ReviewAesthetic plastic surgery2026
Botulinum Toxin Vascular Effectiveness: Low or High Doses?
Review in Aesthetic plastic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Managing Nasal Ischemia and Necrosis Post-Triamcinolone Injection: A New Case Series.Case reports in otolaryngology · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionBotulinum toxin (BoNT) is increasingly recognized for vascular effects beyond its established neuromuscular use. Evidence indicates a dose-dependent mechanism in which BoNT either promotes vasodilation and perfusion or inhibits cholinergic vasodilatory activity, making it relevant for ischemic, vasospastic, and inflammatory conditions. This review evaluates current data on the dose-dependent vascular actions of BoNT and outlines its therapeutic relevance in aesthetic and reconstructive medicine. MATERIALS AND
methodsA narrative review was performed using PubMed, MEDLINE, Embase, and Google Scholar, focusing on studies published from 2000 to 2025. Search terms combined "botulinum toxin" with "vasodilation," "ischemia," "flap survival," "angiogenesis," and related concepts. Eligible publications included clinical trials, animal studies, in vitro models, and systematic reviews assessing vascular outcomes after BoNT exposure. Of 163 records identified, 57 met inclusion criteria and were analyzed.
resultsBoNT demonstrates dual vascular mechanisms. At higher doses, it enhances perfusion and promotes angiogenesis through vascular endothelial growth factor and nitric oxide pathways, supporting applications in ischemic flaps and Raynaud's phenomenon. At lower doses, it reduces excessive cholinergic vasodilation and neurogenic inflammation, offering benefits in conditions such as rosacea and hyperhidrosis. These effects are dose-dependent and tissue-specific, with variability across experimental models. Concentrations above 20 IU/ml may be considered high-dose, whereas lower levels represent low-dose BoNT.
conclusionBoNT exhibits versatile vascular activity. Higher doses support vascular regeneration and angiogenesis, while lower doses modulate hyperreactive vascular responses. Further research is needed to clarify mechanisms, refine dose-response guidelines, and assess long-term safety across clinical indications to optimize its vascular applications. LEVEL OF EVIDENCE V: 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.
Indexed as
Identifiers
41661263What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.