Clostridium botulinum type A toxin for the treatment of upper face animation lines: an Iranian experience

The purpose of this study was to evaluate the treatment of vertical glabellar frown lines, frontal lines and crow's feet by means of direct injection of Dysport (Clostridium botulinum type A toxin - hemagglutinin complex) in Iranian patients. Dysport is one of the commercially available type A subtypes (Ipsen Ltd, Maidenhead Berkshire, UK). It is the one used most often in Iran. Botox, the other form of commercially available botulinum type A toxin, is used most often in the United States and Canada. Dysport is two to four times less effective, in similar unit doses, than Botox, which is why it is manufactured in larger vials (500-U vials for Dysport vs. 100-U vials for Botox). The authors have been using botulinum toxin type A in their practice for cosmetic purposes since 1995. An experience of over 1295 injections to the upper face animation (dynamic) lines in 108 patients is presented. This study included 108 patients and 208 injection sessions. We used Dysport containing 500 U toxin. Toxin was diluted with 2.5 mL of sterile normal saline and yielded 20 U for each 0.1 mL. A dose of 76 to 90 U was injected into each muscle. There were 95 women and 13 men in this study, ranging in age from 20 to 79 years. Doses ranged from 10 to 20 mL per injection, varying according to the severity of wrinkles, intensity of muscle contraction, and the mass of the muscle. The more bulky or greater intensity of muscle contraction, the higher the dose required to obtain good results. Therefore, the more bulky corrugator or frontalis muscle requires more than the thinner orbicularis. Dysport seemed to be a safe and effective alternative to Botox, giving good to excellent cosmetic results lasting at least 4 months in the majority of the patients.