Efficacy and safety of botulinum toxin type A injections by multifocal and standard techniques in the treatment for facialwrinkles

Download in PDF

Widespread use of botulinum toxin therapy in aesthetic practice for the correction of facial wrinkles requires the development of new techniques of injections of botulinum toxin type A (BTA) and to improve traditional approaches.


To compare efficacy and safety of BTA injections by multifocal and standard technique in the treatment for forehead wrinkles.

Material and methods

We conducted a randomized, prospective, open-label clinical trial in 30 patents (aged 28 to 64 years) with forehead wrinkles who were randomly distributed into two groups (1:1) and treated with BTA injections by multifocal and standard techniques. For multifocal injections we used a lower dose of BTA (1 to 12 units) than for standard technique (5 to 15 units). The sites for injections were designated individually given the clinical pattern of forehead, glabella and the lateral angles of eyes muscle activity. The effect of treatment was evaluated using the Global Aesthetic Improvement Scale (GAIS), the wrinkle severity rating scale, the Patient’s Satisfaction Score (PSS), the Physician Satisfaction Score (PhSS) and the Definitive Graduated Score (DSS) at 3 weeks and 4 months after injections.


In both groups of patients who were treated using multifocal and standard technique, we showed a significant improvement in the GAIS score (2.5 vs 2.0 points), the wrinkle severity score (2.0 vs 1.5 points for forehead wrinkles, 2.5 vs 2.0 points for glabellar lines and 2.0 vs 1.0 points for thelateral angles of eyes). Multifocalinjectionswerenotassociatedwith anyadverseevents. However, three patients treated with standard technique developed side effects. At 3 weeks and 4 months, the DGS score was 18.0 and 17.0 points with multifocal injections and 17.2 and 16.5 points with standard technique, respectively.


Multifocal BTA injections for a management of forehead wrinkles, glabellar lines and the lateral angle of eyes lines were more effective and safe compared with the standard injections.