A new study published in Plastic and Reconstructive Surgery suggests that patients living in sunnier climates may require higher doses of botulinum toxin A (Botox) for effective cosmetic treatment of facial lines and wrinkles.
In the study, researchers compared outcomes of Botox treatments in two groups: 292 women in Malta (high-sun exposure) and 231 women in London, U.K. (low-sun exposure). The study focused on injections into the glabellar muscles of the lower forehead, with patients receiving additional “top-up” doses as needed to achieve full clinical paralysis.
Results showed that patients in the high-sun group required significantly higher average total doses of Botox (29.2 units vs. 27.3 units) and higher average top-up doses (2.24 units vs. 1.98 units) compared to the low-sun group. These differences remained significant after adjusting for age and other factors, the researchers noted.
Lead author Dr. Kim L. Borsky from Stoke Mandeville Hospital in the U.K., reported that the increased dose requirements in sunny climates may be due to greater development and functional activation of glabellar muscles, which are primarily involved in squinting. Other potential factors include the effects of higher temperatures or direct sunlight on Botox efficacy.
The study included 523 women aged 35 to 60 years undergoing glabellar botulinum toxin treatment between 2012 and 2019. Treatments were performed by experienced clinicians following standardized procedures. Exclusion criteria included smokers, non-compliance with post-treatment advice, and concurrent illnesses.
While the observed dose differences may not significantly impact treatment costs, the findings have implications for clinical practice. “Rigid protocols about doses and distributions may lead to undertreatment if applied in sunnier climates,” Dr. Borsky notes. “Treatment protocols may need to account for the climate in which treatments are being undertaken to achieve more predictable results.”
This research highlights the importance of considering environmental factors in cosmetic procedures and the need for personalized treatment approaches in aesthetic medicine.
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