title: Dermal and epidermal remodeling using botulinum toxin type A for facial, non reducible, hyperkinetic lines: two case studies.
abstract: BACKGROUND
  Many studies confirm the safety and efficacy of botulinum toxin type A in a variety of clinical indications. Its use for treatment of hyperfunctional facial lines has become the most popular cosmetic procedure. These case studies comprise an evaluation of the long-term treatment of two subjects treated with botulinum toxin type A (BOTOX(R), Allergan, Irvine, CA, USA) for hyperfunctional, non reducible, facial lines.
  
  
  OBJECTIVE
  This paper aims to assess the long-term effectiveness of BOTOX treatment for hyperfunctional facial lines in two subjects over 7 years.
  
  
  METHODS
  Two subjects (case 1: female aged 53 years; case 2: male age 50 years) presenting with glabelar, forehead, and periorbital facial lines were treated with BOTOX over a 7-year period. Case 1 received a total of 24 treatments at 4-monthly intervals, and case 2 received 21 treatments at 3- to 6-monthly intervals.
  
  
  RESULTS
  Skin quality continued to improve over time, revealing a smoother, enhanced, yet "natural" look. In particular, non reducible forehead lines were effaced suggesting dermal and epidermal remodeling over long-term treatment. There was no evidence of development of any new wrinkles secondary to BOTOX use, and both subjects continue to report high levels of treatment satisfaction. No safety issues were raised.
  
  
  CONCLUSIONS
  These case studies demonstrate that non reducible horizontal forehead lines can show long-term reduction with BOTOX treatment and high levels of subject satisfaction.
authors.affiliation: Court House Clinic, London, UK. pbowler@courthouseclinic.com
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bowler
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D020405:Dermis / Q000187:drug effects*; D004817:Epidermis / Q000187:drug effects*; D005145:Face; D005260:Female; D005546:Forehead; D006801:Humans; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D017060:Patient Satisfaction; D012060:Rejuvenation; D015595:Skin Aging / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A