Complications of Cosmetic Botulinum Toxin A Injections to the Upper Face: A Systematic Review and Meta-Analysis

Zargaran D, Zoller F, Zargaran A, Rahman E, Woollard A, Weyrich T, Mosahebi A (2022)

Publication Type: Journal article, Review article

Publication year: 2022

Journal

Aesthetic Surgery Journal Mosby Inc.

Book Volume: 42

Pages Range: NP327-NP336

Journal Issue: 5

DOI: 10.1093/asj/sjac036

Abstract

Background: Botulinum toxin A (BoNT-A) injections are a popular non-surgical procedure for facial rejuvenation. Its increase in popularity and utilization is met with limited regulations, potentially posing a significant risk to patient safety and public health. Objectives: The authors sought to assess the safety profile of cosmetic glabellar and forehead BoNT-A injections and evaluate BoNT-A type on complication rate. Methods: A systematic search of MEDLINE and EMBASE was performed for studies reporting complications after cosmetic BoNT-A in the glabellar or in the forehead region in the glabellar or in the forehead region. A random effects meta-analysis was carried out to assess complication rate. Where there were sufficient randomized-controlled trials, a network meta-analysis was performed. Results: Of 556 identified articles, 24 were included in the final quantitative analysis, with 4268 BoNT-A injection sessions and 1234 placebos. Frequently observed treatment-related complications in the BoNT-A intervention group included headache, local skin reactions, and facial neuromuscular symptoms. The overall BoNT-A complication rate was 16%. The odds ratio of developing complications from abobotulinum toxin injections compared with placebo was 1.62 (1.15, 2.27; P > 0.05) and that from onabotulinum toxin injections compared with placebo was 1.34 (0.52, 3.48; P > 0.05). In 30% of the studies, the injectors were doctors, whereas the training status of the practitioner was not reported in the remaining 70%. Conclusions: Cosmetic BoNT-A injections in the glabellar and forehead region appear to be safe, and most complications are mild and transient. Nevertheless, the literature demonstrates heterogeneous reporting of complications and a lack of consistency of the definition of treatment-related complications. Level of Evidence: 2:

Authors with CRIS profile

Tim Weyrich

Involved external institutions

Chelsea and Westminster Hospital GB United Kingdom (GB) University College London (UCL) GB United Kingdom (GB)

How to cite

APA:

Zargaran, D., Zoller, F., Zargaran, A., Rahman, E., Woollard, A., Weyrich, T., & Mosahebi, A. (2022). Complications of Cosmetic Botulinum Toxin A Injections to the Upper Face: A Systematic Review and Meta-Analysis. Aesthetic Surgery Journal, 42(5), NP327-NP336. https://dx.doi.org/10.1093/asj/sjac036

MLA:

Zargaran, David, et al. "Complications of Cosmetic Botulinum Toxin A Injections to the Upper Face: A Systematic Review and Meta-Analysis." Aesthetic Surgery Journal 42.5 (2022): NP327-NP336.

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