Real-World Outcomes of a Novel Botulinum Toxin A for Upper Face Aesthetics: Insights From Routine Clinical Practice

Abstract Background Aging signs of the upper face result from complex interactions among facial muscles and include forehead lines, glabellar lines, and crow's feet. Botulinum neurotoxin type A (BoNT-A) injections are widely utilized to address these concerns. An optimal treatment strategy should consider the interplay between elevator and depressor muscles. Comprehensive treatment approaches targeting the comprehensive upper face are gaining popularity but remain underreported in the context of newer products such as letibotulinumtoxinA. Objectives The aim of this study is to evaluate the efficacy and safety of a comprehensive upper-face treatment using letibotulinumtoxinA (Letybo) and to assess its effect on glabellar lines, forehead lines, and crow's feet using validated clinical scales. Methods In this prospective, observational study, 20 participants (mean age: 35.8 ± 9.3 years) received standardized injections totaling 64 units. Treatment included 16 intramuscular injections: glabella (5 sites), forehead (5 sites), and crow's feet (3 per side), with 4 units (0.1 mL) per site. Efficacy was evaluated at baseline, Week 2, and Week 16 using the Facial Wrinkle Scale, Clinician's Dynamic Forehead Line Assessment Scale, and Clinician's Dynamic Crow's Feet Assessment Scale. Results At Week 2, ≥2-point improvement was observed in 95% of glabellar, 90% of forehead, and 90% of crow's feet cases. At Week 16, ≥1-point improvements persisted in 70% to 80% of participants. Five participants (25%) required a touch-up at Week 2. No adverse drug reactions were reported. Conclusions Comprehensive upper-face treatment with letibotulinumtoxinA showed meaningful, sustained aesthetic improvement with good tolerability. These findings support further research in larger populations. Level of Evidence: 4 (Therapeutic)