Botox Party

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Botox Party

  1. 1. BOTOX PARTYDr. Pravin Shaw
  2. 2. Non-Invasive Facial Rejuvenation: Injectables : BOTOX
  3. 3. The Aging Process on the Skin• Collagen turnover is decreased• Facial fat pads fall• Facial volume is reduced• Skin loses elasticity
  4. 4. The Aging Face Matarasso et al. Plast Reconstr Surg 2006;117(3 Suppl):3S-34S
  5. 5. Facial Rejuvenation Treatments • Botulinum toxin • Fillers • Lasers • Peels • Topical products
  6. 6. Botulinum Toxin Type A
  7. 7. Botulinum Toxin Structure Clostridium botulinum is a gram positive, anaerobic, rod-shaped bacterium that produces seven serologically distinct neurotoxins (A-G)1. Non-toxic,non-hemagglutinin (NTNH)Hemagglutinin (HA) 150 kD Neurotoxin 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).
  8. 8. Normal Neuromuscular FunctionArnon et al. JAMA 2001;285(8):1059-1070 (with permission).
  9. 9. Botulinum Toxin Mechanism of ActionArnon et al. JAMA 2001;285(8):1059-1070 (with permission).
  10. 10. Manufacturing and Formulation Comparison 1BOTOX® 2DYSPORT® 3MYOBLOC® FIRST APPROVAL • 1989 • 1991 • 2000 SEROTYPE •A •A •B STRAIN • Hall • NCTC 2916 • Bean RECEPTOR/TARGET • SV2/SNAP-25 • SV2/SNAP-25 • Syt II/VAMP PROCESS • Crystallization • Chromatography • Chromatography COMPLEX SIZE • 900 kD* • > 500 kD^ • 700 kD† UNIFORMITY • Homogeneous • Heterogenous • Homogeneous • HSA • HSA • HSA EXCIPIENTS • Sodium chloride • Lactose • Sodium Succinate • Sodium Chloride STABILIZATION • Vacuum drying • Lyophilization • Solution SOLUBILIZATION • Normal saline • Normal saline • N/A pH • ~7 • ~7 • 5.6 UNITAGE (U/VIAL) • 100 • 500 • 2500, 5000, 10000 PROTEIN (ng/VIAL) • <5 • ≤12.5‡ • ~25, 50, 1001BOTOX 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(Suppl5):S22-S28; ‡Pickett et al. Eur J Neurol 2007;14:e11.
  11. 11. Botulinum toxin• 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
  12. 12. 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
  13. 13. Adverse events• 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 1Botox Cosmetic PI
  14. 14. 1. Frontalis2. Procerus3. Corrugator supercilli4. Depressor supercilli 15. Temporalis 56. Obicularis oculi 37. Nasalis 28. Levator labaii superioris 4 alaeque nasi9. Levator labaii 610. Zygomaticus minor 8 711. Zygomaticus major 10 912. Obicularis oris 1113. Modeolus 12 1314. Masseter 1415. Depressor anguli oris16. Depressor labii 15 16 1717. Mentalis
  15. 15. Facial Areas Commonly Treated with BoNT- A Forehead Glabellar lines Brow lift Bunny lines Crow’s feet Perioral linesGummy smile Oral commissures Peau d’orange Platsymal bands
  16. 16. BoNT-A treatment: Forehead lines Before After - Day 30After - Day 120 Carruthers & Carruthers. Dermatol Surg 2007;33:S10-S17
  17. 17. BoNT-A treatment: Forehead lines Before After - Day 30 Carruthers & Carruthers. Dermatol Surg 2003;29:461-67
  18. 18. X X X XForehead X X X XUnits Female: Male:
  19. 19. BoNT-A treatment: Glabellar lines Before After - Day 30 www.Botox.com
  20. 20. BoNT-A treatment: Glabellar lines After - Day 30Before After - Day 120 www.Botox.com
  21. 21. GlabellaUnits X X Female: X X Male: X
  22. 22. BoNT-A treatment: Brow lift Before After Coleman & Carruthers. Dermatol Therap 2006;19:177-88
  23. 23. Brow liftUnits Female: X X X X X X Male: X
  24. 24. BoNT-A treatment: Perioral lines Before After Kane. Oral Maxillofacial Surg Clin N Am 2005;17:41-49
  25. 25. Perioral linesUnits Female: Male: X X X X
  26. 26. BoNT-A treatment: Gummy smile Before After Kane. Oral Maxillofacial Surg Clin N Am 2005;17:41-49
  27. 27. Gummy smileUnits Female: Male: X X
  28. 28. BoNT-A treatment: Oral commissures Before After Carruthers & Carruthers. Dermatol Surg 2003;29:468-76
  29. 29. Oral commisuresUnits Female: Male: X X
  30. 30. BoNT-A treatment: Peau d’orange Before After Kane. Oral Maxillofacial Surg Clin N Am 2005;17:41-49
  31. 31. Peau d’orangeUnits Female: Male: X X
  32. 32. BoNT-A treatment: Platsymal bands Before After Carruthers & Carruthers. Dermatol Surg 2003;29:468-76

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