ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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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 (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15545098Yamauchi/200433 female patients with bilateral, symmetrical periorbital rhytidsRandomized Controlled Trial
Key resultsThis 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).
#2) 11497500Zimbler/200110 females with facial skin agingRandomized Control Trial
Key resultsThis 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/Discipline (Oral Surgery)
Keywords Botox, botulism toxin, laser resurfacing, skin aging, rhytides
ID# 2373
Date of submission: 03/07/2013spacer
E-mail lloydts@livemail.uthscsa.edu
Author Thomas Lloyd
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Gregory Spackman, DDS, MBA
Faculty mentor/Co-author e-mail SPACKMAN@uthscsa.edu
Basic Science Rationale
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