Quality of life in subjects treated with botulinum toxin A for facial wrinkles at return to baseline appearance

Abstract

Objective: The cosmetic benefit of treatment with botulinum toxin A (BoNT-A) has been associated with an increased quality of life (QoL). This study investigated whether such improvements in QoL were maintained upon return to baseline appearance. Methods: Consecutive subjects receiving incobotulinumtoxinA treatment for facial wrinkles had their QoL assessed using the Schedule for the Evaluation of Individual Quality of Life Direct-Weighting (SEIQoL-DW) tool pre-treatment and once their appearance had returned to baseline. At each visit, subjects identified the five areas of their life of the greatest importance to them (‘cues’), weighted the areas as to their relative importance (cumulative score = 100), and rated their status in each area on a visual scale (from 0–100). The SEIQoL-DW index score was calculated as the sum of the weighted scores for each cue. At the return visit, QoL was scored on both the pre-treatment (old) cues and the new cues. Subjects also rated their overall QoL on a visual analogue scale (VAS) from 0–100 and satisfaction with their appearance of a scale of 0–10 at both visits. Results: Fifty subjects (median age 38.5 years; 92% female) with moderate to severe wrinkles to the glabella, forehead or crow's feet had their QoL assessed. Family, work, finance, relationships, and health were the five most frequently identified cues at both visits. Appearance was weighted the second most important cue (after family) when considering those identified by at least 10 subjects. QoL was significantly higher following a return to baseline appearance than pre-treatment according to the overall VAS score (old cues, P = 0.004; new cues, P = 0.0015), but no difference was apparent according to the SEIQoL-DW index (old cues, P = 0.7622; new cues, P = 0.9568). Satisfaction was significantly lower at the return visit than before treatment (P < 0.0001). Conclusion: There may be some longer lasting impact of BoNT-A treatment on QoL beyond the period of cosmetic benefit. The results strengthen the notion that satisfaction is not a surrogate for QoL and that the latter should be more routinely assessed in subjects undergoing this procedure.