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Updated: Oct 30, 2025
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Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
Published on: November 9, 2016
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Botulinum toxin type A for facial wrinkles
Cristina Pires Camargo1, Jun Xia2, Caroline S Costa3
1Laboratory of Microsurgery and Plastic Surgery (LIM-04), School of Medicine, Universidade de São Paulo, São Paulo, Brazil.
The Cochrane Database of Systematic Reviews
|July 5, 2021
Summary
Botulinum toxin type A (BontA) effectively reduces facial wrinkles within four weeks, but may increase the risk of eyelid ptosis. Further research is needed to compare different BontA products and long-term outcomes.
Area of Science:
- Dermatology and Aesthetic Medicine
- Evidence-Based Medicine
- Clinical Trials Analysis
Background:
- Botulinum toxin type A (BontA) is a prevalent treatment for dynamic facial wrinkles.
- Previous comprehensive assessments of BontA's effectiveness and safety in a Cochrane Review were lacking.
- This review addresses the need for a systematic evaluation of commercially available BontA products.
Purpose of the Study:
- To systematically assess the efficacy and safety of all commercially available botulinum toxin type A products.
- To evaluate BontA treatments for all types of facial wrinkles in adult populations.
- To synthesize evidence from randomized controlled trials (RCTs) comparing BontA with placebo, other BontA types, or hyaluronic acid fillers.
Main Methods:
- Conducted a systematic search of multiple databases (Cochrane Skin, CENTRAL, MEDLINE, Embase, LILACS) and trials registers up to May 2020.
- Included 65 RCTs with over 50 participants, comparing BontA versus placebo, other BontA, or hyaluronic acid fillers for facial wrinkles.
- Assessed primary outcomes of participant- and physician-assessed success and major adverse events (AEs), using GRADE to determine evidence certainty.
Main Results:
- BontA treatments, including onabotulinumtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, and daxibotulinumtoxinA, demonstrated higher success rates compared to placebo within four weeks.
- Major adverse events, primarily eyelid ptosis, were found to be potentially more frequent with certain BontA products compared to placebo.
- Evidence certainty varied from low to high for effectiveness and from very low to moderate for AEs, with significant study heterogeneity noted.
Conclusions:
- Botulinum toxin type A effectively reduces facial wrinkles within four weeks but is associated with an increased risk of ptosis.
- Heterogeneity in study designs, BontA types/doses, and treatment regions limited comprehensive meta-analyses.
- Future RCTs should focus on comparing common BontA formulations, evaluating long-term outcomes, and exploring effects of multiple treatment cycles.
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