article | TreATIng The lIps | 50 40 30 20 10 0 1
Patients Physician Final result
2 3 Satisfaction
Figure 13 Patient, physician and overall satisfaction with treatment: cohort 1, botulinum toxin A only
for a successive 2–15 days, 108 (60%) patients
experienced: ■ A loss of control over the perioral muscles (52.7%; 95 patients) ■ A feeling of incontinence of the lips while drinking or eating, (46.1%; 83 patients) ■ A feeling of a distorted mouth, or feeling that one is laughing in strange way or speaking differently (11.6%; 21 patients).
In reality, and aesthetically, nothing is visible, but the
patient’s perception will be altered. After no more than 15–20 days, the patient will naturally become accustomed to their perioral movements. none of these are ‘real’ side-effects, but merely the normal development of the toxin’s effect, and patients must be advised in advance of any possible discomfort or unusual sensations. In 1.6% of the total patient population (n=3), a deviation of the midline of the upper lip was evident, demonstrating greater intake of the toxin in one side. In 6% of Vistabex patients (n=10), the results were too low and for this reason patients were reinjected. In 5.4% of Vistabex patients (n = 9), the recommended doses (0.5 U per point of botulinum toxin) were too high, with patients complaining of the same uneasiness even after 20 days; in 1% (n=2) even after 1 month. In the case of overdose, the only way to decrease the sensation of discomfort is by performing muscular exercises. All patients in the Azzalure population had the sensation of treatment and were not reinjected; 72 patients (40%) did not perceive any unusual sensation. All the hyaluronic acid varieties used were proven safe;
no case of significant side-effects occurred with this procedure. At the most, there was a little bruising and in a
38 ❚ October 2011 |
prime-journal.com in the case
of overdose, the only way to decrease the sensation of discomfort is by performing muscular exercises.
4 5
Patients Physician Final result
10 20 30 40 50 60
0 1 2 3 Satisfaction
Figure 14 Patient, physician and overall satisfaction with treatment: cohort 2, botulinum toxin A plus hyaluronic acid
few cases, an oedema occurred. In no case were there any serious infections, but in one case herpes simplex occurred 10 days after the procedure.
Discussion The fact that all the patients gave a positive result testifies to the safety of the procedure. even if 60% of the patients complained of strange feelings, all reported sensations should be considered a normal effect of the toxin, and if patients are informed of this discomfort beforehand, there is no problem. The two patients who experienced
4 5
40%
60%
Figure 15 Post-treatment
sensation and side-effects after botulinum toxin treatment
No sensation
Some sensation
Number of patients
Number of patients
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