{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T18:46:02Z","timestamp":1778870762304,"version":"3.51.4"},"reference-count":16,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T00:00:00Z","timestamp":1620777600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Plast Surg (Oakv)"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:p>Purpose: This study was designed to investigate the effects of botulinum toxin type A injections diluted with the mixture of sodium bicarbonate and normal saline on pain reduction, onset of action, and duration of action. Methods: This is a prospective, randomized, double-blind clinical study, which included 30 female patients (age &gt;25). The patients were randomized to receive botulinum toxin injections diluted with normal saline and sodium bicarbonate on one side of the face and saline control injections on the other side. Pain severity was assessed using visual analogue scale. The onset and duration of action were recorded according to the patients\u2019 subjective opinions after 1 week and 3 months, respectively. Results: Lower pain intensity ratings were observed when botulinum toxin was diluted with 0.05 and 0.1 mL of sodium bicarbonate as compared to saline. Regarding the onset of action, the botulinum toxin injections diluted with saline and 0.1-mL sodium bicarbonate side showed faster response in many patients than other dilutions ( P &lt; .001). Both the 0.05-mL and 0.1-mL sodium bicarbonate concentrations showed longer duration effects on patients than other concentrations. Conclusion: The use of sodium bicarbonate and saline in a mixture for the dilution of botulinum toxin can decrease patients\u2019 discomfort and provide a faster action with longer duration effects.<\/jats:p>","DOI":"10.1177\/22925503211011971","type":"journal-article","created":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T05:23:10Z","timestamp":1620796990000},"page":"227-232","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Injection Site Pain, Onset and Duration of Action of Botulinum Toxin Reconstituted in Normal Saline With and Without Sodium Bicarbonate: A Prospective, Single Center, Randomized, Double-Blind Interventional Study"],"prefix":"10.1177","volume":"30","author":[{"given":"Yazeed","family":"Alghonaim","sequence":"first","affiliation":[{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, Department of Surgery, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3911-617X","authenticated-orcid":false,"given":"Leen O.","family":"Hijazi","sequence":"additional","affiliation":[{"name":"King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard\u2013Health Affairs (NGHA), Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sondus A.","family":"Alraee","sequence":"additional","affiliation":[{"name":"King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard\u2013Health Affairs (NGHA), Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasser","family":"Alqubaisy","sequence":"additional","affiliation":[{"name":"Head of Dermatology and Dermatologic Surgery Department, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,5,12]]},"reference":[{"issue":"3","key":"bibr1-22925503211011971","first-page":"168","volume":"90","author":"Small R","year":"2014","journal-title":"Am Fam Physician"},{"key":"bibr2-22925503211011971","doi-asserted-by":"publisher","DOI":"10.15537\/smj.2017.7.18528"},{"key":"bibr3-22925503211011971","doi-asserted-by":"publisher","DOI":"10.1007\/s13555-012-0014-6"},{"key":"bibr4-22925503211011971","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.07760.x"},{"issue":"7","key":"bibr5-22925503211011971","first-page":"886","volume":"32","author":"Kranz G","year":"2006","journal-title":"Dermatol Surg"},{"key":"bibr6-22925503211011971","doi-asserted-by":"publisher","DOI":"10.1016\/j.asj.2003.10.002"},{"key":"bibr7-22925503211011971","doi-asserted-by":"publisher","DOI":"10.2217\/14750708.3.5.591"},{"key":"bibr8-22925503211011971","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-016-1522-9"},{"key":"bibr9-22925503211011971","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.138.4.510"},{"key":"bibr10-22925503211011971","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000178"},{"key":"bibr11-22925503211011971","unstructured":"Food Drug Administration label. 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