Journal of Cosmetic Dermatology Publishes Data Demonstrating Patient Satisfaction with Natural-Looking Outcomes Following Treatment with OnabotulinumtoxinA (BOTOX® Cosmetic)

Press Releases

 At day 30, approximately 90% of all study patients were satisfied with treatment resulting in a natural look and more than 80% of all study patients were satisfied with natural-looking outcomes throughout the 12-month study period for the temporary improvement in the appearance of their moderate to severe upper facial lines1
–  At day 30, more than half of patients experienced a notable difference in self-perceived appearance and psychosocial well-being1

IRVINE, Calif., Aug. 30, 2023 /PRNewswire/ -- Allergan Aesthetics, an AbbVie company (NYSE: ABBV), today announced the Journal of Cosmetic Dermatology published results from a year-long, post-hoc analysis of patient-reported outcomes (PROs) from two Phase 3 clinical studies evaluating the impact of onabotulinumtoxinA (BOTOX® Cosmetic) on upper facial lines (UFLs) in adults new to toxin treatment.1 The peer-reviewed study found that, 30 days after receiving treatment, 90.5% of all study patients reported being either mostly or very satisfied with receiving a natural look, as rated on a five-point scale.1 This satisfaction was sustained by more than 80% of patients throughout the 12-month study period for the temporary improvement in the appearance of their moderate to severe UFLs.1 In addition, 30 days after receiving treatment, more than half of treated patients reported an improvement in self-perceived appearance and psychological well-being, defined as those who achieved a meaningful improvement in five areas (how much their facial lines made them feel older, feel unhappy, look angry, look tired, or feel that they negatively affected self-esteem).1

UFLs, which include forehead, glabellar, and crow's feet lines, fall within the main areas of concern for individuals considering aesthetic treatments.1 The study, titled Self-Perception of Natural Outcome, Appearance and Emotional Well-Being After OnabotulinumtoxinA Treatment for Upper Facial Lines: Post-Hoc Analysis Across Age and Gender, analyzed patient-reported outcomes (PROs) from more than 450 neurotoxin-naïve adults treated who saw a reduction in UFL severity with onabotulinumtoxinA (BOTOX® Cosmetic).1  The study used the Facial Line Satisfaction Questionnaire, a validated proprietary questionnaire developed according to FDA guidelines for PRO measures, which assesses treatment satisfaction, appearance, and emotional impact as perceived by patients. 1

"Regardless of age or gender, most patients contemplating facial aesthetic treatments desire refreshed, natural-looking results, and fear of looking unnatural or a 'frozen' look is a common barrier for many," said Steven Dayan, MD, founder of Denova Research and study author. "Self-perceived patient satisfaction, both in physical appearance and emotional wellbeing, is paramount in aesthetics medicine and it is vital physicians understand how patients perceive themselves after treatment to truly address patient concerns and help fulfill their expectations."

"Assessing patient-reported outcomes for toxin treatments is an important advancement in supporting physicians with reliable data and education to help ensure patients achieve their expected and desired results," said John Maltman, vice president, global aesthetics medical affairs, AbbVie. "The study supports that patient satisfaction and a desired natural look that helps improve the appearance of upper facial lines can be achieved with proven facial aesthetic neuromodulator treatment."

BOTOX® Cosmetic (onabotulinumtoxinA) Important Information


BOTOX® Cosmetic (onabotulinumtoxinA) is indicated in adult patients for the temporary improvement in the appearance of:
- Moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity
- Moderate to severe lateral canthal lines associated with orbicularis oculi activity
- Moderate to severe forehead lines associated with frontalis activity


Postmarketing reports indicate that the effects of BOTOX® Cosmetic and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have an underlying condition that would predispose them to these symptoms. In unapproved uses and approved indications, cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and spasticity and at lower doses.

BOTOX® Cosmetic is contraindicated in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation.

Lack of Interchangeability Between Botulinum Toxin Products
The potency units of BOTOX® Cosmetic are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of BOTOX® Cosmetic cannot be compared to nor converted into units of any other botulinum toxin products assessed with any other specific assay method.

Spread of Toxin Effect
Please refer to Boxed Warning for Distant Spread of Toxin Effect.

No definitive serious adverse event reports of distant spread of toxin effect associated with dermatologic use of BOTOX® Cosmetic at the labeled dose of 20 Units (for glabellar lines), 24 Units (for lateral canthal lines), 40 Units (for forehead lines with glabellar lines), 44 Units (for simultaneous treatment of lateral canthal lines and glabellar lines), and 64 Units (for simultaneous treatment of lateral canthal lines, glabellar lines, and forehead lines) have been reported. Patients or caregivers should be advised to seek immediate medical care if swallowing, speech, or respiratory disorders occur.

Serious Adverse Reactions With Unapproved Use
Serious adverse reactions, including excessive weakness, dysphagia, and aspiration pneumonia, with some adverse reactions associated with fatal outcomes, have been reported in patients who received BOTOX® injections for unapproved uses. In these cases, the adverse reactions were not necessarily related to distant spread of toxin, but may have resulted from the administration of BOTOX® to the site of injection and/or adjacent structures. In several of the cases, patients had pre-existing dysphagia or other significant disabilities. There is insufficient information to identify factors associated with an increased risk for adverse reactions associated with the unapproved uses of BOTOX®. The safety and effectiveness of BOTOX® for unapproved uses have not been established.

Hypersensitivity Reactions
Serious and/or immediate hypersensitivity reactions have been reported. These reactions include anaphylaxis, serum sickness, urticaria, soft-tissue edema, and dyspnea. If such reactions occur, further injection of BOTOX® Cosmetic should be discontinued and appropriate medical therapy immediately instituted. One fatal case of anaphylaxis has been reported in which lidocaine was used as the diluent and, consequently, the causal agent cannot be reliably determined.

Cardiovascular System
There have been reports following administration of BOTOX® of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors including pre-existing cardiovascular disease. Use caution when administering to patients with pre-existing cardiovascular disease.

Increased Risk of Clinically Significant Effects With Pre-existing Neuromuscular Disorders
Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junction disorders (e.g., myasthenia gravis or Lambert-Eaton syndrome) should be monitored when given botulinum toxin. Patients with neuromuscular disorders may be at increased risk of clinically significant effects including generalized muscle weakness, diplopia, ptosis, dysphonia, dysarthria, severe dysphagia, and respiratory compromise from onabotulinumtoxinA (see Warnings and Precautions). 

Dysphagia and Breathing Difficulties
Treatment with BOTOX® and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with pre-existing swallowing or breathing difficulties may be more susceptible to these complications. In most cases, this is a consequence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing (see Boxed Warning).

Pre-existing Conditions at the Injection Site
Caution should be used when BOTOX® Cosmetic treatment is used in the presence of inflammation at the proposed injection site(s) or when excessive weakness or atrophy is present in the target muscle(s).

Dry Eye in Patients Treated With BOTOX® Cosmetic
There have been reports of dry eye associated with BOTOX® Cosmetic injection in or near the orbicularis oculi muscle. If symptoms of dry eye (e.g., eye irritation, photophobia, or visual changes) persist, consider referring patients to an ophthalmologist.

Human Albumin and Transmission of Viral Diseases
This product contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases and variant Creutzfeldt-Jakob disease (vCJD). There is a theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD), but if that risk actually exists, the risk of transmission would also be considered extremely remote. No cases of transmission of viral diseases, CJD or vCJD have ever been identified for licensed albumin or albumin contained in other licensed products.

The most frequently reported adverse reactions following injection of BOTOX® Cosmetic for glabellar lines were eyelid ptosis (3%), facial pain (1%), facial paresis (1%), and muscular weakness (1%).

The most frequently reported adverse reaction following injection of BOTOX® Cosmetic for lateral canthal lines was eyelid edema (1%).

The most frequently reported adverse reactions following injection of BOTOX® Cosmetic for forehead lines with glabellar lines were headache (9%), brow ptosis (2%), and eyelid ptosis (2%).

Co-administration of BOTOX® Cosmetic and aminoglycosides or other agents interfering with neuromuscular transmission (e.g., curare-like compounds) should only be performed with caution as the effect of the toxin may be potentiated. Use of anticholinergic drugs after administration of BOTOX® Cosmetic may potentiate systemic anticholinergic effects.

The effect of administering different botulinum neurotoxin products at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin.

Excessive weakness may also be exaggerated by administration of a muscle relaxant before or after administration of BOTOX® Cosmetic.

There are no studies or adequate data from postmarketing surveillance on the developmental risk associated with use of BOTOX® Cosmetic in pregnant women. There are no data on the presence of BOTOX® Cosmetic in human or animal milk, the effects on the breastfed child, or the effects on milk production. 

Please see BOTOX® Cosmetic full Prescribing Information including Boxed Warning and Medication Guide.

About Allergan Aesthetics

At Allergan Aesthetics, an AbbVie company, we develop, manufacture, and market a portfolio of leading aesthetics brands and products. Our aesthetics portfolio includes facial injectables, body contouring, plastics, skin care, and more. Our goal is to consistently provide our customers with innovation, education, exceptional service, and a commitment to excellence, all with a personal touch. For more information, visit

About AbbVie

AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas – immunology, oncology, neuroscience, and eye care – and products and services in our Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at Follow @abbvie on Twitter, Facebook, Instagram, YouTube and LinkedIn


  1. Dayan, S., Ogilvie, P., et al. Self-Perception of Natural Outcome, Appearance and Emotional Well-Being After OnabotulinumtoxinA Treatment for Upper Facial Lines: Post-Hoc Analysis Across Age and Gender. J Cosmet Dermatol. Published online August 24, 2023. doi: 10.1111/jocd.15947.



Media: Toni Haubert, or Investors: Liz Shea,