Between tradition and evidence in Orofacial Harmonization: Post-application care of Botulinum Toxin
DOI:
https://doi.org/10.33448/rsd-v14i11.50190Keywords:
Botulinum Toxin A, Myths, Guidance, Postoperative Care.Abstract
Objective: To critically analyze the recommendations and post-application care for botulinum toxin type A, differentiating scientifically based guidelines from empirical practices still present in clinical practice, in order to promote safer, more effective, and evidence-based management. Methodology: A literature review was conducted to gather and evaluate scientific publications related to post-application guidelines for botulinum toxin type A. The search was conducted in PubMed, SciELO, Medline, and LILACS, using the descriptors "Botulinum Toxin A," "Myths," "Guidance," and "Postoperative Care." Articles in Portuguese, English, and Spanish that addressed recommendations after the use of the toxin were included. Duplicates and texts without full access were excluded. Results and Discussion: The analysis revealed that several widely disseminated recommendations, such as avoiding lying down for four hours, not exercising, or not touching the treated area, lack consistent scientific support. Many of them derive from empirical practices perpetuated without proof. Conversely, guidelines such as avoiding excessive manipulation of the area and informing the patient about possible adverse effects are partially supported. It was observed that excessive unfounded recommendations can generate insecurity and compromise the professional-patient relationship, highlighting the importance of evidence-based guidelines. Conclusion: It is concluded that most post-botulinum toxin recommendations lack scientific proof. Therefore, it is essential to adopt evidence-based practices, dispel myths, and strengthen communication with patients, aiming for a more rational, safe, and individualized clinical practice.
References
Alam, M.; Geisler, A.; Warycha, M. et al (2019). Effect of postinjection facial exercise on time of onset of botulinum toxin for glabella and forehead wrinkles: A randomized, controlled, crossover clinical trial. J Am Acad Dermatol, 80(4), 1144-1147.
Bennek, M.; Rudowitz, D. & Kerscher, M. (2025). Diffusion Characteristics of LetibotulinumtoxinA, OnabotulinumtoxinA, and AbobotulinumtoxinA and its Impact on Muscle Relaxation: A Randomized Split-Face Clinical Trial. Dermatol Ther (Heidelb), 15(6), 2147–2158.
Carruthers, A.; Carruthers, J. & Cohen, J. (2003). A prospective, double-blind, randomized, parallel- group, dose-ranging study of botulinum toxin type a in female subjects with horizontal forehead rhytides. Dermatol Surg, 29(5),461-467.
Choi, S.Y.; Koh, Y. G.; Lee, Y. W. et al (2024). A multicenter, double-blind, randomized, parallel-group, active-controlled, phase 3 clinical trial to compare the effectiveness and safety of two botulinum toxin type A formulations for improving moderate to severe glabellar wrinkles in Asians. J Dermatolog Treat, 35(1), 2359511.
Curi, P.; Quintino, J.V.S.; Golin, I.Z. et al (2024). Fatores de risco para infecções pós-aplicação de toxina botulínica. Revista Ibero-Americana De Humanidades, Ciências E Educação, 10(5), 802–812.
Goodman, G. J.; Liew, S.; Callan, P. & Hart, S. (2020). Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes. Australas. J. Dermatol, 61, 217–225.
Hallett, M. (2015). Explanation of timing of botulinum neurotoxin effects, onset and duration, and clinical ways of influencing them. Toxicon, 107 (8), 64–67.
Li, Y. et al (2024). “Does Linear or Spot Injection Technique Matter in Upper Face Botulinum Toxin Type A Application? A Split-Face Randomized Trial.” Plastic and reconstructive surgery, 154(4), 656e-665e.
Liu, A.; Carruthers, A.; Cohen, J. L. et al (2012). Recommendations and current practices for the reconstitution and storage of botulinum toxin type A. J. Am. Acad. Dermatol, 67 (5), 373–8.
Meretsky, C.R.; Umali, J.P. & Schiuma, A.T. (2024). A Systematic Review and Comparative Analysis of Botox Treatment in Aesthetic and Therapeutic Applications: Advantages, Disadvantages, and Patient Outcomes. Cureus, 16(8), e67961.
Patel, S. (2018). Post-treatment advice following botulinum toxin injections: a review. Journal of Aesthetic Nursing, 7(5), 240-246.
Pellett, S.; Tepp, W.H.; Whitemarsh, R.C. et al (2015). In vivo onset and duration of action varies for botulinum neurotoxin A subtypes 1-5. Toxicon, 107, 37–42.
Pereira, A. S., Shitsuka, D. M., Parreira, F. J. & Shitsuka, R. (2018). Metodologia da Pesquisa Científica. Santa Maria: Editora da UFSM.
Pickett, A. (2019). Continuing Myths About Botulinum Toxin Use in Aesthetics Are Unhelpful and Unnecessary. Aesthetic Surg. J, 39(4), NP150–NP151.
Rother, E. T. (2007). Revisão sistemática x revisão narrativa. Acta Paulista de Enfermagem. 20(2), 5-6.
Santorelli, A.; Salti, G.; Cavallini, M. et al (2025). Are Post-Care Recommendations Following Upper-Face Botulinum Toxin Treatment Scientifically Necessary? A Retrospective Study Based on 5000 Patients. Toxins (Basel), 17(8), 372.
Sapra, P.; Demay, S.; Sapra, S. et al (2017). A Single-blind, Split-face, Randomized, Pilot Study Comparing the Effects of Intradermal and Intramuscular Injection of Two Commercially Available Botulinum Toxin A Formulas to Reduce Signs of Facial Aging. J Clin Aesthet Dermatol, 10(2), 34-44.
Shin, D. M; Lee, J.; Noh, H. et al (2022). A Double-Blind, Split-Face, Randomized Study on the Effects and Safety of Intradermal Injection of Botulinum Toxin A (Incobotulinum Toxin A) in the Cheek. Ann Dermatol, 34(6), 442-450.
Sundaram, H.; Signorini, M.; Liew, S. et al (2016). Global Aesthetics Consensus: Botulinum Toxin Type A--Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications. Plast Reconstr Surg, 137(3), 518e–529e.
Whitcup, S. M. (2021). The History of Botulinum Toxins in Medicine: A Thousand Year Journey. Handb. Exp. Pharmacol, 263 (5), 3–10.
Woodward, J (2016). Review of periorbital and upper face: pertinent anatomy, aging, injection techniques, prevention, and management of complications of facial fillers. J. Drugs Dermatol, 15(4), 1524–31.
Yeilding, R. H. & Fezza, J. P (2015). A Prospective, Split-Face, Randomized, Double-Blind Study Comparing OnabotulinumtoxinA to IncobotulinumtoxinA for Upper Face Wrinkles. Plast Reconstr Surg, 135(5), 1328-1335.
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Copyright (c) 2025 João Victor Pessoa da Silva Lins, Sophie Barbosa de Farias Gama, Joyce da Silva, Anderson de Oliveira Rocha, Sidney Acioly de Albuquerque Costa, Caroline Carnaúba Peixoto Rosário, Renata Elteque Lima de Oliveira Pereira
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