BOTULINUM TOXIN FOR THE TREATMENT OF HYPERFUNCTIONAL LINES OF THE FACE

Objective: To determine the effectiveness of botulinum toxin injection s for the management of hyperfunctional facial lines in patients with dystonia. Design: Twenty-six patients were included in the study: 24 p atients had dystonic movement of the face as either a primary or secon dary component, and two patients were treated for purely hyperfunction al lines. Botulinum toxin type A was injected via a monopolar hollow-b ore Teflon-coated electromyography needle into the facial muscles asso ciated with the hyperfunctional lines. Doses were divided into 1.25- t o 10-U aliquots. Qualitative assessments by the patient and physician were made before injection and 2 to 3 weeks after injection. Patients: Twenty-six patients (two male and 24 female) with hyperfunctional lin es were included. The ages were from 32 to 84 years with an average ag e of 59 years. Twenty had dystonia, four had hemifacial spasm, and two had pure hyperfunction without neuromuscular disease. Results: All of the patients had an effect of toxin within the first 24 to 72 hours. All of the patients experienced benefit from the toxin injections with partial or total resolution of painful contractions or unsightly hype rfunctional lines and spasms. The effects of the injection lasted 3 to 6 months. No systemic side effects were noted. Adverse effects includ ed mild, temporary eyelid or lip weakness. Conclusion: Based on this i nitial pilot study, botulinum toxin may be an important new option for the treatment of patients with hyperfunctional facial lines.