{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T22:29:17Z","timestamp":1779316157483,"version":"3.51.4"},"reference-count":50,"publisher":"Elsevier BV","issue":"1","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jprasurg.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Plastic, Reconstructive & Aesthetic Surgery"],"published-print":{"date-parts":[[2022,1]]},"DOI":"10.1016\/j.bjps.2021.05.074","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T05:53:46Z","timestamp":1623909226000},"page":"392-401","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":22,"title":["Complications of facial cosmetic botulinum toxin A injection: analysis of the UK Medicines & Healthcare Products Regulatory Agency registry and literature review"],"prefix":"10.1016","volume":"75","author":[{"given":"David","family":"Zargaran","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florence E.","family":"Zoller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Zargaran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afshin","family":"Mosahebi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.bjps.2021.05.074_bib0001","unstructured":"Bruce Keogh. Review_of_the_Regulation_of_Cosmetic_Interventions.pdf. Published 2013. Accessed November 17, 2020. https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/192028\/Review_of_the_Regulation_of_Cosmetic_Interventions.pdf."},{"key":"10.1016\/j.bjps.2021.05.074_bib0002","unstructured":"Qualification requirements for delivery of cosmetic procedures: Non-surgical cosmetic interventions and hair restoration surgery. Published November 2015. Accessed November 17, 2020. https:\/\/www.hee.nhs.uk\/sites\/default\/files\/documents\/HEE%20Cosmetic%20publication%20part%20one.pdf."},{"key":"10.1016\/j.bjps.2021.05.074_bib0003","series-title":"Frequently asked questions: Supply and administration of Botox\u00ae, Vistabel\u00ae, Dysport\u00ae and other injectable medicines outside their licensed medicinal uses such as in cosmetic procedures\u00a0: MHRA. Accessed","year":"2020"},{"issue":"10","key":"10.1016\/j.bjps.2021.05.074_bib0004","doi-asserted-by":"crossref","first-page":"913","DOI":"10.3390\/toxins4100913","article-title":"Clinical Uses of Botulinum Neurotoxins: Current Indications, Limitations and Future Developments","volume":"4","author":"Chen","year":"2012","journal-title":"Toxins"},{"issue":"Suppl 1","key":"10.1016\/j.bjps.2021.05.074_bib0005","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1093\/asj\/sjw284","article-title":"AbobotulinumtoxinA: A 25-Year History","volume":"37","author":"Monheit","year":"2017","journal-title":"Aesthet Surg J"},{"key":"10.1016\/j.bjps.2021.05.074_bib0006","unstructured":"Vistabel | SPC | Allergan Ltd | Medicines.ie. Accessed November 10, 2020. https:\/\/www.medicines.ie\/medicines\/vistabel-34207\/smpc."},{"key":"10.1016\/j.bjps.2021.05.074_bib0007","unstructured":"BOTOX 100 Units Powder for solution for injection - Summary of Product Characteristics (SmPC) - (emc). Accessed November 10, 2020. https:\/\/www.medicines.org.uk\/emc\/product\/859\/smpc#gref."},{"key":"10.1016\/j.bjps.2021.05.074_bib0008","unstructured":"Azzalure - Summary of Product Characteristics (SmPC) - (emc). Accessed November 10, 2020. https:\/\/www.medicines.org.uk\/emc\/medicine\/21985#gref."},{"key":"10.1016\/j.bjps.2021.05.074_bib0009","unstructured":"Dysport 300 units Powder for solution for injection - Summary of Product Characteristics (SmPC) - (emc). Accessed November 10, 2020. https:\/\/www.medicines.org.uk\/emc\/product\/964\/smpc#gref."},{"key":"10.1016\/j.bjps.2021.05.074_bib0010","unstructured":"Bocouture 100 Units - Summary of Product Characteristics (SmPC) - (emc). Accessed November 10, 2020. https:\/\/www.medicines.org.uk\/emc\/product\/7418\/smpc#gref."},{"key":"10.1016\/j.bjps.2021.05.074_bib0011","unstructured":"Xeomin 200 units powder for solution for injection - Summary of Product Characteristics (SmPC) - (emc). Accessed November 10, 2020. https:\/\/www.medicines.org.uk\/emc\/product\/2162\/smpc#gref."},{"key":"10.1016\/j.bjps.2021.05.074_bib0012","unstructured":"The American society of plastic surgeons. plastic-surgery-statistics-full-report-2009.pdf. Published 2010. Accessed November 13, 2020. https:\/\/www.plasticsurgery.org\/documents\/News\/Statistics\/2009\/plastic-surgery-statistics-full-report-2009.pdf."},{"issue":"4","key":"10.1016\/j.bjps.2021.05.074_bib0013","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/aogs.13330","article-title":"Information bias in epidemiological studies with a special focus on obstetrics and gynecology","volume":"97","author":"Kesmodel","year":"2018","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"1","key":"10.1016\/j.bjps.2021.05.074_bib0014","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3171\/2010.9.SPINE10151","article-title":"Comparison of ICD-9\u2013based, retrospective, and prospective assessments of perioperative complications: assessment of accuracy in reporting: Clinical article","volume":"14","author":"Campbell","year":"2011","journal-title":"J Neurosurg Spine"},{"key":"10.1016\/j.bjps.2021.05.074_bib0015","series-title":"Registry Design","author":"Gliklich","year":"2014"},{"key":"10.1016\/j.bjps.2021.05.074_bib0016","unstructured":"About us. GOV.UK. Accessed November 9, 2020. https:\/\/www.gov.uk\/government\/organisations\/medicines-and-healthcare-products-regulatory-agency\/about."},{"issue":"2","key":"10.1016\/j.bjps.2021.05.074_bib0017","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1002\/jrsm.12","article-title":"A basic introduction to fixed-effect and random-effects models for meta-analysis","volume":"1","author":"Borenstein","year":"2010","journal-title":"Res Synth Methods"},{"issue":"2","key":"10.1016\/j.bjps.2021.05.074_bib0018","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jaad.2003.11.084","article-title":"A multicenter, randomized, double-blind, placebo-controlled study of efficacy and safety of 3 doses of botulinum toxin A in the treatment of glabellar lines","volume":"51","author":"Ascher","year":"2004","journal-title":"J Am Acad Dermatol"},{"issue":"10","key":"10.1016\/j.bjps.2021.05.074_bib0019","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1111\/j.1524-4725.2009.01261.x","article-title":"Efficacy and Safety of Botulinum Toxin Type A in the Treatment of Lateral Crow's Feet: Double-Blind, Placebo-Controlled, Dose-Ranging Study","volume":"35","author":"Ascher","year":"2009","journal-title":"Dermatol Surg"},{"issue":"6","key":"10.1016\/j.bjps.2021.05.074_bib0020","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1067\/mjd.2002.121356","article-title":"A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines","volume":"46","author":"Carruthers","year":"2002","journal-title":"J Am Acad Dermatol"},{"issue":"5","key":"10.1016\/j.bjps.2021.05.074_bib0021","first-page":"461","article-title":"Double-Blind, Randomized, Parallel- Group, Dose-Ranging Study of Botulinum Toxin Type A in Female Subjects With Horizontal Forehead Rhytides","volume":"29","author":"Carruthers","year":"2003","journal-title":"Dermatol Surg"},{"issue":"4","key":"10.1016\/j.bjps.2021.05.074_bib0022","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1097\/00042728-200504000-00007","article-title":"Dose-Ranging Study of Botulinum Toxin Type A in the Treatment of Glabellar Rhytids in Females","volume":"31","author":"Carruthers","year":"2005","journal-title":"Dermatol Surg"},{"issue":"1 Spec No.","key":"10.1016\/j.bjps.2021.05.074_bib0023","article-title":"Botulinum toxin type A treatment of multiple upper facial sites: patient-reported outcomes","volume":"33","author":"Carruthers","year":"2007","journal-title":"Dermatol Surg Off Publ Am Soc Dermatol Surg Al"},{"issue":"5","key":"10.1016\/j.bjps.2021.05.074_bib0024","first-page":"567","article-title":"A Randomized, Evaluator-Blinded, Two-Center Study of the Safety and Effect of Volume on the Diffusion and Efficacy of Botulinum Toxin Type A in the Treatment of Lateral Orbital Rhytides","volume":"33","author":"Carruthers","year":"2007","journal-title":"Dermatol Surg"},{"issue":"6","key":"10.1016\/j.bjps.2021.05.074_bib0025","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1016\/j.jaad.2009.01.005","article-title":"A single-center, dose-comparison, pilot study of botulinum neurotoxin type A in female patients with upper facial rhytids: Safety and efficacy","volume":"60","author":"Carruthers","year":"2009","journal-title":"J Am Acad Dermatol"},{"key":"10.1016\/j.bjps.2021.05.074_bib0026","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1111\/j.1524-4725.2010.01705.x","article-title":"Randomized, Parallel-Group Study of the Safety and Effectiveness of OnabotulinumtoxinA and Hyaluronic Acid Dermal Fillers (24-mg\/mL Smooth, Cohesive Gel) Alone and in Combination for Lower Facial Rejuvenation","volume":"36","author":"Carruthers","year":"2010","journal-title":"Dermatol Surg"},{"issue":"11","key":"10.1016\/j.bjps.2021.05.074_bib0027","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1097\/DSS.0000000000001612","article-title":"Phase 3 Study of OnabotulinumtoxinA Distributed Between Frontalis, Glabellar Complex, and Lateral Canthal Areas for Treatment of Upper Facial Lines","volume":"44","author":"De Boulle","year":"2018","journal-title":"Dermatol Surg"},{"issue":"5","key":"10.1016\/j.bjps.2021.05.074_bib0028","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1007\/s00266-002-2047-1","article-title":"Long-Term Prospective Follow-Up of Botulinum Toxin Treatment for Facial Rhytides","volume":"26","author":"Bulstrode","year":"2002","journal-title":"Aesthetic Plast Surg"},{"issue":"2","key":"10.1016\/j.bjps.2021.05.074_bib0029","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/j.1473-2165.2005.40207.x","article-title":"A retrospective study in the use of botulinum toxin type-A in a UK multidisciplinary cosmetic practice","volume":"4","author":"Bowler","year":"2005","journal-title":"J Cosmet Dermatol"},{"issue":"12","key":"10.1016\/j.bjps.2021.05.074_bib0030","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1111\/j.1524-4725.2009.01235.x","article-title":"Placebo-Controlled Study of a New Botulinum Toxin Type A for Treatment of Glabellar Lines: Efficacy and Safety","volume":"35","author":"Brandt","year":"2009","journal-title":"Dermatol Surg"},{"issue":"s1","key":"10.1016\/j.bjps.2021.05.074_bib0031","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1111\/j.1524-4725.2006.32325.x","article-title":"Patient-Reported Outcomes with Botulinum Toxin Type A Treatment of Glabellar Rhytids: A Double-Blind, Randomized, Placebo-Controlled Study","volume":"33","author":"Fagien","year":"2007","journal-title":"Dermatol Surg"},{"key":"10.1016\/j.bjps.2021.05.074_bib0032","doi-asserted-by":"crossref","first-page":"S274","DOI":"10.1097\/DSS.0000000000001414","article-title":"Forehead Line Treatment With OnabotulinumtoxinA in Subjects With Forehead and Glabellar Facial Rhytids: A Phase 3 Study","volume":"43","author":"Fagien","year":"2017","journal-title":"Dermatol Surg"},{"issue":"3","key":"10.1016\/j.bjps.2021.05.074_bib0033","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1111\/j.1473-2165.2007.00325.x","article-title":"Clostridium botulinum type A toxin for the treatment of upper face animation lines: an Iranian experience","volume":"6","author":"Farahvash","year":"2007","journal-title":"J Cosmet Dermatol"},{"issue":"5","key":"10.1016\/j.bjps.2021.05.074_bib0034","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1007\/s00266-008-9199-6","article-title":"Randomized, Placebo-Controlled, Two-Dose Comparative Study of Botulinum Toxin Type A for Treating Glabellar Lines in Japanese Subjects","volume":"32","author":"Harii","year":"2008","journal-title":"Aesthetic Plast Surg"},{"issue":"10","key":"10.1016\/j.bjps.2021.05.074_bib0035","first-page":"28","article-title":"A Phase III Study of IncobotulinumtoxinA in the Treatment of Glabellar Frown Lines","volume":"4","author":"Imhof","year":"2011","journal-title":"J Clin Aesthetic Dermatol"},{"key":"10.1016\/j.bjps.2021.05.074_bib0036","first-page":"1","article-title":"UK Registry for Bolutinum Toxin Type A use in Cosmetic Practice","volume":"1","author":"Jandhyala","year":"2015","journal-title":"J Aesthetic Med"},{"issue":"5","key":"10.1016\/j.bjps.2021.05.074_bib0037","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1097\/PRS.0b013e3181b5641b","article-title":"Evaluation of Variable-Dose Treatment with a New U.S. Botulinum Toxin Type A (Dysport) for Correction of Moderate to Severe Glabellar Lines: Results from a Phase III, Randomized, Double-Blind, Placebo-Controlled Study","volume":"124","author":"Kane","year":"2009","journal-title":"Plast Reconstr Surg"},{"issue":"7","key":"10.1016\/j.bjps.2021.05.074_bib0038","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1111\/j.1365-4632.2009.04071.x","article-title":"An open-label, randomized, 64-week study repeating 10- and 20-U doses of botulinum toxin type A for treatment of glabellar lines in Japanese subjects","volume":"48","author":"Kawashima","year":"2009","journal-title":"Int J Dermatol"},{"issue":"1","key":"10.1016\/j.bjps.2021.05.074_bib0039","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1080\/14764170410028997","article-title":"Botulinum toxin A: a 9-month clinical and 3D in vivo profilometric crow's feet wrinkle formation study","volume":"6","author":"Levy","year":"2004","journal-title":"J Cosmet Laser Ther"},{"issue":"3","key":"10.1016\/j.bjps.2021.05.074_bib0040","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/00042728-200503000-00001","article-title":"Double-Blind, Randomized, Placebo-Controlled, Dose-Response Study of the Safety and Efficacy of Botulinum Toxin Type A in Subjects with Crow's Feet","volume":"31","author":"Lowe","year":"2005","journal-title":"Dermatol Surg"},{"issue":"2","key":"10.1016\/j.bjps.2021.05.074_bib0041","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1001\/archfaci.2009.5","article-title":"Long-term Safety and Efficacy of a New Botulinum Toxin Type A in Treating Glabellar Lines","volume":"11","author":"Moy","year":"2009","journal-title":"Arch Facial Plast Surg"},{"issue":"6","key":"10.1016\/j.bjps.2021.05.074_bib0042","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.jaad.2010.02.053","article-title":"Gummy smile and botulinum toxin: A new approach based on the gingival exposure area","volume":"63","author":"Mazzuco","year":"2010","journal-title":"J Am Acad Dermatol"},{"key":"10.1016\/j.bjps.2021.05.074_bib0043","article-title":"Repeated botulinum toxin A injections for the treatment of lines in the upper face: a retrospective study of 4,103 treatments in 945 patients","volume":"33","author":"Rzany","year":"2007"},{"issue":"3","key":"10.1016\/j.bjps.2021.05.074_bib0044","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1097\/DSS.0000000000000626","article-title":"Efficacy and Safety of OnabotulinumtoxinA Treatment of Forehead Lines: A Multicenter, Randomized, Dose-Ranging Controlled Trial","volume":"42","author":"Solish","year":"2016","journal-title":"Dermatol Surg"},{"issue":"5","key":"10.1016\/j.bjps.2021.05.074_bib0045","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1097\/01.prs.0000279377.86280.8d","article-title":"Patient-Reported Benefit and Satisfaction with Botulinum Toxin Type A Treatment of Moderate to Severe Glabellar Rhytides: Results from a Prospective Open-Label Study","volume":"120","author":"Stotland","year":"2007","journal-title":"Plast Reconstr Surg"},{"issue":"1","key":"10.1016\/j.bjps.2021.05.074_bib0046","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1111\/j.1524-4725.2009.01390.x","article-title":"Botulinum Toxin Type A for the Treatment of Glabellar Lines in Chinese: A Double-Blind, Randomized, Placebo-Controlled Study","volume":"36","author":"Wu","year":"2010","journal-title":"Dermatol Surg"},{"issue":"6","key":"10.1016\/j.bjps.2021.05.074_bib0047","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1093\/asj\/sjz174","article-title":"Botulinum Toxin to Treat Horizontal Forehead Lines: A Refined Injection Pattern Accommodating the Lower Frontalis","volume":"40","author":"Zhang","year":"2020","journal-title":"Aesthet Surg J"},{"key":"10.1016\/j.bjps.2021.05.074_bib0048","doi-asserted-by":"crossref","unstructured":"Sethi N, Singh S, DeBoulle K, Rahman E. A Review of Complications Due to the Use of Botulinum Toxin A for Cosmetic Indications. Aesthetic Plast Surg. Published online October 13, 2020. doi:10.1007\/s00266-020-01983-w.","DOI":"10.1007\/s00266-020-01983-w"},{"issue":"s1","key":"10.1016\/j.bjps.2021.05.074_bib0049","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1111\/j.1524-4725.2006.32327.x","article-title":"Repeated Botulinum Toxin A Injections for the Treatment of Lines in the Upper Face: A Retrospective Study of 4,103 Treatments in 945 Patients","volume":"33","author":"Rzany","year":"2007","journal-title":"Dermatol Surg"},{"issue":"1-2","key":"10.1016\/j.bjps.2021.05.074_bib0050","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1159\/000370245","article-title":"Serious and Long-Term Adverse Events Associated with the Therapeutic and Cosmetic Use of Botulinum Toxin","volume":"95","author":"Yiannakopoulou","year":"2015","journal-title":"Pharmacology"}],"container-title":["Journal of Plastic, Reconstructive & Aesthetic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1748681521003326?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1748681521003326?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T20:44:25Z","timestamp":1761684265000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1748681521003326"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":50,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["S1748681521003326"],"URL":"https:\/\/doi.org\/10.1016\/j.bjps.2021.05.074","relation":{},"ISSN":["1748-6815"],"issn-type":[{"value":"1748-6815","type":"print"}],"subject":[],"published":{"date-parts":[[2022,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Complications of facial cosmetic botulinum toxin A injection: analysis of the UK Medicines & Healthcare Products Regulatory Agency registry and literature review","name":"articletitle","label":"Article Title"},{"value":"Journal of Plastic, Reconstructive & Aesthetic Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.bjps.2021.05.074","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.","name":"copyright","label":"Copyright"}]}}