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

Carruthers, Jean; Fournier, Nathalie; Kerscher, Martina; Ruiz-Avila, Javier; Almeida, António Bernardino de; Kaeuper, Gina

doi:10.1111/dsu.12148

Cited by 65 publications

(72 citation statements)

References 66 publications

(66 reference statements)

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“…Recent evidence-based consensus reviews on BoNT/A applications in aesthetic medicine have summarized the evidence supporting a 1:1 dose relationship between ONA and INCO [18–20]. When converting between ABO and ONA, a ratio of 2–3 ABO units for 1 unit of ONA has been proposed in several publications [17, 21, 22].…”

Section: Clinical Comparisonsmentioning

confidence: 99%

Pharmaceutical, Biological, and Clinical Properties of Botulinum Neurotoxin Type A Products

2015

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Botulinum neurotoxin injections are a valuable treatment modality for many therapeutic indications and have revolutionized the field of aesthetic medicine so that they are the leading cosmetic procedure performed worldwide. Studies show that onabotulinumtoxinA, abobotulinumtoxinA, and incobotulinumtoxinA are comparable in terms of clinical efficacy. Differences between the products relate to the botulinum neurotoxin complexes, specific biological potency, and their immunogenicity. Protein complex size and molecular weight have no effect on biological activity, stability, distribution, or side effect profile. Complexing proteins and inactive toxin (toxoid) content increase the risk of neutralizing antibody formation, which can cause secondary treatment failure, particularly in chronic disorders that require frequent injections and long-term treatment. These attributes could lead to differences in therapeutic outcomes, and, given the widespread aesthetic use of these three neurotoxin products, physicians should be aware of how they differ to ensure their safe and effective use.

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Section: Clinical Comparisonsmentioning

confidence: 99%

Pharmaceutical, Biological, and Clinical Properties of Botulinum Neurotoxin Type A Products

2015

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Section: Overviewmentioning

confidence: 53%

“…However, based on their clinical experience, the consensus group agreed that onabotulinumtoxinA and incobotulinumtoxinA could be used at a 1:1 dose ratio, as suggested previously 25,30,31. Considering the dosing for glabellar frown lines, a ratio of 2.5:1 for abobotulinumtoxinA and incobotulinumtoxinA was considered appropriate and in agreement with other consensus recommendations 25,30,31. Head-to-head comparisons of incobotulinumtoxinA and onabotulinumtoxinA have reported the products to have equivalent efficacy when used at the same dose for the treatment of periocular rhytides and masseteric hypertrophy,33 for the treatment of focal hyperhidrosis,34 and for the treatment of glabellar frown lines at respective concentrations of 30 U and 20 U,35 at a 3:1 respective dose ratio,8 and at respective concentrations of 20 U and 30 U 36…”

Section: Overviewmentioning

confidence: 87%

“…Before reaching consensus on the use of incobotulinumtoxinA in facial aesthetics, the expert group reviewed and analyzed the existing literature and previous consensus recommendations (eg, two global consensuses, German guidelines and a French consensus)16,22–25,30,31 and discussed the extensive practical experience among the panel in the use of incobotulinumtoxinA in aesthetics. A list of relevant literature for the experts to review was compiled through searching PubMed (National Center for Biotechnology Information, Bethesda, MD, USA).…”

Section: Consensus Group and Methodologymentioning

confidence: 99%

“…The four BoNT/A preparations available in Russia may differ not only in terms of formulation but also in terms of their relative efficacy and tolerability profiles 13–15,30,32. It is important to understand the similarities and differences between available BoNT/A products, as this enables clinicians to make informed decisions about their most appropriate applications in clinical practice.…”

Section: Overviewmentioning

confidence: 99%

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IncobotulinumtoxinA in aesthetics: Russian multidisciplinary expert consensus recommendations

Yutskovskaya

Gubanova

Khrustaleva

et al. 2015

CCID

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BackgroundAlthough there are various international consensus recommendations on the use of botulinum neurotoxin type A (BoNT/A) in facial aesthetics, there are no global or Russian guidelines on the optimal dose of incobotulinumtoxinA, free from complexing proteins, within specific aesthetic indications. This article reports the outcomes of two expert consensus meetings, conducted to review and analyze efficacy and tolerability data for incobotulinumtoxinA in various facial aesthetic indications and to give expert consensus recommendations to ensure best clinical practice among Russian clinicians.MethodsThirteen dermatology and/or plastic surgery experts attended meetings held in Paris, France (November 2013), and Moscow, Russia (March 2014). The expert group reviewed and analyzed the existing evidence, consensus recommendations, and Russian experts’ extensive practical experience of incobotulinumtoxinA in aesthetics to reach consensus on optimal doses, potential dose adjustments, and injection sites of incobotulinumtoxinA for facial aesthetics.ResultsAll experts developed guidance on the optimal doses for incobotulinumtoxinA treatment of different regions of the upper and lower face. The expert panel agreed that there are no differences in the efficacy and duration of the effect between the four BoNT/As that are commercially available for facial aesthetic indications in Russia and that, when administered correctly, all BoNT/As can achieve optimal results. Experts also agreed that nonresponse to BoNT/A can be caused by neutralizing antibodies.ConclusionOn the basis of the scientific and clinical evidence available for incobotulinumtoxinA, coupled with the extensive clinical experience of the consensus group, experts recommended the optimal doses of incobotulinumtoxinA effective for treatment of wrinkles of the upper and lower face to achieve the expected aesthetic outcome. These first Russian guidelines on the optimal use of incobotulinumtoxinA for augmentation of glabellar lines, periorbital wrinkles, forehead lines, bunny lines, perioral wrinkles, depressor anguli oris, mentalis, masseters and platysmal bands, and performing the Nefertiti lift, are presented here.

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Alterations in the Elasticity, Pliability, and Viscoelastic Properties of Facial Skin After Injection of Onabotulinum Toxin A

Bonaparte

Ellis

2015

JAMA Facial Plast Surg

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IMPORTANCE This prospective cohort study provides evidence and information on the mechanism of action of onabotulinum toxin A on the reduction of skin elasticity and pliability. Understanding the natural course that onabotulinum toxin A has on the elasticity of skin may help physicians understand why there appears to be a progressive reduction in wrinkle levels with repeated treatments OBJECTIVE To determine whether onabotulinum toxin A increases skin pliability and elasticity with a corresponding decrease in the contribution of the viscoelastic component of skin resistance.

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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

Abstract: A range of product- and patient-specific factors influence the treatment plan. Truly optimized outcomes are possible only when the treating physician has the requisite knowledge, experience, and vision to use BoNTA as part of a unique solution for each patient's specific needs.

Cited by 65 publications

References 66 publications

Pharmaceutical, Biological, and Clinical Properties of Botulinum Neurotoxin Type A Products

Pharmaceutical, Biological, and Clinical Properties of Botulinum Neurotoxin Type A Products

IncobotulinumtoxinA in aesthetics: Russian multidisciplinary expert consensus recommendations

Alterations in the Elasticity, Pliability, and Viscoelastic Properties of Facial Skin After Injection of Onabotulinum Toxin A

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