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A Comprehensive Review of Patient-Reported Satisfaction with Botulinum Toxin Type A for Aesthetic Procedures

Fagien, Steven M.D.; Carruthers, Jean D.A. M.D.

Plastic and Reconstructive Surgery: December 2008 - Volume 122 - Issue 6 - p 1915-1925
doi: 10.1097/PRS.0b013e31818dbfe3

Background: The success of any medical procedure can be measured in many ways. Patient-reported outcomes, specifically those related to the patient's personal satisfaction, are among the most important measures of success in aesthetic treatments. This analysis assessed satisfaction with botulinum toxin type A treatment in aesthetic indications and identified approaches to help optimize clinical outcomes.

Methods: For this comprehensive, evidence-based review, electronic databases were searched for clinical trials, meta-analyses, or randomized controlled trials examining patient satisfaction following botulinum toxin type A aesthetic treatments. Reference lists and meeting/conference abstracts were also inspected to ensure capture of relevant literature. Inclusion and exclusion criteria were established a priori. Twenty-three articles met all inclusion criteria and were analyzed in detail.

Results: Studies were highly heterogeneous in the methods used to assess satisfaction. Most utilized Likert-type scales and included other patient-reported outcomes as well as satisfaction. The majority were done in the glabellar area. Nevertheless, patient satisfaction with botulinum toxin type A treatment was consistently and significantly high, typically ranging from more than 65 percent to more than 90 percent, depending on facial area treated, dose, assessment, and other treatment specifics. Treatment also significantly improved patient self-perceptions and reduced perceived age relative to current age by approximately 5 years. Preliminary data suggest that patient satisfaction may improve when botulinum toxin type A is combined with other treatment modalities and when multiple areas of the face, rather than a single area, are treated.

Conclusions: Regardless of facial area studied or the specific assessment scale, patient satisfaction with botulinum toxin type A treatment is consistently high, and patient-reported outcomes indicate significant improvement.

Boca Raton, Fla.; and Vancouver, British Columbia, Canada

From the Aesthetic Eyelid Plastic Surgery Private Practice and the Department of Ophthalmology, University of British Columbia.

Received for publication January 28, 2008; accepted May 6, 2008.

Disclosure:Both authors are consultants and advisors to Allergan, Inc., and Medicis Aesthetics, Inc.

Steven Fagien, M.D., 660 Glades Road, Suite 210, Boca Raton, Fla. 33431,

©2008American Society of Plastic Surgeons