SAN FRANCISCO, March 3 -- A new case report comparing the appearance of facial lines in identical twins, one of whom received regular BOTOX^® Cosmetic (botulinum toxin type A) treatments over 13 years beginning at age 25 and one of whom did not, suggests that long-term, consistent treatment with BOTOX^® Cosmetic may prevent the development of lines that are visible without facial muscle contraction (the so-called "imprint" or "at rest" lines most associated with the aging process). The results are being presented at the American Academy of Dermatology's Annual Winter Meeting in San Francisco.(i)

"This report is exciting because for the first time we can assess wrinkle formation over time in identical twins with similar facial anatomies," said William J. Binder, M.D., F.A.C.S., the report's author. Dr. Binder is a facial plastic surgeon in Beverly Hills, CA and a pioneer in the use of BOTOX^® Cosmetic for the treatment of facial lines. Dr. Binder is also Associate Clinical Professor in the Department of Head and Neck Surgery at the UCLA School of Medicine and Attending Surgeon at Cedars Sinai Medical Center. "It is clear that the twin who received regular BOTOX^® Cosmetic treatments for a period of 13 years had no visible wrinkles at rest in her forehead or in the glabellar region between the brows. This makes sense since BOTOX^® Cosmetic prevents those repetitive muscle contractions which may aid in breaking down the dermal and epidermal tissue that cause imprint (or at-rest) lines to form."
Photographic documentation was used to compare the appearance of hyperfunctional facial lines at maximal contraction and at rest in 38-year-old twin sisters. One sister (the "treated" twin) had received BOTOX^® Cosmetic injections in the forehead and glabellar regions (the vertical "frown lines" between the brows) 2-3 times per year during a period of 13 years, beginning at age 25. In the last two years she had also received two BOTOX^® Cosmetic treatments in the crow's feet area. She was last treated more than four months before forehead, glabellar and crow's feet "at rest" photographs were taken. The "untreated" twin had received only two BOTOX^® Cosmetic treatments in the forehead and glabellar regions during the same 13-year period, the first administered seven years ago and the second administered three years ago.

Photographic documentation shows no visible forehead or glabellar lines at rest in the "treated" twin, while noticeable imprinted forehead and glabellar lines at rest are evident in the "untreated" twin. Crow's feet when smiling also are less visible in the "treated" twin.

The clinical effect of BOTOX^® Cosmetic in the "treated" twin was consistently sustained for at least six months per treatment. Furthermore, the duration of effect did not diminish with repeat treatments and the dosage remained stable throughout the 13-year treatment period. Neither twin experienced any adverse effects from treatment.

BOTOX^® Cosmetic has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of moderate to severe glabellar lines but not for the treatment of horizontal forehead lines or crow's feet.


This study was funded by an unrestricted grant from Allergan, Inc.

(i) Binder W. Lack of forehead and glabellar lines after long-term botulinum toxin type A treatment: a comparison of identical twins. Presented at the 64th annual meeting of the American Academy of Dermatology, March 3-7, 2006, San Francisco, CA. Poster #211