Title	Combining Botulism Toxin Pre-Treatment with Laser Therapy Improves Skin Aging
Clinical Question	In a patient with skin aging, does botulism toxin therapy combined with laser resurfacing as compared to laser resurfacing alone, result in a decrease in skin wrinkles?
Clinical Bottom Line	Two randomized controlled trials have shown improved reduction in skin wrinkles when laser therapy is combined with botulism toxin injections than when laser therapy is used alone.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 15545098 Yamauchi/2004 33 female patients with bilateral, symmetrical periorbital rhytids Randomized Controlled Trial Key results This study examined 33 female patients with bilateral, symmetrical periorbital rhytids. The patients were randomized to receive Botox injections on one side of the face and saline on the other side of the face. Both sides of the face were then treated with Erbium:YAG laser resurfacing at 2-6 weeks post injection. A second injection of Botox and saline was given at week 12. Facial wrinkles were then graded by a professional on a scale of 0 - 3 (0 = none, 1 = mild, 2 = moderate, 3 = severe). Although laser resurfacing alone did improve the rhytids, the side of the face that also received Botox showed even greater improvement. This is true when the face was at rest and during maximum contraction (with a greater improvement during maximum contraction). 11497500 Zimbler/2001 10 females with facial skin aging Randomized Control Trial Key results This study examined 10 female patients with facial skin aging. All 10 patients received botulism toxin injections at specific anatomic sites and no injections at other sites. One week later all sites (those receiving botulism toxin and those not) were treated by laser therapy. Patients were then evaluated by an in person observer and via photographs by a panel of 3 expert judges. The sites receiving both botulism toxin injections and laser therapy showed statistically significant improvement (P≤0.05) over the sites receiving laser therapy alone.
Evidence Search	(("Botulinum Toxins, Type A"[Majr]) AND "Laser Therapy"[Mesh]) AND "Skin Aging"[Majr]
Comments on The Evidence	The studies listed represent a strong level of evidence. The sample size of each randomized controlled trial is small, however, so to reach a more conclusive result, more studies with larger sample size should be completed.
Applicability	These studies are applicable to the patient experiencing skin aging in the facial region. Many patients present with this chef compliant and oral surgeons can use this evidence to help treat their patients.
Specialty	(Oral Surgery) (Dental Hygiene)
Keywords	Botox, botulism toxin, laser resurfacing, skin aging, rhytides
ID#	2373
Date of submission	03/07/2013
E-mail	lloydts@livemail.uthscsa.edu
Author	Thomas Lloyd
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Gregory Spackman, DDS, MBA
Faculty mentor e-mail	SPACKMAN@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available