Treating glabellar lines with botulinum toxin type A-hemagglutinin complex: A review of the science, the clinical data, and patient satisfaction

Abstract

Botulinum toxin type A treatment is the foundation of minimally invasive aesthetic facial procedures. Clinicians and their patients recognize the important role, both negative and positive, that facial expression, particularly the glabellar frown lines, plays in self-perception, emotional well-being, and perception by others. This article provides up-to-date information on fundamental properties and mechanisms of action of the major approved formulations of botulinum toxin type A, summarizes recent changes in naming conventions (nonproprietary names) mandated by the United States Food and Drug Administration, and describes the reasons for these changes. The request for these changes provides recognition that formulations of botulinum toxins (eg, onabotulinumtoxinA and abobotulinumtoxinA) are not interchangeable and that dosing recommendations cannot be based on any one single conversion ratio. The extensive safety, tolerability, and efficacy data are summarized in detail, including the patient-reported outcomes that contribute to overall patient satisfaction and probability treatment continuation. Based on this in-depth review, the authors conclude that botulinum toxin type A treatment remains a cornerstone of facial aesthetic treatments, and clinicians must realize that techniques and dosing from one formulation cannot be applied to others, that each patient should undergo a full aesthetic evaluation, and that products and procedures must be selected in the context of individual needs and goals.

S1‐Leitlinie Ästhetische Botulinumtoxin‐Therapie

“…(Azzalure ® [31][32][33][34][35][36][37][38][39], Bocouture ® [40,41], Vistabel ® [15,[42][43][44][45][46][47][48][49][50]). Die Effektivität und Sicherheit konnte auch für Langzeitbehandlungen nachgewiesen werden [14,15,36,48].…”

A comparative assessment of three formulations of botulinum toxin A for facial rhytides: a systematic review and meta-analyses

“…Producers of each formulation often highlight a number of factors distinguishing their product from their competitors. These features typically include: dose potency and/or equivalency [1], the onset of action [2], duration of action [3], local diffusion of the toxin [4,5], side-effect profile [6], and differences in immunogenicity.…”

“…One of the primary differences between botulinum toxin formulations is the presence or absence of these complexing proteins [1]. The manufacturers of incobotulinum toxin A use this feature in marketing to professionals, particularly with respect to the proposed low potential for antigenicity [12].…”

“…With respect to dose equivalency, previous data suggest that abobotulinum toxin A and onabotulinum toxin have non-parallel dose–response curves, and thus differ in their relative potencies [1]. Studies often assess these medications at varying dose ratios with abobotulinum toxin requiring 2 to 3 times the relative dose in ‘units’ compared to the other formulations.…”

Patient Satisfaction and Safety With Aesthetic OnabotulinumtoxinA After At Least 5 Years

“…[10][11][12] Selfimage is a key motivator for patients deciding to undergo aesthetic procedures, and outcomes are strongly associated with changes in self-esteem that drive patient satisfaction. [13][14][15] In clinical trials of onabotulinumtoxinA, patient satisfaction has been high but not rigorously documented over a long period, 16 with the longest period being a prospective 26-month study showing progressively increasing patient satisfaction across 6 treatment cycles. 17 Despite widespread clinical experience with onabot-ulinumtoxinA, there are little data on its long-term safety because of the generally short duration of randomized controlled trials that frequently investigated only a single treatment cycle.…”