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Surgical Technique |

Long-Term Effects of Botulinum Toxin Type A (Botox) on Facial Lines:  A Comparison in Identical Twins

William J. Binder, MD
Arch Facial Plast Surg. 2006;8(6):426-431. doi:10.1001/archfaci.8.6.426.
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Published online

Objective  To evaluate the presence of imprinted facial lines in identical twin sisters, one of whom had received botulinum toxin type A (Botox) treatment in the forehead and glabellar region regularly for 13 years and one of whom had not. Crow's feet were also compared.

Methods  One twin received Botox in the forehead and glabellar region (approximately 2 to 3 times each year over the past 13 years) and in the crow's feet (twice in past 2 years). Her twin received Botox only twice (in the forehead and glabellar region, 3 and 7 years ago).

Results  Imprinted forehead and glabellar lines were not evident in the regularly treated twin but were evident in the minimally treated twin. Crow's feet were less noticeable when the regularly treated twin smiled (even at 7 months after treatment) than when the minimally treated twin smiled. Untreated facial areas (eg, nasolabial folds) showed comparable aging in both twins. Neither twin experienced adverse effects.

Conclusions  Long-term treatment with Botox can prevent the development of imprinted facial lines that are visible at rest. Botox treatment can also reduce crow's feet. Treatment is well tolerated, with no adverse events reported during 13 years of regular treatment in this study.

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Figure 1.

Approximate sites of botulinum toxin type A (Botox; Allergan Inc, Irvine, Calif) injections in the forehead, glabellar, and crow's feet regions.

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Figure 2.

The minimally treated twin (A, B, and C) and the regularly treated twin (D, E, and F). Hyperfunctional lines in the forehead (B and E) and glabellar regions (C and F) are visible in the minimally treated twin but not in the regularly treated twin.

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Figure 3.

Oblique views of the forehead and glabellar lines that are visible in the minimally treated twin (A and B) but not in the regularly treated twin (C and D). The crow's feet are also shown at rest.

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Figure 4.

Crow's feet when smiling are more visible in the minimally treated twin (A and B) than in the regularly treated twin (C and D), even though the crow's feet of the regularly treated twin had been treated with botulinum toxin type A (Botox; Allergan Inc, Irvine, Calif) only twice in the last 2 years.

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