Background: Botulinum toxin A is a commonly used biological medication in the field of facial plastic surgery.\r\nCurrently, there are three distinct formulations of botulinum toxin A, each with their purported benefits and\r\nadvantages. However, there is considerable confusion as to the relative efficacy and side-effects associated with\r\neach formulation. Therefore, the purpose of this paper is to systematically assess published studies and perform a\r\nmeta-analysis to determine if there is a significant advantage of any of the individual formulations.\r\nMethods/design: A systematic literature search was performed for all relevant English language randomized\r\ncontrolled trials using Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, World\r\nHealth Organization (WHO) International Clinical Trials Registry Platform, European Union (EU) Clinical Trials Register,\r\nCochrane Library databases of clinical trials, and ClinicalTrials.gov. Inclusion criteria included any randomized\r\ncontrolled trial (RCT) that assessed the use of botulinum toxin for cosmetic purposes. The included articles were\r\nalso analyzed for bias using the Cochrane Collaboration�s tool for assessing the risk of bias in RCTs.\r\nDiscussion: The results of this review will provide clinicians with an unbiased, high level of evidence of the\r\ncomparative efficacy of individual preparations of botulinum toxin A.
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