BACKGROUND The use of intradermal botulinum toxin A (onabotulinumtoxinA) remains a relatively
new technique and is an off-label cosmetic application for facial skin rejuvenation. There is little doc-
umented clinical evidence of the objective benefits of this therapy.
PURPOSE To determine whether intradermal facial onabotulinumtoxinA injection has any benefits.
STUDY DESIGN Interventional, comparative, split face clinical trial.
METHODS Informed consent was obtained from 10 physicians. One half of the physician’s faces were
randomly injected with onabotulinumtoxinA (2 U/0.1 mL; 30 facial injections on half of the face, each
0.1 mL) intradermally and the other half of the face with normal saline (30 facial injections on half of the
face, each 0.1 mL). The injecting clinician and the subjects were blinded to the contents of the syringes.
One and 4 weeks later, two neutral, blinded observers assessed the subjects in person. The patients were
also photographed in ambient light surroundings and the same observers compared the halves of their
faces in photographs and rated them on a scale of 4 to 1 4.
RESULTS Global improvement in skin texture and tightness was noted in the post-treatment photo-
graphs (the skin appeared to be tenser and smoother), although there was no difference between the two
groups and, hence, the changes could not be clinically ascribed to the intradermal botulinum toxin
injections. No other meaningful clinical difference could be demonstrated between the two sides of the
face, in any of the 10 subjects, in person or in photographs. The small study sample precluded formal
CONCLUSION Intradermal botulinum toxin A injection does not appear to have any benefit in facial
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Dr. Debraj Shome is Director and Co founder of The Esthetic Clinics. He has been rated amongst the top surgeons in India by multiple agencies. The Esthetic Clinics patients include many international and national celebrities who prefer to opt for facial cosmetic surgery and facial plastic surgery in Mumbai because The Esthetic Clinics has its headquarters there.