title: Effect of botulinum toxin pretreatment on laser resurfacing results: a prospective, randomized, blinded trial.
abstract: 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.
  
  
  METHODS
  Institutional review board-approved, prospective, randomized, blinded study at university-affiliated outpatient cosmetic surgery offices.
  
  
  METHODS
  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.
  
  
  METHODS
  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< or =.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.
authors.affiliation: Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, Beth Israel Medical Center, 10 Union Square E, Suite 4J, New York, NY 10003, USA. mzimbler@bethisraelny.org
authors.forename: M S
authors.initials: MS
authors.lastname: Zimbler
authors.forename: J B
authors.initials: JB
authors.lastname: Holds
authors.forename: M S
authors.initials: MS
authors.lastname: Kokoska
authors.forename: D A
authors.initials: DA
authors.lastname: Glaser
authors.forename: S
authors.initials: S
authors.lastname: Prendiville
authors.forename: C S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: J R
authors.initials: JR
authors.lastname: Thomas
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005152:Facial Muscles / Q000187:drug effects*; D005260:Female; D006801:Humans; D007267:Injections; D053685:Laser Therapy; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage; D011184:Postoperative Period; D011446:Prospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D016037:Single-Blind Method; D015595:Skin Aging / Q000187:drug effects*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A