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Digital Image Speckle Correlation to Optimize Botulinum Toxin Type A Injection: A Prospective, Randomized, Crossover Trial

Verma, Richa M.D.; Klein, Gabriel M.D.; Xu, Yan Ph.D.; Rafailovich, Miriam Ph.D.; Gilbert Fernandez, Juan Jose M.D.; Khan, Sami U. M.D.; Bui, Duc T. M.D.; Dagum, Alexander B. M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1614-1618
doi: 10.1097/PRS.0000000000005637
Cosmetic: Original Articles

Background: Historically, physicians have relied on their subjective measures when determining the site and dosages for botulinum toxin type A injections. Digital image speckle correlation is a technology that tracks pore movement from rest to maximal exertion, allowing for the determination of the optimal sites of injection. In this prospective, randomized, crossover trial, the efficacy of using digital image speckle correlation was compared to physician assessment in choosing botulinum toxin type A injection sites.

Methods: Ten female patients were analyzed in this blinded crossover study. Subjects were randomized to either injections based on digital image speckle correlation analysis or injections based on the 2004 facial aesthetics consensus recommendations. All patients received 20 U of botulinum toxin type A in the glabellar region and were crossed over and reinjected after 6 months. Follow-up was completed with the Facial Line Outcomes 11-item survey and repeated imaging with digital image speckle correlation, to measure patient satisfaction and degree of paralysis, respectively. Statistical comparison was completed by means of matched sample t test.

Results: On average, the digital image speckle correlation analysis provided 4.8 injection sites, whereas the practitioner chose five injections sites. Patients receiving digital image–directed injections had higher rates of satisfaction on the Facial Line Outcomes instrument (p = 0.0003) and a larger degree of paralysis (p = 0.003). Furthermore, muscle function returned to normal later in patients injected with digital image speckle correlation (17.9 weeks versus 20 weeks; p = 0.03).

Conclusions: This study demonstrates the benefits of using digital image speckle correlation in determining optimal botulinum toxin type A injection location. Digital analysis allows practitioners to better treat facial rhytides by eliminating subjective decisions regarding dose and site of injection.


Stony Brook and East Meadow, N.Y.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Stony Brook University Hospital; the Department of Materials Science and Chemical Engineering, Stony Brook University; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Nassau University Medical Center.

Received for publication December 10, 2017; accepted October 17, 2018.

Presented in part at the Senior Resident’s Conference at Plastic Surgery The Meeting 2016, Annual Meeting of the American Society of Plastic Surgeons, in Los Angeles, California, September 23 through 27, 2016.

Disclosure:Drs. Rafailovich, Dagum, and Bui have a professional patent application for the method of using DISC for botulinum injections (R8348, filed with the U.S. Patent Office). The authors have no other financial disclosures to report.

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This work was supported by THE PLASTIC SURGERY FOUNDATION.

Alexander B. Dagum, M.D., Department of Surgery, Division of Plastic and Reconstructive Surgery, Stony Brook University Hospital, HSC T-19, Room 060, Stony Brook, N.Y. 11794-8191,

Copyright © 2019 by the American Society of Plastic Surgeons