title: Botulinum toxin A adjunctive use in manual chemabrasion: controlled long-term study for treatment of upper perioral vertical wrinkles.
abstract: BACKGROUND
  The treatment of perioral vertical wrinkles is a very common request from female patients as of their 40th decade of life. Actinic damage, cigarette smoking, loss of deep structures volume, sleep positions, orthodontic deformities, and dynamic components have been thought to cause this aesthetic problem.
  
  
  OBJECTIVE
  The objective was to investigate the combination of botulinum toxin type A (BoNTA) pretreatment of the orbicularis oris muscle with manual chemabrasion to increase its clinical efficacy in the therapy of upper perioral vertical rhytides.
  
  
  METHODS
  Twelve women presenting moderate to severe upper lip vertical rhytides were randomized to receive two unilateral BoNTA injections at the vermilion border, 1 week before chemabrasion (35% trichloroacetic acid followed by dermasanding) of the upper perioral cosmetic unit. Wrinkle severity was assessed by two blinded observers at baseline, 30 days, 90 days, 180 days, and 3 years by using a four-point Facial Wrinkle Severity Scale (FWSS).
  
  
  RESULTS
  From Day 90 to Year 3, the BoNTA-injected sides showed smaller grades in the FWSS than control sides (p<.05).
  
  
  CONCLUSIONS
  Previous injections of BoNTA improve short- and long-term results of chemabrasion in the upper lip region.
authors.affiliation: Dermatologic Clinic, Hospital do Servidor Publico Municipal, São Paulo, Brazil. bog@uol.com.br
authors.forename: Bogdana Victoria
authors.initials: BV
authors.lastname: Kadunc
authors.forename: Ada Regina
authors.initials: AR
authors.lastname: Trindade DE Almeida
authors.forename: Adriana Amorin
authors.initials: AA
authors.lastname: Vanti
authors.forename: Nilton
authors.initials: N
authors.lastname: DI Chiacchio
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002615:Chemexfoliation; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008046:Lip / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D015595:Skin Aging / Q000187:drug effects*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A