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

We read


Self-perception of natural outcome, appearance, and emotional well-being after Onabotulinum toxin a treatment for upper facial lines: Post hoc analysis across age and gender
To the editor, We read with interest your article entitled "Self-perception of natural outcome, appearance, and emotional well-being after OnabotulinumtoxinA treatment for upper facial lines: Post hoc analysis across age and gender".Considering patient factors is essential when planning collaborative treatment, especially in cosmetic surgery when patient engagement significantly contributes to perceived success and reasonable expectations. 1tient reported outcome measures are excellent indicators for standardized assessment of treatment satisfaction, and the results in the study regarding gender and age differences in perception of onabit-ulinumtoxinA are of use and generalizable for many aesthetic clinicians.
We suggest that another avenue for exploration should be differences in patient reported outcomes based on practitioner type.Research has demonstrated a high degree of variability in experience and role of practitioners delivering cosmetic injectables-a recent national cohort study found that only 32% of injectables were delivered by doctors. 2 Concerns about the safety of the cosmetic industry in the UK are not new, having first been highlighted by the Keogh review in 2013, 3 however, the proposals made in this report have not all yet been implemented.
A recent mixed-methods study surveying adverse effects experienced by over 500 patients has demonstrated the significant impact of such effects on emotional well-being. 4This report also highlighted, concerningly, that 84% of respondents did not know who regulates the aesthetic industry with 78.4% of patients feeling that their practitioner refused to support them when they reported adverse effects.These findings are at odds with earlier studies performed more than 15 years ago, which reported high levels of satisfaction with botulinum toxin injections. 5,6This may be for various reasons.
A significant increase in incidence of injectable cosmetic procedures has placed demand on a market that is not highly regulated, 3 which may have resulted in unsafe care being provided.Furthermore, there are concerns that reporting mechanisms for complications in the UK are inadequate or inaccessible, which may lead to under-representation of adverse events. 4A significantly greater number of practitioners who are not doctors are now delivering botulinum toxin as a cosmetic injectable therapy and not enough is known about how this affects patient safety and outcomes.

CO N FLI C T O F I NTER E S T S TATEM ENT
None.
It would be of great interest to investigate whether complications (and subsequent support from the injector) and perceived aesthetic outcomes varied based on practitioner background, and we feel more research is required in this field.In conclusion, there are significant concerns about the safety of delivery of botulinum toxin injections for cosmetic purposes due to under-regulation.Investigating patient outcomes and adverse effects based on practitioner type may give vital information to assist with regulation and increased safety in care delivery.AUTH O R CO NTR I B UTI O N SH Cook was involved in conception and writing manuscript.D Zargaran was involved in writing manuscript.A Mosahebi shared senior authorship and involved in consulting and advice and editing final draft.