ArticleAesthetic plastic surgery2026
The Impact of Dosage and Injection Site on Type A Botulinum Toxin Treatment for Oral Commissure Ptosis: A Prospective Study.
Article in Aesthetic plastic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveBotulinum toxin type A (BTX-A) is a simple and effective method for treating drooping mouth corners. However, the effective dosage and injection sites remain controversial. The authors propose a triangular three-point injection technique and compare the effects of different dosages tailored to varying severity levels of drooping mouth corners.
methodsBefore the start of this prospective self-controlled study, subjects with drooping mouth corners received two treatment methods. First, participants received a single-point injection of 3 U of BTX-A per side. Four months later, an individualized approach was adopted, with 3-15 U of BTX-A injected at three sites per side based on severity. Data were collected at baseline and at 4- and 12-week follow-ups.
resultsFifty-one subjects were enrolled. At 4 weeks after injection, both methods significantly improved drooping mouth corners, with the indicators returning to baseline levels by 12 weeks (P < 0.05). Based on clinical manifestations, subjects were categorized into mild, moderate, severe, and most severe cases, receiving 3 U, 6/9 U, 9/12 U, and 12/15 U per side, respectively. The results showed that 3 U/side for mild cases, 6 U/side for moderate cases, and 12 U/side for severe cases were the safest and most effective dosages, while most severe cases still did not achieve satisfactory results even at 15 U/side. Overall, at 4 weeks post-treatment, the reduction in the vertical distance from the mouth corner to the pupillary line and the angle of drooping were significantly greater with the triangular three-point injection technique compared to the single-point injection (P ≤ 0.05). No adverse events were observed in any subjects.
conclusionIt is necessary to increase the injection dosage according to the severity of drooping mouth corners. The new triangular three-point injection technique is safe and demonstrates favorable clinical outcomes. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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