DISCLAIMER
Today’s presentation will include the use of Botulinum Toxin A in the FDA approved Glabellar, Crow’s Feet, and Forehead areas (on a botulinum toxin A)
In addition, areas of the upper face that are not included in the FDA indication will be shared.
These injections are considered off-label use and within accepted and published standards.
LESSON 1: Botulinum toxin A therapy
Alan B. Scott
(1960’s) attempted to find an agent to use on eye muscles for strabismus. First used in 1978 on humans.
Carruthers and Carruthers
(Canadian physicians) did joint dermatological-ophthalmologic research starting in 1987 with Alan Scott.
LESSON 2: Pharmacology
Three step process
01. IRREVERSIBLE binds topresynaptic terminal of motor end plate
02- Internalized into axon by endocytosis
03. Cleavage of SNARE (receptor) proteins resulting in inhibition of neurotransmitter release
SNARE proteins N-ethylmaleimide sensitive factor attachment protein receptor
Each serotype binds to a specific residue of one of the
docking proteins Botox=SNAP-25 Jeuveau=SNAP-25
Dysport=SNAP-25 Xeomin=SNAP-25
Mechanism of Action
Light chain blocks fusion of neurotransmitter
vesicle with nerve membrane by cleaving SNAP-25 with Type A
Botulinum Toxin A Mechanism of Action
Before Botulinum Toxin A: Endplate sits upon muscle fiber
The Botulinum Toxin is internalized via receptor-mediated
endocytosis
Botulinum Toxin A binds to nerve terminal
The endplate expands and collateral axonal sprouts emerge. Sprouts subsequently retract and are eliminated; parent terminal is II I I re-established
BOTOX
(on a botulinum Toxin A)
MANUFACTURER: ALLERGAN
ONSET: 5-7 DAYS
APPROVAL: FULL FACE + THERAPEUTIC
FINAL RESULT: 14 DAYS
SHIPPING: BUSINESS ONLY + ON DRY ICE
Dysport (abobotulinum Toxin A)
MANUFACTURER: GALDERMA
ONSET: 5-7 DAYS
APPROVAL: FULL FACE + THERAPEUTIC
FINAL RESULT: 14 DAYS
SHIPPING: BUSINESS ONLY + ON DRY ICE
- Ratio of diffusion differs from Botox®
- Specific training for Dysport® is
Xeomin (Incobotulinum Toxin A)
MANUFACTURER: MERZ
ONSET: 5-7 DAYS
APPROVAL: FULL FACE + THERAPEUTIC
FINAL RESULT: 14 DAYS
SHIPPING: BUSINESS OR RESIDENTIAL
SHIPPING: ROOM TEMPERATURE
- Ratio of diffusion is similar to Botox.
- However, package insert cautions that the units of biological activity cannot be compared orconverted to other botulinum toxin products using other assay methods.
LESSON 3: Antitoxin
An antitoxin is available if overdose or mis-injection occurs.
Contact your Local or State Health Department to process a request for antitoxin through the CDC. If you do not receive a response within 50 minutes, contact the CDC directly at 770-488-7100.
Antitoxin will not reverse Botulinum toxin induced muscle weakness already apparent by the time antitoxin is administered.
Alternatives to Injectables
Surgery Laser
IPL Topical Skin Products Microdermabrasion
Medical Needling Radiofrequency
LED Light Treatments Microcurrent Toning Chemical Peels
