Preliminary Report on an Objective, Fast, and Reproducible Method to Measure the Effectiveness of Botulinum Toxin Type A

Aesthet Surg J. 2015 Aug;35(6):715-20. doi: 10.1093/asj/sju104. Epub 2015 May 12.


Background: The injection of botulinum toxin type A for cosmetic proposes is a popular procedure, although the interpretation of its effectiveness still poses a challenge. In fact, although the methods that evaluate the efficacy of the treatment are validated and reliable, they are usually based on subjective scales, while an objective and quantitative scale is still needed.

Objectives: I propose an objective, fast, and reproducible method to evaluate the severity of wrinkles with a three-dimensional imaging and texture analysis.

Methods: Digital Analysis of the Cutaneous Surface (DACS) is employed to analyze cutaneous texture. Measures are performed in the glabellar area before and one month after infiltration of 15 units of onabotulinumtoxin-A.

Results: Eight women were included in this study. DACS was able to detect improvements in all cases. On average, static lines decreased by 12.4% and dynamic lines by 41.2%.

Conclusions: DACS provides an objective, direct, fast, and reproducible method to measure the results of botulinum toxin type A usage. It avoids the use of subjective scores, gives a direct measure of the wrinkles, is simple to perform, and allows the operator to analyze only the desired area.

Level of evidence: 4 Therapeutic.

MeSH terms

  • Acetylcholine Release Inhibitors / administration & dosage*
  • Adult
  • Age Factors
  • Aged
  • Algorithms
  • Botulinum Toxins, Type A / administration & dosage*
  • Cosmetic Techniques*
  • Esthetics
  • Female
  • Humans
  • Image Interpretation, Computer-Assisted / methods*
  • Injections
  • Middle Aged
  • Predictive Value of Tests
  • Rejuvenation*
  • Reproducibility of Results
  • Skin Aging / drug effects*
  • Time Factors
  • Treatment Outcome


  • Acetylcholine Release Inhibitors
  • Botulinum Toxins, Type A