Self‐perception of natural outcome, appearance, and emotional well‐being after OnabotulinumtoxinA treatment for upper facial lines: Post hoc analysis across age and gender

Journal of Cosmetic Dermatology
Open Access

Clinical Summary

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What was studied

Post hoc analysis of two 12‑month phase 3 randomized, placebo‑controlled trials evaluating patient‑reported outcomes after onabotulinumtoxinA for upper facial lines (20 U forehead, 20 U glabellar, ±24 U crow’s feet) in 458 neurotoxin‑naive adults who achieved ≥2‑grade forehead line improvement at Day 30; results stratified for millennials and men.

Key findings

At Day 30, 90.5% overall (94.6% millennials; 85.7% men) were satisfied with a natural look, with rates >80% across 12 months; at Day 60, 89.8% overall (95.7% millennials; 83.3% men) were satisfied with treatment effect, and >90% reported results met expectations. Millennials had higher odds of satisfaction (natural look OR 3.30, 95% CI 1.30–8.41; effect OR 2.22, 1.14–4.33), men had lower odds of psychological benefit (Impact Domain OR 0.43, 0.23–0.80), and repeat treatments increased odds of psychological benefit (OR 1.41 and 1.57 vs first).

Study limitations

Responder‑only, post hoc analysis (included participants with ≥2‑grade forehead improvement) without an active comparator for PROs. Small male subgroup (n=43) with attrition by cycle 3, and a predominantly White, female sample limits generalizability.

Clinical implications

Among toxin‑naive adults who achieve a ≥2‑grade forehead line response on on‑label onabotulinumtoxinA dosing, most report natural‑looking results and high satisfaction for up to 12 months. Counsel that men may report less psychological benefit and that perceived appearance/emotional benefits may improve with repeat treatments.