Botulinum toxin for the correction of hyperkinetic facial lines

The present article illustrates the effects of low dose botulinum toxin (BTx) injections for the improvement of hyperkinetic facial lines and presents a grading treatment chart designed to standardize the reporting of the improvement seen. A questionnaire of patient acceptance, the patients' impression of therapy and short-term results and complications are reported. Twelve patients with 26 injected-paired regions were charted and the response to injection was graded. Patients had hyperkinetic facial lines in glabella, periorbital regions or horizontal forehead lines. Diluted BTx type A (1 IU/0.1 mL) was injected and patients were assessed at 10 days. A second follow up injection was offered to patients at this stage if required. Objectively, all patients' hyperkinetic actions and lines improved or diminished. The degree of improvement was similar in all areas injected and a symmetry of results was always observed. In a minority of cases, all movement was lost (7/26) and in others it was weakened but present (19/26). In some injected areas the actual expression line that was visible at rest disappeared entirely (11/26): in the others it was diminished (15/26). Complications were few. Two patients had temporary brow ptosis that spontaneously recovered within the first week. No eyelid ptosis was noted. Bruising and headaches were the most common reported complications. Low dose BTx is an effective and well-tolerated treatment for hyperkinetic facial lines with few significant complications in this small pilot study. The grading chart may allow easier comparisons of results between studies on the effects of BTx therapy.