated side, with the crow's feet region showing the greatest
improvement. Comparing results between the carbon dioxide and erbium lasers
did not result in any statistically significant differences.
Conclusions Hyperdynamic facial lines, pretreated with botulinum toxin before laser
resurfacing, heal in a smoother rhytid-diminished fashion. These results were
clinically most significant in the crow's feet region. We recommend pretreatment
of movement-associated rhytides with botulinum toxin before laser resurfacing.
For optimum results, we further recommend continued maintenance therapy with
botulinum toxin postoperatively.
From the Division of Facial Plastic Surgery, Department of Otolaryngology–Head
and Neck Surgery, Beth Israel Medical Center, New York, NY (Dr Zimbler); Departments
of Ophthalmology (Dr Holds), Otolaryngology–Head and Neck Surgery (Dr
Holds), and Dermatology (Dr Glaser) and Division of Facial Plastic Surgery
of the Department of Otolaryngology–Head and Neck Surgery (Drs Kokoska
and Prendiville), Saint Louis University Hospital, St Louis, Mo; Departments
of Surgery and Health Evaluation Sciences, Penn State College of Medicine,
Hershey, Pa (Dr Hollenbeak); and Division of Facial Plastic Surgery, Department
of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago
School of Medicine (Dr Thomas).
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