title: The Efficacy and Safety of Fractional CO₂ Laser Combined with Topical Type A Botulinum Toxin for Facial Rejuvenation: A Randomized Controlled Split-Face Study.
abstract: OBJECTIVE
  We evaluated synergistic efficacy and safety of combined topical application of Botulinum Toxin Type A (BTX-A) with fractional CO2 laser for facial rejuvenation.
  
  
  METHODS
  Twenty female subjects were included for this split-face comparative study. One side of each subject's cheek was treated with fractional CO2 plus saline solution, and the other side was treated with fractional CO2 laser plus topical application of BTX-A. Patients received one session of treatment and evaluations were done at baseline, one, four, and twelve weeks after treatment. The outcome assessments included subjective satisfaction scale; blinded clinical assessment; and the biophysical parameters of roughness, elasticity, skin hydration, transepidermal water loss (TEWL), and the erythema and melanin index.
  
  
  RESULTS
  BTX-A combined with fractional CO2 laser sides showed higher physician's global assessment score, subject satisfaction score, roughness, skin hydration, and skin elasticity compared to that of fractional CO2 plus saline solution side at 12 weeks after treatment. TEWL and erythema and melanin index showed no significant differences between two sides at baseline, one, four, and twelve weeks after treatment.
  
  
  CONCLUSIONS
  Topical application of BTX-A could enhance the rejuvenation effect of fractional CO2 laser.
authors.affiliation: Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Department of Dermatology, The First Affiliated Hospital of Nanjing University of TCM, Nanjing, Jiangsu 210029, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Department of Dermatology, Nanjing Maternal and Child Health Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210029, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Ji
authors.affiliation: Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Department of Dermatology, Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Department of Dermatology and Venereology, Nanjing Jingdu Hospital, Nanjing, Jiangsu 210029, China.
authors.forename: Xiao-e
authors.initials: XE
authors.lastname: Chen
authors.affiliation: Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Jia-an
authors.initials: JA
authors.lastname: Zhang
authors.affiliation: Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Luo
authors.affiliation: Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Bing-rong
authors.initials: BR
authors.lastname: Zhou
mesh_terms: D000287:Administration, Topical; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003357:Cosmetic Techniques; D004548:Elasticity / Q000187:drug effects; D004890:Erythema / Q000209:etiology / Q000378:metabolism; D005145:Face; D005260:Female; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods*; D008543:Melanins / Q000378:metabolism; D008875:Middle Aged; D010865:Pilot Projects; D012867:Skin / Q000378:metabolism*; D014870:Water Loss, Insensible / Q000187:drug effects
chemical_list: D008543:Melanins; D019274:Botulinum Toxins, Type A