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Botulinum Toxin Type A: Evaluation of Onset and Satisfaction

Alouf, Erin, BBA, RN; Murphy, Tina, RN, BSN; Alouf, Gregory, MD

doi: 10.1097/PSN.0000000000000236
Departments: Aesthetics Department

With the increasing interest in nonsurgical cosmetic procedures, this research study sought to evaluate the onset of Botulinum toxin Type A (BoNTA) between naive and non-naive consumers and its effect on satisfaction. This single-blinded research study consisted of 15 adults with scheduled appointments for neurotoxin treatment of undesired glabellar lines. Participants completed pretreatment FACE-Q scales. Both the participant and the researcher rated pretreated glabellar lines with the Merz 5-point scale. Daily photographs of the treated area were taken by the participant and submitted to the researcher over a secure electronic system. Photographs were started on the treatment day and continued until both participant- and researcher-reported onset. The day of onset was determined with at least 1-point improvement when observed by both the participant and the researcher on the Merz 5-point scale. Once onset was determined, participants completed posttreatment FACE-Q scales. The average onset of treatment was 2.3 days. The average day of onset was 1.8 days in the naive group and 2.65 days in the non-naive group. Posttreatment, patients reported an average of 47.65% reduction in the appearance of glabellar lines; a 35.65% reduction was reported in the non-naive group, and a 59.67% reduction was reported in the naive group. The average participants perceived themselves 2.07 years younger prior to treatment and 6.47 years younger than their actual age posttreatment. On average, participants perceived themselves 4.4 years younger than at baseline. Both groups reported a high level of satisfaction with decision at an average of 85.73% and an average of 86.20% on satisfaction with outcome. The posttreatment FACE-Q expectation scores on average exceeded the pretreatment expectation scores by 8.25%; in the naive group, the scores were exceeded by 25.54%. The onset of BoNTA treatment in naive and non-naive participants demonstrated differences. The naive group experienced onset, on average, 1 day sooner than the non-naive group. The amount of time for a participant to see a noticeable difference influences patient satisfaction. Improvements in appearance and a reduction in the appraisal of age in relation to actual age enhanced satisfaction with treatment. Findings indicate that satisfaction is not solely based on onset, improvements in appearance, and reports of looking younger. The patient perception is also a key factor affecting satisfaction, which can be improved by setting clear expectations, improving patient communication, and encouraging follow-up assessments. The need for additional research on naive and non-naive patients demonstrating the influence of onset on satisfaction scores is crucial to confirm the evidence of this study.

Erin Alouf, BBA, RN, is Family Nurse Pracitioner graduate students at Simmons College School of Nursing and Health Sciences, Boston, MA.

Tina Murphy, RN, BSN, is Family Nurse Pracitioner graduate students at Simmons College School of Nursing and Health Sciences, Boston, MA.

Gregory Alouf, MD, is a Cosmetic Surgeon, Medical Director at Alouf Aesthetics in Salem, VA.

Address correspondence to Erin Alouf, BBA, RN, Simmons College School of Nursing and Health Sciences, 7425 Willow Leaf Drive, Roanoke, VA 24018. (e-mail:

The authors report no conflicts of interest.

Copyright © 2018 by American Society of Plastic Surgical Nurses