BOTOX PARTY Dr. Pravin Shaw
BOTOX PARTY
Dr. Pravin Shaw
Non-Invasive Facial Rejuvenation:
Injectables : BOTOX
• Collagen turnover is decreased
• Facial fat pads fall• Facial volume is
reduced• Skin loses elasticity
The Aging Process on the Skin
The Aging Face
Matarasso et al. Plast Reconstr Surg 2006;117(3 Suppl):3S-34S
• Botulinum toxin• Fillers• Lasers• Peels• Topical products
Facial Rejuvenation Treatments
Botulinum Toxin Type A
Botulinum Toxin Structure
1Hathaway. In: Hauschild AHW, ed. Clostridium Botulinum: Ecology and Control in Foods New York, NY: Marcel Dekker, Inc.;1993;54:pp 3-20.
2Inoue et al. Infect Immun 1996;64:1589-1594.3Lacy et al. Nat Struct Biol 1998;5:898-902 (with permission).
150 kD Neurotoxin
Non-toxic, non-hemagglutinin
(NTNH)
Hemagglutinin (HA)
Clostridium botulinum is a gram positive, anaerobic, rod-shaped bacterium that produces seven serologically distinct neurotoxins (A-G)1.
Normal Neuromuscular Function
Arnon et al. JAMA 2001;285(8):1059-1070 (with permission).
Botulinum Toxin Mechanism of Action
Arnon et al. JAMA 2001;285(8):1059-1070 (with permission).
Manufacturing and Formulation Comparison
• 1989 • 1991 • 2000
• A • A • B
• Hall • NCTC 2916 • Bean
• SV2/SNAP-25 • SV2/SNAP-25 • Syt II/VAMP
• Crystallization • Chromatography • Chromatography
• 900 kD*• Homogeneous
• > 500 kD^• Heterogenous
• 700 kD†
• Homogeneous
• HSA • Sodium chloride
• HSA • Lactose
• HSA• Sodium Succinate• Sodium Chloride
• Vacuum drying• Normal saline• ~7
• Lyophilization• Normal saline• ~7
• Solution• N/A• 5.6
• 100 • 500 • 2500, 5000, 10000
• <5 • ≤12.5‡ • ~25, 50, 100
1BOTOX® 2DYSPORT® 3MYOBLOC®
1BOTOX PI, Allergan, Inc., 2004; 2DYSPORT SPC, Ipsen, 2004; 3MYOBLOC PI, Solstice Neurosciences, 2004; *Schantz and Johnson. Microbial Rev 1992;56:80-99; Allergan Inc., data on file, 2005; ^Hambleton. J Neurol 1992;239:16-20; †Setler. Neurology 2000:55(Suppl 5):S22-S28; ‡Pickett et al. Eur J Neurol 2007;14:e11.
SEROTYPE
STRAIN
PROCESS
COMPLEX SIZEUNIFORMITY
EXCIPIENTS
STABILIZATIONSOLUBILIZATION
pH
UNITAGE (U/VIAL)
FIRST APPROVAL
PROTEIN (ng/VIAL)
RECEPTOR/TARGET
• Botulinum toxin type A (BoNT-A) works by blocking the release of a neurotransmitter necessary for muscles to contract
• The effects of BoNT-A last approximately 3-4 months, with complete re-activation of the nerves and muscles
• BoNT-A has been available and used for therapeutic uses since 1980
Botulinum toxin
• Botulinum toxin treatment has consistently been the top cosmetic procedure, with >2.7M procedures in 2007
• Botulinum toxin type A for cosmetic use was approved in the U.S. in 2002 under the name “Botox Cosmetic”
• Botox Cosmetic is indicated for the temporary improvement of moderate to severe frown lines
Botulinum toxin
• Adverse events to botulinum toxin treatment are usually mild and resolve on their own within a few days
• AEs include: headache, swelling, pain at the injection site, and bruising
Adverse events
1Botox Cosmetic PI
1. Frontalis
2. Procerus
3. Corrugator supercilli
4. Depressor supercilli
5. Temporalis
6. Obicularis oculi
7. Nasalis
8. Levator labaii superioris alaeque nasi
9. Levator labaii
10. Zygomaticus minor
11. Zygomaticus major
12. Obicularis oris
13. Modeolus
14. Masseter
15. Depressor anguli oris
16. Depressor labii
17. Mentalis
1
2
3
4
5
6
78
910
11
1213
14
15
16 17
Facial Areas Commonly Treated with BoNT-A
Forehead
Brow lift
Perioral lines
Platsymal bands
Glabellar lines
Oral commissures
Peau d’orange
Gummy smile
Crow’s feetBunny lines
BoNT-A treatment: Forehead lines
Carruthers & Carruthers. Dermatol Surg 2007;33:S10-S17
Before After - Day 30
After - Day 120
BoNT-A treatment: Forehead lines
Carruthers & Carruthers. Dermatol Surg 2003;29:461-67
Before After - Day 30
X
XX
X X X
X XForehead
Units
Female:
Male:
BoNT-A treatment: Glabellar lines
Before After - Day 30
www.Botox.com
BoNT-A treatment: Glabellar lines
Before
After - Day 30
After - Day 120
www.Botox.com
XXX
X
X
Glabella
Units
Female:
Male:
BoNT-A treatment: Brow lift
Before After
Coleman & Carruthers. Dermatol Therap 2006;19:177-88
X
XXX
X
Brow lift
Units
Female:
Male:X
X
BoNT-A treatment: Perioral lines
Kane. Oral Maxillofacial Surg Clin N Am 2005;17:41-49
Before After
X X
Perioral lines
Units
Female:
Male:
X X
BoNT-A treatment: Gummy smile
Kane. Oral Maxillofacial Surg Clin N Am 2005;17:41-49
Before After
X
Gummy smile
Units
Female:
Male:
X
BoNT-A treatment: Oral commissures
Carruthers & Carruthers. Dermatol Surg 2003;29:468-76
Before After
X
Oral commisures
Units
Female:
Male:
X
BoNT-A treatment: Peau d’orange
Kane. Oral Maxillofacial Surg Clin N Am 2005;17:41-49
Before After
X
Peau d’orange
Units
Female:
Male:
X
BoNT-A treatment: Platsymal bands
Carruthers & Carruthers. Dermatol Surg 2003;29:468-76
Before After