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Botulinum Toxin Can Go Systemic for Facial Lines: Presented at AAO-HNSF

By Roberta Friedman
Special to DG News

SAN DIEGO, CA -- September 24, 2002 -- Trying to raise the dose of botulinum toxin to prolong its duration of action in smoothing facial furrows may increase side effects that indicate the agent is going systemic, suggest results presented here Sept. 23^rd.

Speaking at the 106^th annual meeting of the American Academy of Otolaryngology and the Head and Neck Surgery Foundation (AAO-HNSF), Dr. Eugene Kim, of the facial plastic surgery division at the University of California, San Francisco, presented data comparing the incidence of side effects with type B toxin compared to type A.

Type B botulinum toxin was approved by the U.S. Food and Drug Administration for dystonia in 2001, and type A was FDA approved for glabellar hyperkinetic facial lines in 2002.

In a study of 168 patients treated with 1000 to 3000 units of type B toxin per muscle group, the side effects begin to approach those reported in treating cervical dystonia, Dr. Kim said. Here the evidence is that the agent is going systemic, with resulting cholinergic effect -- 3 percent to 9 percent of patients will report dry mouth, which lasts for a month or even two months. Percentages of patients reaching into the teens also report dysphagia.

In the type B toxin study, bruising appeared in 34 percent. Bruising due to botulinum toxin appears to relate to experience of the provider, and is not correlated to dose, Dr. Kim said, and eases within a week or two.

"There is a systemic absorption and a dose related effect," giving autonomic side effects, with increasing doses of botulinum, Dr. Kim explained. If the dose is raised in an attempt to prolong the easing of wrinkles, he said, there may be a limit reached due to these autonomic effects.

He noted that the shelf life of type A botulinum toxin is not as long as that for type B. With type A toxin, headache occurs in 13 percent and 3 percent of patients report nausea, he said.

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