Skin Tightening Research Articles

Subcutaneous Application of a Gelatin/Hyaluronic Acid Hydrogel Induces the Production of Skin Extracellular Matrix.

The development of injectable hydrogels with natural biopolymers such as gelatin (Ge) and hyaluronic acid (Ha) is widely performed due to their biocompatibility and biodegradability. The combination of both polymers crosslinked with N-Ethyl-N'-(3-dimethyl aminopropyl) carbodiimide hydrochloride (EDC) can be used as an innovative dermal filler that stimulates fibroblast activity and increases skin elasticity and tightness. Thus, crosslinked Ge/Ha hydrogels with different concentrations of EDC were administered subcutaneously to test their efficacy in young and old rats. At higher EDC concentrations, the viscosity decreases while the particle size of the hydrogels increases. At all concentrations of EDC, amino and carboxyl groups are present. The histological analysis shows an acute inflammatory response, which disappears seven days after application. At one and three months post-treatment, no remains of the hydrogels are found, and the number of fibroblasts increases in all groups in comparison with the control. In addition, the elastic modulus of the skin increases after three months of treatment. Because EDC-crosslinked Ge/Ha hydrogels are biocompatible and induce increased skin tension, fibroblast proliferation, and de novo extracellular matrix production, we propose their use as a treatment to attenuate wrinkles and expression lines.

Exploring facial overfilled syndrome from the perspective of anatomy and the mismatched delivery of fillers.

Facial fillers and injectables have transformed the landscape of cosmetic procedures, offering rejuvenation possibilities. However, the emergence of "Facial Overfilled Syndrome (FOS)" presents a concerning trend attributed to excessive filler use and suboptimal injection techniques. Understanding the interplay between facial aging and augmentation techniques is crucial in addressing and preventing FOS. Facial overfilled syndrome is characterized by the excessive use of fillers, resulting in a distorted and heavy appearance. It manifests in various forms, including 'flowerhorn' foreheads, 'sunset' eyes, 'chipmunk' cheeks, 'witch' chins, and 'pillow' faces. The syndrome arises from attempts to combat anatomical aging with dramatic filler treatments, causing rapid volume changes and skin tightening. Skeletal structures and soft tissue distribution across different ethnicities play a significant role in FOS development. Understanding the aging process across facial tissues is essential, as fillers cannot entirely reverse aging manifestations. Tailored assessment and treatment plans should precede filler injections, involving muscle assessment, observation of facial movements during injection, and ultrasound imaging of fat layers. Attention should be given to filler pressure and migration risks, particularly in areas with elevated pressure. Additionally, alternative approaches like energy-based devices and polymer reinforcement of facial ligaments should be considered to minimize filler use. Ethnic variations in facial anatomy require careful consideration to avoid overcorrection. FOS predominantly affects individuals of East Asian descent due to specific facial characteristics. Prevention strategies involve minimizing filler use, addressing underlying bone changes, and considering ethnic and gender differences in facial anatomy. Recent MRI and ultrasound studies challenge the notion of filler breakdown, emphasizing the importance of filler selection and injection techniques. Education, individualized treatments, and a holistic understanding of facial anatomy are key to preventing and managing FOS and ensuring natural and harmonious facial aesthetics.

Unilateral Platysma Muscle Rupture as an Effect of Using a Hard Wooden Block for Facial Massage.

Facial massages are frequently performed to achieve a feeling of freshness, rejuvenation, skin tightening, and delayed onset of wrinkles. However, vigorous massages can induce unexpected symptoms. Here, we present a case of a woman who complained of an asymmetric facial appearance and a mass-like lesion following a long-term facial massage intervention. A facelift incision was performed. Platysma muscle rupture was observed intraoperatively, which was then repaired. To our knowledge, this is the first report of a vigorous facial massage-induced ipsilateral platysma rupture.

Evaluating the Efficacy of Continuous Water-Cooling 115-Watt 6.78-MHz Monopolar RF Therapy for Fine Wrinkle Reduction.

Cosmetic procedures using radiofrequency (RF) technology have garnered significant attention as noninvasive approaches to skin rejuvenation and wrinkle reduction. This study investigates the efficacy of RF therapy in enhancing skin texture, firmness, and appearance. By harnessing the 6.78-MHz "VolNewMer" RF device, skin aging concerns, particularly in terms of skin roughness, laxity, and wrinkles, can be treated. This study engaged a cohort of 50 participants seeking wrinkle reduction and skin-lifting treatments. Employing noninvasive methods, the efficacy of RF therapy was evaluated immediately posttreatment and 1-month posttreatment. Skin roughness was quantified using a computer-based analysis of standardized 3D scanner images, capturing uniform lighting and angles to ensure accurate measurements. Among the 45 participants who completed the study, significant improvements in skin roughness were observed. The average roughness (Ra) value decreased from 16.71 to 11.88 arbitrary units immediately posttreatment, signifying a 28.42% enhancement. At the 1-month follow-up, the Ra value further decreased to 12.33 arbitrary units, reflecting a sustained 26.23% improvement. However, 16 participants exhibited even greater improvements at 1 month than immediate. RF therapy's profound impact on skin tightening and rejuvenation is rooted in its ability to trigger immediate collagen contraction, bolstering skin elasticity. The dual-phase process of immediate and delayed skin improvement underscores the intricate interplay between thermal stimulation and collagen remodeling. Optimal energy levels and controlled endpoint monitoring ensure safe and effective RF treatments. The use of the VolNewMer device tips and sliding technique contributes to patient comfort and treatment precision.

Subjective evaluation of monopolar radiofrequency treatment by patients in aesthetic rejuvenation.

To assess the subjective experiences of patients following monopolar radiofrequency (RF) treatment for facial rejuvenation and anti-aging purposes. A study involving 50 female patients (aged 30-70years, Fitzpatrick skin type III and IV) who received a single session of RF treatment. Exclusion criteria comprised active infections, skin diseases, pregnancy, or history of recent anti-aging treatments. Thirty-four patients completed a 10-question questionnaire after 3months of treatment. Among the respondents, 82% expressed satisfaction with the RF treatment, reporting significant improvements primarily in the mid and lower face, and eyelids. Mainly, patients noted improvements in skin laxity (52.9%), skin texture (17.6%), and skin tone (11.7%). Notably, 73.5% noticed changes within 1-2months post-treatment, with the peak effect observed at 1-2months. Mild complications (swelling and erythema) were reported, usually resolving within a week. The mean pain score was 1.94 (±0.66), indicating mild to moderate discomfort. Monopolar RF devices, apply high-frequency electric currents generating heat, stimulating collagen production for skin tightening. This study's unique focus on detailed subjective patient experiences provides insights valuable in clinical settings, aiding clinicians in managing patient expectations and achieving optimal results. The satisfaction rates align with previous findings, emphasizing RF treatment's efficacy in addressing facial laxity, especially in the mid and lower face. Positive feedback extended beyond skin tightening, encompassing skin texture and tone improvements. While the study's observation period was 3months post-treatment, longer-term studies are warranted for comprehensive assessments. The study underscores the efficacy of monopolar RF device, as a non-invasive and effective anti-aging treatment. The findings contribute to diversifying the RF market, potentially aiding clinicians in optimizing patient care. Considering the growing complexity of patient demands and treatment responses, this study serves as a valuable reference for clinicians engaging in RF treatments.

Expansion of Renuvion Application to Areas Beyond the Submental Region: Review and Experience.

Minimally invasive and consistent skin redraping following liposuction remains an elusive goal. With the application of Renuvion (Apyx Medical, Clearwater, FL), helium induced cold atmospheric plasma provides coagulation, collagen contraction, and subsequent skin tightening, making this elusive goal attainable. The objective of this study is to evaluate energy settings, and the safety profile of Renuvion in an effort to achieve optimal cosmesis through the improvement of skin laxity. A retrospective review at a single site evaluated cases of Renuvion between March 2020 and May 2022. Energy settings, use of concomitant VASER (Solta Medical, Bothwell, WA) liposuction frequency, and adverse events were analyzed. In total, 180 patients were evaluated, of whom 135 (75%) underwent concomitant VASER liposuction. Renuvion was used on the abdomen (47.8%), thighs (45.6%), arms (27.2%), submental region (25%), hip rolls (21.2%), and back (19.4%). Among the entire cohort, there were a total of 24 (13.3%) complications. The complications consisted of 3 (12.5%) hematomas, 1 (4.2%) burn, 6 (25%) persistent skin laxity with 2 returned operating room (OR) treatments, 4 (16.7%) seromas, 9 (37.5%) postoperative lymphedema that self-resolved, and 1 (4.2%) self-limited neuralgia. There were no complications that required an immediate return to the OR. Renuvion utilization with or without VASER has a relatively high complication rate-with minor complications as the most common-relatively safe barring proper patient selection, which can be mitigated with proper patient selection.

Case Series: Therapeutic Combination of VoluDerm Radiofrequency Microneedling and Glycolic Acid Peel in Scaled-Up Concentrations

Abstract Background Glycolic acid (GA) is an α-hydroxy peeling agent that causes controlled removal of the epidermis, with or without the dermis. Studies have shown the ability of GA to stimulate fibroblast proliferation, induce collagen synthesis, and decrease collagen degradation. The VoluDerm radiofrequency microneedling (RFMN; Pollogen, Tel Aviv, Israel) utilizes an array of microelectrodes to penetrate the epidermis and deliver energy to the skin. The controlled fractional thermal injury promotes neocollagenesis in the correction of skin laxity and wrinkle reduction. It was theorized that GA and VoluDerm could synergistically boost collagen production in combined treatment. Objectives Safety and efficacy of the combination treatment were investigated in patients seeking corrections of the age-related skin deteriorations. Methods Seven female patients (aged 42-70 years, Fitzpatrick II-IV) with photo- and chrono-damaged skin received 5 treatments of VoluDerm followed by the GA peel at increasing 30% to 70% concentrations. Results Clinical photography taken 6 months after the treatment demonstrated improvement in elasticity, wrinkling, roughness, pigmentation, erythema, and pore size across the entire treated group. Efficacy quantified by the physician and patients per 1 to 5 Global Aesthetic Improvement Scale was average 4.3 and 4.5, respectively. The treatments were tolerated well without preprocedural anesthesia. Skin phenomena observed after GA application were suggestive of the acid passing to deeper layers. Conclusions A novel combination of VoluDerm RFMN and GA at increased concentrations provided safe and effective synergy in the treatment of aging facial skin. Visible results demonstrated skin tightening, reduction of rhytidids, and improvement of the skin texture which may be a result of the combination. Level of Evidence: 4

Histopathologic Examination Changes Observed as Mechanotransduction Following Focused and Radial Acoustic Wave Therapy

The author executed a series of self-biopsies following focused acoustic, and focused and radial acoustic wave therapy to examine the effectiveness of the two types of acoustic wave therapy and to identify and investigate mechanotransduction; the mechanism of action produced by acoustic wave therapy. A case of a 28-year-old patient’s acoustic wave therapy that improved a vascular malformation is reported as a successful example. The series of histopathologic examinations following acoustic wave therapy strongly suggest that mechanotransduction causes neither fatal damage nor critical degeneration of tissue, and rather create moderate changes; indicating that the treatment is safely effective. There are distinctive differences in histopathologic changes between the two types of acoustic waves; the combination of focused and radial acoustic wave therapy leads to a faster normalizing change with less infiltration of cells than that following only focused-acoustic wave therapy. Further research on the mechanism of acoustic wave therapy is awaited, and a clear elucidation of this mechanism will bring about widespread recognition of this modality as a promising treatment for skin tightening and rejuvenation.

Skin tightening effecacy and safety: high-intensity focused ultrasound alone or in combination with monopolar radiofreqeuncy treatment in Republic of Korea: retrospective clinical study

Skin tightening effecacy and safety: high-intensity focused ultrasound alone or in combination with monopolar radiofreqeuncy treatment in Republic of Korea: retrospective clinical study

Pilot Study of Microfocused Ultrasound, Incobotulinum Toxin, and Calcium Hydroxyapatite in Triple Therapy for Skin Tightening after Weight Loss

Pilot Study of Microfocused Ultrasound, Incobotulinum Toxin, and Calcium Hydroxyapatite in Triple Therapy for Skin Tightening after Weight Loss

Minimally Invasive 980 nm Laser-Assisted Lipolysis and Skin Tightening on Lower Eyelids of Asian Patients.

The present study aimed to evaluate the effectiveness of minimally invasive 980 nm laser-assisted lipolysis and skin tightening in lower eyelid blepharoplasty of Asian patients. Patients with mild and moderate degree of eyebags underwent 980 nm laser-assisted lipolysis via lower eyelid stab incision between December 2017 and December 2019. Evaluation criteria was reviewed by photographs taken preoperatively and 6 months postoperatively in accordance with guidelines of Global Aesthetic Improvement Scale, the patient's perspective from the questionnaire with the perception of reduction in eyebags size, the average perception of improvement in skin tightening, and the patient overall satisfaction, all with a score of 1 to 5 (5 being the most noticeable and very satisfied) and complications such as dyspigmentation, hematoma, prolonged edema, skin bump and thermal burn were documented as well. A total of 178 cases with 137 women and 41 men (age range from 23 to 50 years) were included. Total energy of 1200 J to 2000 J was delivered to both eyebags at 6 to 10 W. They were followed up for at least 6 months. A total of 166 patients (93.26%) revealed an improvement in Global Aesthetic Improvement Scale, with the 12 patients (6.74%) complaint no change 6 month postoperatively. Perception of improvement in eye bag protrusion scored 4.39 ± 0.59, improvement in skin tightening scored 4.42 ± 0.58 and the overall patient's satisfaction scored 4.59 ± 0.53. The patients' average recovered swelling from 4.35 ± 2.3 days. There were 5 patients (2.8%) with dyspigmentation, 3 patients (1.69%) with prolonged edema and 2 patients (1.12%) with skin bump and none of the patients had thermal burn. All of them resolve after 6 months of follow up. Patients with mild to moderate degree of eyebags who resist surgery are good candidates for laser-assisted lower eyelid blepharoplasty.

Cryolipolysis: A promising nonsurgical technique for localized fat reduction.

Cryolipolysis, also known as fat freezing, is a nonsurgical technique specialized for localized fat reduction. Utilizing targeted cold exposure to adipose tissue, cryolipolysis devices induce cellular apoptosis in adipocytes while sparing surrounding tissues, resulting in the selective disruption of fat cells and subsequent removal of damaged cells by macrophages. A reduction of the fat layer produces a noninvasive cosmetic benefit that provides an accessible alternative to liposuction. Objective and subjective measurements have demonstrated significant reduction in fat volume and high patient satisfaction rates. Cryolipolysis has been proven to be safe with minimal adverse effects. However, further research is needed to fully understand the mechanism of cryolipolysis and its efficacy in different treatment areas. This paper aims to provide a comprehensive overview of cryolipolysis, including its mechanism of action, indications, contraindications, adverse effects, results and outcomes, safety profile, and areas requiring further research. Our primary phase of literature review consisted of a PubMed search looking for all published literature around cryolipolysis. We employed a review approach that examined over 30 papers with the key search terms of "cryolipolysis," "fat-freezing," "cosmetic dermatology," "body contouring," "adverse effects," "adipocyte apoptosis," "Coolsculpting®," "cold panniculitis," and "localized fat reduction." We then analyzed each paper, extracting relevant information to gain a multidimensional understanding of cryolipolysis to provide a comprehensive review. Cryolipolysis, with its ability to target and reduce localized adipose tissue, has emerged as a promising nonsurgical technique in the field of body contouring. It offers patients a valuable option for achieving their desired fat reduction without the need for a lengthy recovery period or major surgery. Cryolipolysis has shown to reduce the number of adipocytes in the treated area, a phenomenon that can be objectively quantified through various means, including fat caliper measurements, ultrasound assessments, and 3D imaging, or subjectively observed through patient satisfaction rates, clinical observations, and investigator assessments. In addition to its effectiveness in reducing localized adipose tissue, cryolipolysis also holds potential in the area of skin tightening. Preliminary studies suggest that cryolipolysis may have a positive impact on skin elasticity and tightening. Further investigation of this mechanism is needed to provide a better understanding of its potential in achieving optimal cosmetic outcomes for patients. By combining the benefits of fat reduction and skin tightening, cryolipolysis has the potential to offer a comprehensive nonsurgical solution for body contouring.

Trifarotene Reduces Risk for Atrophic Acne Scars: Results from A Phase 4 Controlled Study.

Atrophic acne scarring often accompanies acne vulgaris. The efficacy of topical retinoids for treatment of acne is well documented; however, evidence for use in atrophic acne scars is limited. In this randomized, split-face, double-blind study, subjects (age: 17-34years, N = 121) with moderate-to-severe facial acne, with acne scars present, were treated with either trifarotene 50μg/g or vehicle once daily for 24weeks. Efficacy was assessed by absolute and percent change from baseline in atrophic acne scar counts, Scar Global assessment (SGA), and IGA success rates as well as acne lesion counts. At week 24, a statistically significantly greater reduction in the mean absolute change from baseline in the total atrophic scar count was noted in the trifarotene- vs vehicle-treated area (- 5.9 vs - 2.7; p < 0.0001) with differences between sides noted as early as week 2 (- 1.5 vs - 0.7; p = 0.0072). The SGA success rate was higher in the trifarotene side at week 12 (14.9% vs 5.0%, P < 0.05) and improved through week 24 (31.3% vs 8.1%, P < 0.001). Similarly, at week 24, the IGA success rate was higher with trifarotene (63.6% vs 31.3%, P < 0.0001) along with reductions in total (70% vs 45%) and inflammatory (76% vs 48%) lesion counts. The incidence of treatment-emergent adverse events was 5.8% (trifarotene) and 2.5% (vehicle); most common (> 1%) was skin tightness (1.7% vs 0.8%), and all events were mild to moderate in severity. Trifarotene was effective and well tolerated in treating moderate-to-severe facial acne and reducing atrophic acne scars, with reduction of total atrophic scar count as early as week 2. Clinicaltrials.gov NCT04856904.

Erasmus Syndrome: A Rare Case Report of Systemic Sclerosis with Silicosis and Progressive Massive Fibrosis

Erasmus Syndrome is a rare disorder that is characterized by the development of systemic sclerosis after significantly prolonged exposure to silica with or without silicosis. Systemic Sclerosis is a multisystem autoimmune disease with vascular changes, inflammation, and diffuse tissue fibrosis. We report a case of Erasmus syndrome in a 45-year-old male who worked in the marble industry. The patient presented with difficulty in breathing, skin tightening, joint pain, Raynaud’s phenomenon, microstomia, and progressive massive fibrosis. Keywords: Erasmus Syndrome, Systemic Sclerosis, Silicosis, Progressive Massive Fibrosis

P14 A rare adverse event of eosinophilic fasciitis secondary to immune checkpoint inhibitor therapy

P14 A rare adverse event of eosinophilic fasciitis secondary to immune checkpoint inhibitor therapy

Skin microbiome in patients with acne

In the past few years, our formulation of the role of Cutibacterium acnes in the pathophysiology of acne has undergone a paradigm shift. According to modern concepts, this disease is caused by not C. acnes hyperproliferation, but an imbalance between various phylotypes of this microorganism that develops due to changes in the skin microbiome composition.Antibiotics are medicines that are usually used to treat this disease. However, the need to use them for a long time, which causes skin dysbacteriosis, increasing resistance to antibiotics, as well as new understanding of the pathophysiology of acne encourage to change the direction of acne treatment. The use of topical benzoyl peroxide and antibiotic combination products not only improves the effectiveness of therapy, especially for inflammatory acne, but also prevents the development of antibiotic resistant pathogenic microflora. Benzoyl peroxide is a lipophilic substance that concentrates in the skin inside the sebaceous hair follicles, producing benzoic acid and reactive oxygen species. Benzoyl peroxide as an oxidizing agent can suppress the synthesis of proteins and nucleotides, activities of mitochondria in microorganisms through inhibiting their growth and reproduction. The combination of this component and antibiotics contributes to the synergy of their action, and effectively reduces inflammation and acne. As examples, we present the clinical case reports of a 20-year-old patient S., who complained of rashes on the facial skin at puberty, as well as an 18-year-old patient A. with rashes on her face. These cases showed that the topical drug was well tolerated, and the only undesirable side effect reported was a feeling of skin tightness.

A Study On Preparation And Evaluation Of Herbal Peel Off Face Mask

Skin care preparations are designed to exert local activity when applied over the skin mucous membrane, these skin preparations include gel, lotion, ointment, cream, peel off mask etc. Peel off mask is the type of dosage form which is gently applied onto the facial skin surface and is peeled off after a few minutes of its application. It is designed to address common skin concerns and tightening of skin, moisturizing and tan removal from the skin. Here we are formulating of Turmeric peel off face mask. Turmeric extract adds glow to the skin, treats acne, slows down skin ageing. Aloe vera gel helps to remove acne and moisturizing the skin and have soothing property. Excipients used in the formulation are PVA (polyvinyl alcohol), glycerin, gelatin citric acid. Different formulations were taken and evaluated for the various parameters like spreadability, pH, stability studies, peeling time etc. The formulation evaluated for the parameters stands in standard range.

The role of dermatocosmetics in the management of rosacea

Rosacea is a chronic inflammatory disease that affects the facial skin. This pathology is characterized by hyperaemia, erythema, telangiectasia and other manifestations. It is also accompanied by a group of unpleasant symptoms, such as burning sensations, itching, and skin tightness. The pathogenesis of the disease has not been sufficiently studied. But it is generally accepted that it is based on abnormalities in the immune system. In addition, excessive Demodex colonization and exposure to ultraviolet radiation may play a role in the development of rosacea. The incidence rate of rosacea worldwide reaches 5%. It is emphasized that some ethnicities face a greater risk of this disease than others. It is a very difficult task to treat rosacea for a specialist. The therapeutic approach differs in different forms of the disease. There is a wide range of treatments available for papulopustular rosacea, including systemic and topical medications and even physiotherapy. However, the therapy of erythematous rosacea mainly centres around the use of dermatocosmetic care. For patients with rosacea, it is important to choose products that, first of all, can effectively reduce skin redness and discomfort and will be well tolerated. A dermo-cosmetic composition has to have an anti-inflammatory effect and the ability to repair damaged skin. This article presents our own experience of using such drug in the monotherapy of erythematous rosacea and in the complex treatment of papulopustular disease. A significant effect had been achieved at 3–4 weeks of complex therapy in patients with papulopustular rosacea. We present a clinical case report of a 46-year-old patient N. as an example of the effectiveness of therapy.

Esophageal motility in systemic sclerosis before and after autologous hematopoietic cell transplantation.

Systemic sclerosis (SSc) is associated with esophageal dysmotility. Autologous hematopoietic cell transplantation (HCT) results in improvement of skin tightness and lung function. Whether esophageal motility improves after HCT is unknown. Esophageal motility was studied using high-resolution esophageal manometry in 21 SSc patients before and at multiple time points after autologous HCT. Median posttransplant follow-up was 2years (range, 6months to 5years). Prior to HCT, all 21 patients had abnormal motility-10 (48%) had unmeasurable and 11 (52%) had measurable peristalsis. Manometric diagnosis in the former 10 patients was "absent contractility" and in the latter 11 patients "ineffective esophageal motility (IEM)." After HCT, among the 10 patients with absent contractility, 9 continued to have absent contractility and one demonstrated weak measurable peristalsis. Of the 11 patients with IEM, 5 experienced SSc relapse, and 2 out of these 5 patients developed absent contractility. Among the 6 non-relapsed patients, 4 continued to have IEM, and 2 developed normal motility. HCT appears to have no beneficial effect on motility in patients with unmeasurable peristalsis. In patients with measurable peristalsis, HCT appears to stabilize and in some normalize motility, unless relapse occurs. Key Points • In patients with systemic sclerosis, esophageal dysmotility is a significant contributor to morbidity and so far, there has been no data describing the effects of hematopoietic cell transplantation on esophageal motility. • Our work demonstrated that in patients with systemic sclerosis and unmeasurable esophageal peristalsis prehematopoietic cell transplantation, there was no measurable beneficial effect of transplantation on esophageal motility. • In patients with systemic sclerosis and measurable peristalsis prehematopoietic cell transplantation, esophageal motility stabilized, except in relapsed patients.

Safety and tolerability of onabotulinumtoxinA in the treatment of upper facial lines from global registration studies in 5298 participants: A meta-analysis

Since its discovery as a facial aesthetic treatment >30years ago, onabotulinumtoxinA has received worldwide approval for dynamic upper facial line treatment. Meta-analysis examining the safety of onabotulinumtoxinA for treatment of glabellar lines (GL), crow's feet lines (CFL), and forehead lines (FHL). Participants (N= 5298) with moderate to severe GL, CFL, or FHL at maximum contraction received onabotulinumtoxinA or placebo in 1 of 18 registration studies (14 double-blind, placebo-controlled [DBPC]; 1 double-blind; 3 open-label). Adverse events (AEs) were analyzed by descriptive statistics and fixed-effects meta-analysis. In the overall double-blind placebo-controlled (DBPC) population, AEs were reported in 1443 (42.1%) and 486 (35.8%) participants in the onabotulinumtoxinA (n=3431) and placebo (n=1359) groups, respectively. Serious AEs were reported in 54 (1.6%) and 17 (1.3%) participants; 1 (spontaneous abortion) was considered possibly treatment related by the investigator. Using fixed-effects statistical meta-analysis, AEs of interest that were found to be statistically higher for onabotulinumtoxinA than placebo in the DBPC population were eyelid ptosis, eyelid sensory disorder, skin tightness, brow ptosis, eyelid edema, and facial pain (P≤.05). Retrospective, ad hoc analysis. This meta-analysis confirms the onabotulinumtoxinA safety profile for GL, CFL, and FHL treatment, with no new onabotulinumtoxinA-associated AEs.