From the Journals

Facial exercises hastened the effects of botulinum toxin in small study

 

Key clinical point: Recommending facial muscle exercises after botulinum toxin injections to the forehead is now evidence based.

Major finding: Posttreatment facial exercise after botulinum toxin injections reduced the appearance of forehead wrinkles one day earlier.

Study details: A randomized, crossover clinical trial of 22 women treated with botulinum toxin for dynamic rhytids of the forehead and glabella.

Disclosures: The study was supported by research funds from the department of dermatology at Northwestern University. The authors had no relevant disclosures.

Source: Alam M et al. J Am Acad Dermatol. 2018. doi: 10.1016/j.jaad.2018.10.013.


 

FROM THE JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

Performing facial muscle exercises after botulinum toxin injections to the forehead speeds up the clinical effects of the injections by 1 day, a small, randomized study has shown.

Dr. Murad Alam of Nothwestern University in Chicago

Dr. Murad Alam

The study addressed the lack of data regarding whether exercising treated muscles for several hours after injections helped “to enhance uptake” of botulinum toxin, said Murad Alam, MD, chief of cutaneous and aesthetic surgery and a professor of dermatology at Northwestern University, Chicago, and his coauthors.

“The results of this study suggest that a postinjection facial exercise regimen is a safe and effective method for achieving an earlier onset of clinical effect of botulinum toxin injections,” he and his coauthors concluded. The results were reported in the Journal of the American Academy of Dermatology.

The study enrolled 22 women, aged 27-66 years (mean age, 47 years) who received botulinum toxin injections for forehead and glabella dynamic rhytids. Following the injections, half of the women did the exercises for 4 hours and the other half avoided facial contractions for 4 hours. Exercises included raised motions of the forehead and scowls – such as knitting the brows – in three sets of 40 repetitions separated by 10 minutes, according to a Northwestern University press release. At 7 months, the women came back for treatment, and switched groups.

Two blinded dermatologists rated photos of forehead and glabella dynamic creases at baseline and on days 1,2,3,4,7, and 14 with the 5-point Carruthers’ Forehead Lines Grading Scale and the 4-point Gladys study group rating scale for glabellar frown lines. The women also assessed their own dynamic creases using a 7-point Subject Self-Evaluation Improvement Scale.

By day 3, ratings by dermatologists and patients of glabellar and forehead wrinkles were statistically significantly better for patients who had performed the exercises after the injections. When facial exercises followed the injections, women said they saw noticeable glabellar improvement by day 2 or 3, compared with day 3 or 4 among those who did not do facial exercises after the injections (P = .02).

“A significant advantage in the exercise group was detectable as early as day 3, at which point patients’ self-evaluation wrinkle scores increased by approximately twice as much in exercisers compared to non-exercisers,” the study authors noted.

But by 2 weeks, the effects of treatment were similar in both groups, and the effects of treatment lasted for a similar period of time with or without exercises.

“Expediting the time to noticeable benefit, even by one day, may be clinically significant for some patients,” the authors wrote. Exercises could be recommended only to those patients who need faster results “to avoid needless inconvenience,” they added.

The study was supported by research funds from the department of dermatology at Northwestern University. The authors had no relevant disclosures.

SOURCE: Alam M et al. J Am Acad Dermatol. 2018. doi: 10.1016/j.jaad.2018.10.013.

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