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Botulinum toxin and muscle atrophy: A wanted or unwanted effect
Paul D. Durand MD
Rafael A. Couto MD
Raymond Isakov MD
Donald Yoo MD
Babak Azzizzadeh MD
Bahman Guyuron MD
James E. Zins MD
Cleveland Clinic Foundation
2015-03-15
Presenter: Paul D. Durand, MD
Affidavit:
I certify that this is the original work of my resident Paul Durand, MD.
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
While the facial rejuvenating effect of botulinum toxin type A (BtA) is well known and widespread, its use in body and facial contouring is less well accepted. We first describe its use for deliberate muscle volume reduction, and then document instances of unanticipated and undesirable muscle atrophy. Finally, we investigate the potential long-term adverse effects of BtA-induced muscle atrophy.
Although the use of BtA in the cosmetic patient has been extensively studied, there are several questions yet to be addressed. (1) Does prolonged BtA treatment increase its duration of action? (2) What is the mechanism of muscle atrophy and what is the cause of its reversibility once treatment has stopped? We proceed to examine how prolonged chemodenervation with BtA can increase its duration of effect and potentially contribute to muscle atrophy.
Instances of inadvertent BtA-induced atrophy are also described. Amongst these the "hourglass deformity" secondary to BtA treatment for migraine headaches and a patient with atrophy of multiple facial muscles from BtA injections for hemifacial spasm.
Numerous reports demonstrate that muscle atrophy after BtA treatment occurs and is both reversible and temporary, with current literature supporting the notion that repeated chemodenervation with BtA is likely responsible for both therapeutic and incidental temporary muscle atrophy. Furthermore, duration of response may be increased with subsequent treatments thus minimizing frequency of reinjection. Practitioners should be aware of the temporary and reversible effect of BtA-induced muscle atrophy and be prepared to reassure patients on this matter.
