Botox: Shaken, Not Stirred

Kazim, N.A.; Black, Evan H.

doi:10.1097/iop.0b013e3181607475

Cited by 20 publications

(13 citation statements)

References 8 publications

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“… 44 However, compelling evidence now suggests that reconstitution using preserved saline dramatically improves patient comfort without compromising efficacy. 50 – 54 In addition, aggressive reconstitution may reduce efficacy. 44 , 55 …”

Section: Myth 5: Reconstitution Solution Mattersmentioning

confidence: 99%

“…Some studies suggest that vigorous reconstitution may undermine outcomes. Kazim and Black 54 injected one side of the foreheads of 7 consecutive patients with BoNT-A that had been reconstituted vigorously and the other side with product gently reconstituted, as recommended by the manufacturers. There was no difference between the results obtained with the 2 reconstitution methods during the 6-month follow-up.…”

Section: Myth 5: Reconstitution Solution Mattersmentioning

confidence: 99%

“…There was no difference between the results obtained with the 2 reconstitution methods during the 6-month follow-up. 54 …”

Section: Myth 5: Reconstitution Solution Mattersmentioning

confidence: 99%

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Botulinum Toxin in Aesthetic Medicine: Myths and Realities

Dover

Monheit²,

Greener³

et al. 2018

Dermatol Surg

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BACKGROUNDSeveral formulations of Botulinum toxin serotype A (BoNT-A) for aesthetic indications are available, with numbers likely to increase. Preparations are not interchangeable, based on dose unit comparisons.OBJECTIVENumerous myths and misconceptions regarding the use of BoNT-A for aesthetic indications have arisen, which this review aims to lay to rest.MATERIALS AND METHODSThis review assesses evidence for and against each of the most common myths regarding BoNT use in aesthetics.RESULTSBoNT-A neurotoxin/protein complexes are irrelevant to the toxin's therapeutic/aesthetic indications. BoNT-A neurotoxin/protein complexes do not influence movement from injection site or immunogenicity. Any relationship between neutralizing antibody formation and clinical response is complex and clinicians should consider other factors that may induce an apparent loss of clinical response. Diffusion appears predominately, perhaps exclusively, dose dependent. Careful placement and correct dosing optimizes likelihood of good outcomes. Manufacturers recommend reconstitution of products with sterile nonpreserved saline. However, compelling evidence suggests that reconstitution using preserved saline dramatically improves patient comfort without compromising efficacy. Several post-treatment instructions/restrictions are widely used despite the lack of evidence, but muscle activity after injection may be beneficial. Cooling the treatment area might hinder BoNT-A translocation and should probably be abandoned.CONCLUSIONThe existing evidence suggests that experienced users should achieve equivalent results regardless of BoNT-A formulation, but additional, well-designed, adequately powered, controlled randomized studies should be performed.

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Section: Myth 5: Reconstitution Solution Mattersmentioning

confidence: 99%

Section: Myth 5: Reconstitution Solution Mattersmentioning

confidence: 99%

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Botulinum Toxin in Aesthetic Medicine: Myths and Realities

Dover

Monheit²,

Greener³

et al. 2018

Dermatol Surg

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“… 76 This was supported by a prospective, double-blinded, randomized study carried out by Kazim and Black who used a Vortex Touch Model 232 at maximum speed for 30 seconds (vigorous reconstitution of ONA). 77 The 2004 consensus panel has reported that the fragility of BoNT-A is not as previously reported. 78 It is now understood that a lot of the precautions, mainly recommended by the manufacturers, are “too restrictive”.…”

Section: Reconstitutionmentioning

confidence: 86%

Botulinum neurotoxin formulations: overcoming the confusion

Samizadeh¹,

Boulle²

2018

CCID

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Botulinum toxin A is produced by anaerobic spore-forming bacteria and is used for various therapeutic and cosmetic purposes. Botulinum toxin A injections are the most popular nonsurgical procedure worldwide. Despite an increased demand for botulinum toxin A injections, the clinical pharmacology and differences in formulation of commonly available products are poorly understood. The various products available in the market are unique and vary in terms of units, chemical properties, biological activities, and weight, and are therefore not interchangeable. For safe clinical practice and to achieve optimal results, the practitioners need to understand the clinical issues of potency, conversion ratio, and safety issues (toxin spread and immunogenicity). In this paper, the basic clinical pharmacology of botulinum toxin A and differences between onabotulinum toxin A, abobotulinum toxin A, and incobotulinum toxin A are discussed.

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“…It was shown that the preparation style of the toxin did not alter the efficacy and the duration of action could still be sustained after reconstitution till 6th week. [9][10][11][12] Additionally, while most manufacturers recommend unpreserved saline for reconstitution, 4 so many contents including lidocaine, epinephrine, bupivacaine, and albumin showed similar or superior efficacy without any side effects and in 2004, a consensus panel recommended preserved saline as the ideal diluent. 3 Except, incobotulinum toxin A (IncoBONT-A), all BONT types are subject to cold chain applications that need to be supplied at every stage ranging from the production, distribution to the administration.…”

Section: Discussionmentioning

confidence: 99%

Bioactivity of abobotulinum toxin is preserved till 2 weeks upon storage at room temperature: Half body comparative study on rabbit model

Esme

Botsalı

Erbil

et al. 2020

J of Cosmetic Dermatology

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Botulinum neurotoxin (BONT) is the most commonly used minimal invasive cosmetic procedure. It is known as a most potent toxin to human being and caused to deaths of many people in the 17th century due to botulism. Today, it has been approved as a therapeutic agent for various cosmetic and medical purposes all over the world. 1 The action mechanism of BONT includes several steps, and the most important is the inhibition of acetylcholine (Ach) release from the synaptic vesicle, thus compromising signal induction through the neuromuscular junction. 2 Consensus panel published about BONT in 2004 suggests that BONT may not be as fragile as previously supposed due to its complex protein contents. 3,4 Numerous precious studies have eliminated some of the taboos about our understanding of BONT, and one of the most important foundations of these studies was

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Botox: Shaken, Not Stirred

Abstract: The effect of botulinum toxin type A is maintained and has the same duration when it is reconstituted vigorously compared with when it is reconstituted gently.

Cited by 20 publications

References 8 publications

Botulinum Toxin in Aesthetic Medicine: Myths and Realities

Botulinum Toxin in Aesthetic Medicine: Myths and Realities

Botulinum neurotoxin formulations: overcoming the confusion

Bioactivity of abobotulinum toxin is preserved till 2 weeks upon storage at room temperature: Half body comparative study on rabbit model

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