Majority of recipients quantify their perceptions - when asked the right way

August 1, 2007

A review of six studies of Botox treatments for upper facial lines shows patients believe they look an average of five years younger post-treatment. Asking patients how they think they look in comparison to their age can help clinicians establish realistic patient expectations and track results reliably over time.

Vancouver, British Columbia - Data from six studies of botulinum toxin A (Botox, Allergan Medical) treatments for upper facial rhytides show that many patients say the treatments make them look an average of five years younger, according to a recent review.

"This is one of many studies where we are looking at one of the most important aspects about patient acceptance of cosmetic treatments - how it looks to them rather than how it looks to us," says Alastair Carruthers, M.D., clinical professor of dermatology and skin science at the University of British Columbia and lead author of the study.

Traditionally, physicians have assessed results by grading parameters such as a patient's ability to frown, he tells Dermatology Times.

However, he says the above methods of evaluation fail to address the real reasons that patients return for cosmetic treatments. One important reason is because such treatments make them feel they look younger, he says. The other reason is "they feel they look less grumpy or stressed" after treatment, Dr. Carruthers says.

Simple questions, straight answers

Dr. Carruthers says the new study addresses both of these reasons through "a couple simple questions: 'Do you think you look younger or older than your current age?' and "How many years younger or older?"

Specifically, researchers analyzed data of 295 patients from six clinical studies treated once with botulinum toxin A or placebo - three for glabellar rhytides, one for crow's feet and two for multiple upper facial rhytides (glabella, crow's feet and forehead).

Among a total of 116 patients treated with 20 units for glabellar lines, 47 (40.5 percent) reported looking younger, while two patients reported looking older post-treatment. Similarly, 44.8 percent of 29 patients treated with 12 units for crow's feet reported looking younger, while 62.5 percent of 40 patients treated with 64 units for multiple upper facial lines reported looking younger.

"If one treats multiple areas," Dr. Carruthers observes, "individuals are more likely to think that they look younger. We showed that pretty conclusively."

Conversely, only 22 percent of 110 patients given placebo injections reported looking younger four weeks post-treatment. Among all patients who reported looking younger at this point, the mean number of years younger was 5.3.

Beauty of getting 'carded'

In one of the Canadian studies included in the review, Dr. Carruthers and his co-authors asked patients if they'd been required to show identification during the period of the study, Dr. Carruthers adds.

"Of the 60 females in that study," he says, "more than 10 of them had been asked for ID because someone didn't believe their age. That makes women feel really good."

Because the review combines results from different studies, Dr. Carruthers cautions, "There's always a hesitation to compare results from one study to another, even though it's such a simple question."

Nevertheless, quantifying the chronologic impact of botulinum toxin A treatments can help physicians establish appropriate expectations for patients who seek these treatments for upper facial lines, Dr. Carruthers says.

Additionally, Dr. Carruthers says patients rarely express their own assessments of treatment effects in statements such as "My wrinkles got better."

Rather, he says, "They say things like, 'I live in a different world.' What they mean is that if they're squinting in bright sunlight, for example, people no longer cross the street" to avoid them because they appear grumpy, Dr. Carruthers explains.

"Once one gets rid of the frown," he adds, "then people see the smile, and they smile back."