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Botulinum toxin type A effectively treated posterior cheek enlargement in HIV patients
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CHICAGO — Botulinum toxin type A was an effective and well-tolerated treatment for posterior cheek enlargement in HIV-positive patients, according to results of an ongoing study presented at the American Society for Dermatologic Surgery annual meeting.
Shannon Humphrey, MD, FRCPC, Carruthers Dermatology Centre, Vancouver, presented an ongoing proof-of-concept study of patients with HIV displaying prominent posterior cheek enlargement and concurrent HIV-associated facial lipoatrophy. Humphrey and colleagues currently are treating four patients and are working to recruit the fifth patient, she said.
A frequent complication of HIV is the altered contour of the lower face, and while botulinum toxin type A (BoNTa) has been shown to be safe and effective as a minimally invasive option for reducing the width and improving the lower face’s shape and jaw line, it has not been studied in the HIV setting, the researchers said. The study was designed “to characterize the anatomical changes contributing to posterior cheek enlargements in patients with HIV, and to explore treatment options with BoNTa.”
Four patients with HIV who exhibited significant posterior cheek enlargement were treated with 50U BoNTa per side, and were to be assessed at weeks 4, 8 and 12, and at 6 and 12 months. At baseline and at all follow-up visits, photographs were taken. Volumetric changes of the parotid gland and masseter muscle were measured by computed tomography (CT) at baseline and 12 weeks post-treatment.
At baseline, huge discrepancies in the volumes of parotid glands and masseter muscles in the patients existed, Humphrey said. It was unclear, however, whether patients’ baseline parotid gland and masseter muscle volumes were outside of the normal range.
No adverse events were reported, including xerostomia or changes in bite force. There was a significant reduction in the size of the parotid gland and masseter muscle (19% and 19.4%, mean reduction, respectively) at 12 weeks after BoNTa injection.
“In different patients, we were able to see variable percentages in improvement in reduction in both the parotid [gland] and masseter [muscle],” Humphrey said.
Humphrey displayed before and after photos showing results from two patients, whom she said “were really happy with the degree of improvement.”
“The preliminary interim results … do confirm that the relative contributions of parotid and masseter hypertrophy to posterior cheek enlargement are still not well characterized, but it probably varies from patient to patient,” Humphrey concluded. “Botulinum toxin A is a highly effective and minimally invasive option for these patients. It appears to be well tolerated and long lasting.”
Disclosure: Humphrey declared no relevant financial disclosures.
For more information:
Humphrey S. Treatment of Posterior Cheek Enlargement in HIV+ Patients with Botulinum Toxin Type A. Presented at: American Society for Dermatologic Surgery 2013 Annual Meeting; Oct 3-6, Chicago.