@article {1635651, title = {Safety of Botulinum Toxin A Injections for Facial Rejuvenation: A Meta-Analysis of 9,669 Patients}, journal = {Ophthalmic Plast Reconstr Surg}, volume = {39}, number = {1}, year = {2023}, month = {2023 Jan-Feb 01}, pages = {13-25}, abstract = {PURPOSE: To quantitatively evaluate safety profile for botulinum toxin A (BTX-A) injections among patients undergoing treatment for cosmetic indications is produced, with special attention to clinically relevant covariates and their relative impact on safety. METHODS: A systematic literature search was performed using PubMed (1996-January 2020) and Embase (1947-January 2020) to identify all randomized controlled trials (RCTs) that reported safety data for patients receiving BTX-A for cosmetic indications compared to placebo. A meta-analysis was performed to determine pooled risk ratios (RR) for treatment-related adverse events (TRAEs) and for specific adverse events. Meta-regression and additional analyses were performed for significant and/or clinically relevant covariates. RESULTS: Following the review of 8,690 studies, 32 RCTs involving 9,669 patients were included. The pooled RR of any TRAE occurring after BTX-A injection compared to placebo injection was 1.53 (95\% CI, 1.33-1.77; p \< 0.001). Statistically significant covariates included individual injection volume and total injection volume. The type of BTX-A formulation, treatment site, total BTX-A units, and BTX-A units per injection were not significant. Specific adverse events more likely to occur following BTX-A injection rather than placebo injection included eyelid/eyebrow malposition (RR 3.55; p \< 0.001), facial paresis (RR 2.42; p = 0.316), and headache (RR 1.45; p = 0.003). Injection site reactions and injection site bruising occurred at similar rates in both groups. CONCLUSIONS: The overall safety profile of BTX-A is acceptable and consistent with previous publications. The authors{\textquoteright} additional analyses provide a relative comparison of the impact of various treatment parameters on safety.}, keywords = {Botulinum Toxins, Type A, Face, Humans, Injections, Randomized Controlled Trials as Topic, Rejuvenation}, issn = {1537-2677}, doi = {10.1097/IOP.0000000000002169}, author = {Gostimir, Mi{\v s}o and Liou, Victor and Yoon, Michael K} }