This activity is supported by an educational grant from Merz Aesthetics. Alastair Carruthers, Michael Kane, Timothy Flynn, Peter Huang and Nowell Solish are consultants for Merz. Sang Duck Kim is a consultant for Amore Pacific. A. Carruthers and Michael Kane are consultants for Allergan. N. Solish is a consultant for Allergan, Revance, and Medicis.
The Convergence of Medicine and Neurotoxins: A Focus on Botulinum Toxin Type A and Its Application in Aesthetic Medicine—A Global, Evidence-Based Botulinum Toxin Consensus Education Initiative
Part I: Botulinum Toxin in Clinical and Cosmetic Practice
Article first published online: 4 MAR 2013
© 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.
Special Issue: The Convergence of Medicine and Neurotoxins: A Focus on Botulinum Toxin Type A and Its Application in Aesthetic Medicine—A Global, Evidence-Based Botulinum Toxin Consensus Education Initiative
Volume 39, Issue 3pt2, pages 493–509, March 2013
How to Cite
Carruthers, A., Kane, M. A. C., Flynn, T. C., Huang, P., Kim, S. D., Solish, N. and Kaeuper, G. (2013), The Convergence of Medicine and Neurotoxins: A Focus on Botulinum Toxin Type A and Its Application in Aesthetic Medicine—A Global, Evidence-Based Botulinum Toxin Consensus Education Initiative. Dermatologic Surgery, 39: 493–509. doi: 10.1111/dsu.12147
- Issue published online: 4 MAR 2013
- Article first published online: 4 MAR 2013
The U.S. Food and Drug Administration has approved four distinct formulations of botulinum toxin (BoNT) serotypes A and B (BoNTA and BoNTB) for medical use. These four products are indicated for many medical applications, but the three BoNTA formulations are the most widely used worldwide and are the only products approved for aesthetic use. The latest approval of a BoNTA with no complexing proteins (incobotulinumtoxinA) necessitates a review and discussion of differences between available formulations and the effect that these differences may have on clinical practice.
To review the history, science, safety information, and current and emerging applications of BoNT in clinical and cosmetic practice and to compare commercially available BoNTA formulations.
Methods and Materials
Publications, clinical trials, and author experience were used as a basis for an up-to-date review of BoNT and its use in human medicine. The similarities and differences between formulations are presented, and diffusion, spread, equivalency ratios, stability, and storage are discussed.
Each commercial formulation has unique characteristics that may influence its use in aesthetic medicine. Familiarity with the similarities and differences between products will aid physicians in making patient care decisions.
New formulations, emerging uses, and continued research into the science and uses of BoNTA will lead to increasingly refined therapeutic approaches and applications. Continued education is important for physicians to optimize use of the agent according to the most current evidence and approaches.