AESTHETICSINFOCUS FACIALAESTHETICS
Botulinum toxin can also be used to treat hyperhydrosis or excessive sweating
The effects of botulinum toxin in smoothing facial lines clinically. Botulinum toxin was originally used in medicine for treating cerebral palsy, torticollis and blepharopasm. The practitioners who were using Botox in blepharopasm patients noted the decrease in glabella lines in these patients and hence the boom of Botox cosmetics began.
PRODUCTS AVAILABLE At present there are numerous Botox products that are available. Differences in formulation and the way every unit test is performed, results in ‘units’ varying in potency. It is therefore important to understand that a dosage of ‘one unit’ cannot necessarily be
BOTULINUM TOXINS AVAILABLE Name
Units
Botox (Allergan)
100
Vistabel (Allergan)
50
Azzalure
100
Xeomin (Merz)
100
Dysport (Ipsen)
500
transferred to different types of Botox. For example it is reported that a unit of Botox equates to three or four units of Dysport. This will become more clear when training on the products is completed and dosage units are discussed. In addition, the neurotoxin protein load in each product differs. Botox (Allergan) is reported to have a lower protein content and it is this protein content that may cause immune response that can lead to formation of antibodies. At present, research shows that 5% of Botox users may show antibody formation in the long term.
RECONSTITUTION AND HANDLING With all neurotoxins it is recommended to dilute with bacteriostatic saline. Recent reports show bacteriostatic (or preserved) saline to be less painful during injection and from experience it certainly is. Volume dilution varies but the most common dilution per vial is 2.5cc. It is recommended that botulinum toxin should be used within four hours on reconstitution and stored prior to dilution in freezers at -5°C.
Simple diabetic syringes can be used to administer Clinical experience and recent studies suggest that potency can be maintained for up to six weeks with proper storage at 4°C. Xeomin is a botulinum toxin which isn’t dependant on storage at -5°C and may be useful to those practitioners who may travel or not have the facility for a freezer.
TREATMENT As with any treatment, informed and written consent is essential. It is important to inform the patients about the toxin - it’s ‘off the label’ use of the drug in alternative therapies.
PPD May 2011 133
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