Intradermal Microdroplet Injection of Diluted Incobotulinumtoxin-A for Sebum Control, Face Lifting, and Pore Size Improvement

January 2021 | Volume 20 | Issue 1 | Original Article | 49 | Copyright © January 2021

Published online December 21, 2020

Je-Young Park MDa*, Soo Ick Cho MD, PhDb*, Keunyoung Hur MDb, Dong Hun Lee MD, PhDb

aApkoo-Jung Oracle Dermatology Center, Seoul, Republic of Korea
bDepartment of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea

*These authors contributed equally to this work.

Background: Intradermal injections of botulinum toxin have been reported to improve sebum secretion, facial skin laxity, and facial pores. However, the effects of Incobotulinumtoxin-A for these indications have not been reported.
Objective: To evaluate the efficacy of Incobotulinumtoxin-A for the improvement of sebum secretion, face laxity, and facial pores.
Materials and Methods: This single-center retrospective study included patients treated with Incobotulinumtoxin-A to improve facial skin laxity, sebum secretion, and facial pores. The microdroplet injection protocol included injection points on the lateral face, anterior medial cheek, mandibular line, depressor anguli oris points, mid-glabella area, and chin. Outcomes were measured using a Sebumeter and three-dimensional scanner and were evaluated by facial laxity ratings and the Global Aesthetic Improvement Scale.
Results: Twenty patients were included in the analysis. Sebum secretion, mandibular length, facial pores, and facial laxity ratings were improved at 1 week and results were sustained through 12 weeks. All outcomes showed maximum improvement after 4 weeks. Evaluation using the Global Aesthetic Improvement Scale showed that all subjects reported at least a score of 2 (improved) after 4 weeks.
Conclusion: This study showed that intradermal injection with Incobotulinumtoxin-A could be effective for face lifting, reduced sebum production, and improved facial pores.

J Drugs Dermatol. 2021;20(1):49-54. doi:10.36849/JDD.2021.5616


Botulinum toxin (BTX) has been widely applied for various cosmetic indications, such as glabellar rhytides, crow’s feet, eyelid wrinkles, perioral wrinkles, chin rhytides, masseter hypertrophy, and platysmal bands, since its first aesthetic approval by the US FDA in 2002 for the treatment of glabella lines.1-5 Currently, BTX is one of the most popular minimally invasive cosmetic procedures performed.6

The primary mechanism of BTX is muscle paralysis via inhibiting the exocytosis of presynaptic acetylcholine,7 and wrinkles related to muscular contraction can be improved by intramuscular injection of BTX.5 More recently, intradermal injection of BTX has been used off-label for various aesthetic conditions, including facial skin laxity, excess sebum production, and enlarged facial pores.8-13 These effects could be attributed to the paralysis of arrector pili muscles or decreased sebum production via acetylcholine inhibition.10,13,14 However, previous studies relied on subjective evaluation and lacked long-term clinical data. Regarding sebum production or facial pore reduction, some studies showed conflicting results.10,15 Additionally, previous studies applied intradermal injections of Abobotulinumtoxin-A (ABO) or Onaboulinumtoxin-A (ONA), but no currently published study used Incobotulinumtoxin-A (INCO) for these indications.

INCO is a highly purified and precisely manufactured BTX type A preparation, which contains the pure 150 kDa active neurotoxin without complexing proteins.16 Without complexing proteins, INCO is known to have a low antigenicity compared to that of other products of BTX type A.1,17,18 INCO is also free of other impurities/adjuvants, such as inactive neurotoxin, flagellin, and clostridial DNA contaminants.17 Here, we retrospectively reviewed patients who received facial treatments with intradermal INCO and evaluated the changes in sebum production, face lifting, and facial pore improvement for up to 12 weeks after a single treatment session.


Study Design and Patients
This study was a single-center, retrospective clinical study. The