Forehead lines (FHL), glabellar lines (GL), and crow’s feet lines (CFL) are all upper facial lines (UFLs), and onabotulinumtoxinA has been shown to be safe and effective for treating these areas. The purpose of this study was to examine the relationship between the efficacy of onabotulinumtoxinA and patient-reported psychological effects and satisfaction with UFL.

Investigator-assessed more than equal to 1-grade severity improvement on the Allergan Facial Wrinkle Scale at Day 30 was analyzed in a pooled analysis of data from 4 pivotal Phase 3 trials (onabotulinumtoxinA vs. placebo in FHL ± GL, FHL + GL ± CFL, CFL, and CFL + GL  over 180 days) (responders). In addition, subjects’ perceptions of their own pleasure with their physical appearance were measured using the Subject Assessment of Satisfaction with Appearance (SASA), the Facial Line Outcomes (FLO-11) Questionnaire, and the Facial Line Satisfaction Questionnaire.

The final tally of patients treated with onabotulinumtoxinA (FHL, GL, or CFL) was 921, 921, and 833, respectively, whereas 786 individuals were given a placebo. Most patients were white women between 45 and 50 years (median). Over the course of 150 days, onabotulinumtoxinA response rates were more than 42% in FHL, more than 43% in GL, and more than equal to 32% in CFL. High levels of pleasure were reported (FLSQ and SASA), along with reductions in negative psychological effects connected to respondents’ physical appearance (FLO-11). In UFL, a clinically significant outcome is achieved when patients report an improvement of at least 1 grade after treatment with onabotulinumtoxinA>1. This is associated with sustained improvement in patient-reported psychological sequelae and high satisfaction.