Abstract
Since its development for aesthetic use, botulinum toxin type A rapidly became one of the most popular cosmetic procedures. It is a fast minimally invasive and low-risk procedure, used with high efficacy in facial and non-facial indications.
Three commercial formulations are approved for cosmetic use, but they are not interchangeable. Dose equivalences between these formulations have been studied to provide similar results. The field of effects of all toxins is dose dependent.
Glabella was the first cosmetic indication approved by the regulatory agencies. Initially, only upper facial indications were targeted. Over time, middle and lower face indications and also non-facial indications started to be treated with successful results.
Proper technique, knowledge of facial anatomy, and correct evaluation of each individual’s characteristics are essential to obtain the best efficacious results. Non-cosmetic and cosmetic side effects may occur after the use of botulinum toxin type A. They are mostly technique related, mild, and transitory.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Lamanna C, McElroy OE, Eklund HW. The purification and crystallization of clostridium botulinum type A toxin. Science. 1946;103(2681):613–4.
Kegeles G. The molecular size and shape of botulinus toxin. J Am Chem Soc. 1946;68:1670.
Putnam FW, Lamanna C, Sharp DG. Molecular weight and homogeneity of crystalline botulinus A toxin. J Biol Chem. 1946;165(2):735.
Putnam FW. Physical chemical properties of crystalline botulinus A toxin. Fed Proc. 1947;6(1 Pt 2):284.
Scott AB, Rosenbaum A, Collins CC. Pharmacologic weakening of extraocular muscles. Investig Ophthalmol. 1973;12:924–7.
Carruthers A, Carruthers J. You want to inject what? Dermatol Surg. 2015;41(Suppl 1):S2–8.
Carruthers JD, Carruthers JA. Treatment of glabellar frown lines with C. botulinum-A exotoxin. J Dermatol Surg Oncol. 1992;18:17–21.
Peck MW, Smith TJ, Anniballi F, et al. Historical perspectives and guidelines for botulinum toxins neurotoxin subtype nomenclature basel. Toxins. 2017;9(1):pii: E38.
Pellett S, Tepp WH, Bradshaw M, et al. Purification and characterization of botulinum neurotoxin FA from a genetically modified clostridium botulinum strain. mSphere. 2016;1(1):pii: e00100–15.
Shelley WB, Talanin NY, Shelley ED. Botulinum toxin therapy for palmar hyperhidrosis. J Am Acad Dermatol. 1998;38(2 Pt 1):227–9.
Schnider P, Binder M, Auff E, Kittler H, Berger T, Wolff K. Double-blind trial of botulinum A toxin for the treatment of focal hyperhidrosis of the palms. Br J Dermatol. 1997;136(4):548–52.
Li ZJ, Park SB, Sohn KC, et al. Regulation of lipidproduction by acetylcholine signalling in human sebaceous glands. J Dermatol Sci. 2013;72(2):116–22.
Khan TT, Herne K, Dayan SH, Woodward JA. Facial blanching due to neurotoxins: proposed mechanisms. Dermatol Surg. 2013;39(1 Pt 1):24–9.
Finzi E, Rosenthal NE. Treatment of depression with onabotulinumtoxinA: a randomized, double-blind, placebo controlled trial. J Psychiatr Res. 2014;52:1–6.
Heckmann M, Teichmann B, Schröder U, Sprengelmeyer R, Ceballos-Baumann AO. Pharmacologic denervation of frown muscles enhances baseline expression of happiness and decreases baseline expression of anger, sadness, and fear. J Am Acad Dermatol. 2003;49(2):213–6.
Hexsel D, Brum C, Siega C, et al. Evaluation of self-esteem and depression symptoms in depressed and nondepressed subjects treated with onabotulinumtoxinA for glabellar lines. Dermatol Surg. 2013;39(7):1088–96.
Magid M, Reichenberg JS, Poth PE, et al. Treatment of major depressive disorder using botulinum toxin A: a 24-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2014;75(8):837–44.
Wollmer MA, de Boer C, Kalak N, et al. Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res. 2012;46(5):574–81.
Xiao Z, Zhang M, Liu Y, Ren L. Botulinum toxin type a inhibits connective tissue growth factor expression in fibroblasts derived from hypertrophic scar. Aesthet Plast Surg. 2011;35(5):802–7.
Xiaoxue W, Xi C, Zhibo X. Effects of botulinum toxin type A on expression of genes in keloid fibroblasts. Aesthet Surg J. 2014;34(1):154–9.
ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000 Feb 29 – Identifier NCT02939326, Evaluate safety and efficacy of a single treatment cycle of EB-001 in subjects with Glabellar Frown Lines; 2016 Oct 11 [cited 2017 Aug 21]; [about 5 screens]. Available from: https://clinicaltrials.gov/ct2/show/study/NCT02939326?term=bonti&rank=2.
Dessy LA, Fallico N, Mazzocchi M, Scuderi N. Botulinum toxin for glabellar lines: a review of the efficacy and safety of currently available products. Am J Clin Dermatol. 2011;12(6):377–88.
Karsai S, Raulin C. Current evidence on the unit equivalence of different botulinum neurotoxin A formulations and recommendations for clinical practice in dermatology. Dermatol Surg. 2009;35(1):1–8.
Hexsel D, Brum C, do Prado DZ, et al. Field effect of two commercial preparations of botulinum toxin type A: a prospective, double-blind, randomized clinical trial. J Am Acad Dermatol. 2012;67(2):226–32.
Carruthers J, Fournier N, Kerscher M, Ruiz-Avila J, Trindade de Almeida AR, Kaeuper G. 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 II: incorporating botulinum toxin into aesthetic clinical practice. Dermatol Surg. 2013;39(3 Pt 2):510–25.
Dressler D. Comparing Botox and Xeomin for axillar hyperhidrosis. J Neural Transm. 2010;117:317–9.
Dressler D, Mander G, Fink K. Measuring the potency labelling of onabotulinumtoxinA (Botox®) and incobotulinumtoxinA (Xeomin®) in an LD50 assay. J Neural Transm (Vienna). 2012;119(1):13–5.
Sattler G, Callander MJ, Grablowitz D, et al. Noninferiority of incobotulinumtoxinA, free from complexing proteins, compared with another botulinum toxin type A in the treatment of glabellar frown lines. Dermatol Surg. 2010;36:2146–54.
Hexsel D, Hexsel C, Siega C, Schilling-Souza J, Rotta FT, Rodrigues TC. Fields of effects of 2 commercial preparations of botulinum toxin type A at equal labeled unit doses: a double-blind randomized trial. JAMA Dermatol. 2013;149(12):1386–91.
Fagien S, Raspaldo H. Facial rejuvenation with botulinum neurotoxin: an anatomical and experiential perspective. J Cosmet Laser Ther. 2007;9(Suppl 1):23–31.
Sundaram H, Signorini M, Liew S, et al. Global aesthetics consensus: botulinum toxin Type A--evidence-based review, emerging concepts, and consensus recommendations for aesthetic use, including updates on complications. Plast Reconstr Surg. 2016;137(3):518e–29e.
Sundaram H, Huang PH, Hsu NJ, et al. Aesthetic applications of botulinum toxin A in Asians: an international, multidisciplinary, Pan-Asian consensus. Plast Reconstr Surg Glob Open. 2016;4(12):e872.
de Maio M. Ethnic and gender considerations in the use of facial injectables: male patients. Plast Reconstr Surg. 2015;136(5 Suppl):40S–3S.
Dayan SH, Ashourian N. Considerations for achieving a natural face in cosmetic procedures. JAMA Facial Plast Surg. 2015;17(6):395.
Sundaram H, Liew S, Signorini M, et al. Global aesthetics consensus: hyaluronic acid fillers and botulinum toxin type A-recommendations for combined treatment and optimizing outcomes in diverse patient populations. Plast Reconstr Surg. 2016;137(5):1410–23.
Carruthers A, Carruthers J, Monheit GD, Davis PG, Tardie G. Multicenter, randomized, parallel-group study of the safety and effectiveness of onabotulinumtoxinA and hyaluronic acid dermal fillers (24-mg/mL Smooth, Cohesive Gel) alone and in combination for lower facial rejuvenation. Dermatol Surg. 2010;36:2121–34.
Wu WT. Microbotox of the lower face and neck: evolution of a personal technique and its clinical effects. Plast Reconstr Surg. 2015;136(5 Suppl):92S–100S.
Steinsapir KD, Rootman D, Wulc A, Hwang C. Cosmetic microdroplet botulinum toxin A forehead lift: a new treatment paradigm. Ophthal Plast Reconstr Surg. 2015;31(4):263–8.
Bloom BS, Payongayong L, Mourin A, Goldberg DJ. Impact of intradermal abobotulinumtoxinA on facial erythema of rosacea. Dermatol Surg. 2015;41(Suppl 1):S9–16.
Rose AE, Goldberg DJ. Safety and efficacy of intradermal injection of botulinum toxin for the treatment of oily skin. Dermatol Surg. 2013;39(3 Pt 1):443–8.
Jeong HS, Lee BH, Sung HM, et al. Effect of botulinum toxin type A on differentiation of fibroblasts derived from scar tissue. Plast Reconstr Surg. 2015;136(2):171e–8e.
Shaarawy E, Hegazy RA, Abdel Hay RM. Intralesional botulinum toxin type A equally effective and better tolerated than intralesional steroid in the treatment of keloids: a randomized controlled trial. J Cosmet Dermatol. 2015;14(2):161–6.
Prodromidou A, Frountzas M, Vlachos DE, et al. Botulinum toxin for the prevention and healing of wound scars: a systematic review of the literature. Plast Surg (Oakv). 2015;23(4):260–4.
Haubner F, Leyh M, Ohmann E, Sadick H, Gassner HG. Effects of botulinum toxin A on patient-specific keloid fibroblasts in vitro. Laryngoscope. 2014;124(6):1344–51.
Cavallini M, Cirillo P, Fundarò SP, et al. Safety of botulinum toxin A in aesthetic treatments: a systematic review of clinical studies. Dermatol Surg. 2014;40(5):525–36.
Jia Z, Lu H, Yang X, et al. Adverse events of botulinum toxin type A in facial rejuvenation: a systematic review and meta-analysis. Aesthet Plast Surg. 2016;40(5):769–77.
Ascher B, Talarico S, Cassuto D, et al. International consensus recommendation on the aesthetic usage of botulinum toxin type A (Speywood unit)--part I: upper facial wrinkles. J Eur Acad Dermatol Venereol. 2010;24(11):1278–84.
Ascher B, Talarico S, Cassuto D, et al. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit)--Part II: Wrinkles on the middle and lower face, neck and chest. J Eur Acad Dermatol Venereol. 2010;24(11):1285–95.
Hexsel DM, Dal Forno T, Soirefmann M, Porto MD, Hexsel CL. Effective, low-cost, simple, disposable cooling tool for patient comfort in common dermatologic procedures. Dermatol Surg. 2013;39(9):1402–4.
Carruthers J, Rivkin A, Donofrio L, et al. A multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of repeated onabotulinumtoxinA treatments in subjects with Crow’s Feet Lines and Glabellar Lines. Dermatol Surg. 2015;41(6):702–11.
Fabbri M, Leodori G, Fernandes RM, et al. Neutralizing antibody and botulinum toxin therapy: a systematic review and meta-analysis. Neurotox Res. 2016;29(1):105–17.
Naumann M, Boo LM, Ackerman AH, Gallagher CJ. Immunogenicity of botulinum toxins. J Neural Transm (Vienna). 2013;120(2):275–90.
Cohen JL, Dayan SH, Cox SE, Yalamanchili R, Tardie G. OnabotulinumtoxinA dose-ranging study for hyperdynamic perioral lines. Dermatol Surg. 2012;38(9):1497–505.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Hexsel, D., Camozzato, F., Siega, C. (2020). Introduction: What Is Botulinum Toxin?. In: Costa, A. (eds) Minimally Invasive Aesthetic Procedures . Springer, Cham. https://doi.org/10.1007/978-3-319-78265-2_25
Download citation
DOI: https://doi.org/10.1007/978-3-319-78265-2_25
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-78264-5
Online ISBN: 978-3-319-78265-2
eBook Packages: MedicineMedicine (R0)