The wrinkles soothing effect on the middle and lower face by intradermal injection of botulinum toxin type A

Int J Dermatol. 2008 Dec;47(12):1287-94. doi: 10.1111/j.1365-4632.2008.03895.x.


Background: Botulinum toxin type A (BTA) has been used on facial expressive muscles to reduce wrinkles. We assumed that intradermal injection with BTA on the middle and lower face can produce face-lifting and wrinkles-soothing effect by promoting collagen synthesis.

Methods: Nine volunteers were included to undergo intradermal injections of a total dose of 20~25 U BTA into one-half of the face, and normal saline into the other half as control. Clinical photographs were taken every 4 weeks for 16 weeks, and evaluated by a doctor blinded to the assignments. Patients graded the results of wrinkles elimination on each follow-up. Skin biopsies were taken before the treatment and 8 weeks after the injection. The specimens were assessed by a pathologist using hematoxylin and eosin stain, elastin stain, Masson trichrome stain and immunohistochemical stain with type I procollagen.

Results: By photographic documentation, there was no significant face-lifting effect. However, there was statistical significance in wrinkles reduction on the BTA sides compared to pre-treatment. Subjectively, six subjects noticed better wrinkles soothing effect on the BTA sides. This effect was noted as early as 4 weeks after injection, and lasted for a minimum 8 weeks. The histologic examination revealed slight neocollagen synthesis by Masson trichrome stain on both sides.

Conclusions: Based on this pilot study, the face-lifting effect of intradermal injection with BTA was not conclusive. Interestingly, BTA showed moderate but significant wrinkles-soothing effect without obvious side effects on the lower face.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Botulinum Toxins, Type A / administration & dosage*
  • Cosmetic Techniques
  • Double-Blind Method
  • Female
  • Humans
  • Injections, Intradermal
  • Male
  • Middle Aged
  • Neuromuscular Agents / administration & dosage*
  • Skin / cytology
  • Skin / drug effects
  • Skin Aging / drug effects*


  • Neuromuscular Agents
  • Botulinum Toxins, Type A