Complications of Cosmetic Botulinum Toxin A Injections to the Upper Face: A Systematic Review and Meta-Analysis

Abstract

Background: Botulinum toxin A (BoNT-A) injections are a popular non-surgical procedure for facial rejuvenation with increasingly pervasive use. The increase in popularity and use is met with limited regulations potentially posing a significant risk to patient safety and public health. Aim: This study aims to assess the safety profile of cosmetic glabellar and forehead BoNT-A injections and further evaluates BoNT-A type on the complication rate. Methods: A systematic search of MEDLINE and EMBASE was performed for studies reporting complications after cosmetic BoNT-A injections glabellar or in the forehead region. A random effects meta-analysis was carried out to assess complication rate. Where there were sufficient Randomized-Controlled Trials (RCTs) a network meta-analysis was performed. Results: Of 556 identified articles, 24 were included in the final quantitative analysis with 4,268 BoNT-A injection sessions and 1,234 placebos. Frequently observed treatment-related complications in the BoNT-A intervention group included headache, local skin reactions and facial neuromuscular symptoms. Overall BoNT-A complication rate was 16%. The odds ratio of developing complications from Abobotulinum toxin injections compared to placebo was 1.62 [1.15, 2.27; p>0.05]. The odds ratio of developing complications from Onabotulinum toxin injections compared to placebo was 1.34 [0.52, 3.48; p>0.05]. In 30% of the studies the injectors were doctors, whilst in the remaining 70% the training status of practitioners was not reported. Conclusions: Cosmetic BoNT-A injections in the glabellar and forehead region appear to be safe and the majority of complications are mild and transient. Nevertheless, the literature demonstrates heterogeneous reporting of complications and a lack of consistency of the definition of treatment-related complications.

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Complications of Cosmetic Botulinum Toxin A Injections to the Upper Face: A Systematic Review and Meta-Analysis. David Zargaran, Florence Zoller, Alexander Zargaran, Eqram Rahman, Alexander Woollard, Tim Weyrich, Afshin Mosahebi. Aesthetic Surgery Journal, 42(5), pp. NP327–NP336, Oxford University Press, March 2022.David Zargaran, Florence Zoller, Alexander Zargararan, Eqram Rahman, Alexander Woollard, Tim Weyrich, and Afshin Mosahebi. Complications of cosmetic botulinum toxin A injections to the upper face: a systematic review and meta-analysis. Aesthetic Surgery Journal, 42(5):NP327–NP336, February 2022.Zargaran, D., Zoller, F., Zargararan, A., Rahman, E., Woollard, A., Weyrich, T., and Mosahebi, A. 2022. Complications of cosmetic botulinum toxin A injections to the upper face: a systematic review and meta-analysis. Aesthetic Surgery Journal 42, 5 (Feb.), NP327–NP336.D. Zargaran, F. Zoller, A. Zargararan, E. Rahman, A. Woollard, T. Weyrich, and A. Mosahebi, “Complications of cosmetic botulinum toxin A injections to the upper face: a systematic review and meta-analysis,” Aesthetic Surgery Journal, vol. 42, no. 5, pp. NP327–NP336, Feb. 2022. [Online]. Available: https://doi.org/10.1093/asj/sjac036 BibTeX Suppl. Material (90 KB)