title: Repeated botulinum toxin A injections for the treatment of lines in the upper face: a retrospective study of 4,103 treatments in 945 patients.
abstract: BACKGROUND
  Although botulinum toxin type A (BoNT-A) is a common aesthetic intervention, there are few published data on treatment over more than two cycles.
  
  
  OBJECTIVE
  To evaluate the effectiveness/safety of repeated doses of BoNT-A (Dysport, Ipsen Ltd., Slough, UK) in the upper face for reduction of wrinkles.
  
  
  METHODS
  Retrospective, cross-sectional patient chart review from 945 patients who had received a minimum of three consecutive, documented treatment cycles.
  
  
  RESULTS
  The glabella was treated most frequently (93.9%), with the majority (81.5%) of patients receiving treatment in more than one area of the face. BoNT-A treatments were combined with other aesthetic procedures in 57.5% of cases, mostly with fillers (37.1%). There was no evidence of tachyphylaxia: the dose applied, the interval between treatments, and satisfaction with the results remained stable over the course of treatment. Adverse events were those expected with BoNT-A treatment (most common: local bruising and ptosis) and were all mild or moderate in intensity. There was no sign of any cumulative adverse effects: indeed, the adverse-event rate decreased in later treatment cycles.
  
  
  CONCLUSIONS
  Long-term, repeated injections of BoNT-A for corrections of wrinkles in the upper face yield a continuously high level of safety and effectiveness in actual practice.
authors.affiliation: Division of Evidence Based Medicine, Department of Dermatology, Charité Universitätsmedizin, Berlin, Germany. berthold.rzany@charite.de
authors.forename: Berthold
authors.initials: B
authors.lastname: Rzany
authors.forename: Dorothee
authors.initials: D
authors.lastname: Dill-Müller
authors.forename: Doris
authors.initials: D
authors.lastname: Grablowitz
authors.forename: Marc
authors.initials: M
authors.lastname: Heckmann
authors.forename: David
authors.initials: D
authors.lastname: Caird
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003357:Cosmetic Techniques; D005138:Eyebrows / Q000033:anatomy & histology*; D005145:Face; D005260:Female; D006801:Humans; D007267:Injections; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A