title: A Pilot Study on the Treatment of Posterior Cheek Enlargement in HIV+ Patients With Botulinum Toxin A.
abstract: BACKGROUND
  Posterior cheek enlargement in human immunodeficiency virus (HIV)+ individuals can lead to significant cosmetic disfigurement. Both parotid gland and masseter muscle overlie the mandibular ramus, contributing to lower facial contour. However, posterior cheek enlargement has not been well characterized anatomically. There are also limited treatment options. Botulinum toxin is a highly efficacious minimally invasive option for improving the shape of the lower face.
  
  
  OBJECTIVE
  A pilot study was undertaken to better characterize posterior cheek enlargement in HIV+ patients and explore treatment with botulinum toxin A.
  
  
  METHODS
  Five HIV+ patients with posterior cheek enlargement were treated with botulinum toxin A. Clinical, photographic, and radiological evaluations allowed the precise calculation of any change in volumes resulting from botulinum toxin A.
  
  
  RESULTS
  All 5 patients had a good response with a mean decrease of 21.4% and 11.2% in the volumes of the masseter muscle and parotid gland, respectively. The effect was long lasting even at 6 months after injection and well tolerated.
  
  
  CONCLUSIONS
  Botulinum toxin A may be a less invasive treatment of posterior cheek enlargement in HIV+ patients, with advantages of a good result that is long lasting with good tolerability and minimal risk.
authors.affiliation: *Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada; †South Australian Institute of Technology, Adelaide, Australia.
authors.forename: Christina
authors.initials: C
authors.lastname: Scali
authors.forename: Alastair
authors.initials: A
authors.lastname: Carruthers
authors.forename: Dean
authors.initials: D
authors.lastname: Malpas
authors.forename: Shannon
authors.initials: S
authors.lastname: Humphrey
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D002610:Cheek / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000821:virology; D008297:Male; D008406:Masseter Muscle / Q000002:abnormalities* / Q000000981:diagnostic imaging; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D010306:Parotid Gland / Q000000981:diagnostic imaging / Q000473:pathology*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011859:Radiography
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A