Comparison of different consensuses of BTXA in different countries

Abstract

The most international dosing guidelines on the use of botulinum toxin type A (BTXA) drugs support a 1:1 dose relationship between OnaBTXA and IncoBTXA and 1:2.5 between OnaBTXA and AboBTXA. However, different facial zones demonstrate different doses conversion ratios. The comparative analysis of nine consensuses on the use of Abo-, Ona-, and IncoBTXA in the United States, Russia, and Europe has been performed. We conducted a review of publications adopting the key words "botulinum toxin consensus," "botulinum toxin guideline." Information search has been carried out primarily in specialized databases (DB). To find the relevant RCTs and guidelines/consensuses, the following databases were used: PubMed and Medline that were screened up to May 2008. Results regarding dose ratios for OnaBTXA:AboBTXA and IncoBTXA:AboBTXA showed that in most cases it is characterized both by increase and by decrease compared to the ratio of 1:2.5. The mean value of dose ratios OnaBTXA:AboBTXA adopted in the United States is 1:2.8. The ratio IncoBTXA:AboBTXA according to international and Russian data is 1:1.9. There are some differences in clinical approach of BTXA use in certain countries. In Russia, low doses are recommended for "crow's feet" and forehead. The US consensus recommends a higher dosage to correct perioral wrinkles. Despite many years of experience in using BTXA, there is no strict international uniformity of clinical guidelines. The recommended doses for the individual areas of the face may differ in different countries. Therefore, physicians in their practice should be guided not by international consensuses, but prefer a national guidelines.

Botulinum toxin application in facial esthetics and recent treatment indications (2013-2018)

“…The cosmetic indications such as crow's feet, vertical and horizontal frown, wrinkles on the nose, upper lip rhytids, nasolabial fold, horizontal and vertical neck bands, scar management, and pebbly chin. [715161718192021222324252627282930313233343536373839404142] The noncosmetic indications are migraine, strabismus, hemifacial spasm, bruxism, blepharospasm, spasmodic torticollis, postfacial nerve palsy synkinesis, hyperhidrosis, and esophageal achalasia. [434445464748]…”

“…Review of literature provides more information on dosage preferences by practitioners. [42] BT is potent and very expensive, so each drop must be used cautiously even 0.0125 mL is effective in certain areas. [8] The comparison of the average doses of different BT products for different esthetic purposes showed a significant deviation from accepted 1:1 equivalence coefficients for OnaBTXA: IncoBTXA and 1:2.5 for OnaBTXA: AboBTXA, depending on a particular area of the face.…”

“…[8] The comparison of the average doses of different BT products for different esthetic purposes showed a significant deviation from accepted 1:1 equivalence coefficients for OnaBTXA: IncoBTXA and 1:2.5 for OnaBTXA: AboBTXA, depending on a particular area of the face. [42] Hence, the clinician can follow national guidelines with their experience during various esthetic procedures.…”

Types of periocular wrinkles based on anatomical and contractile characteristics of participating periocular muscles: A modified classification method and personalized injection technique

“…wrinkles around the lower eyelid due to concerns of lower eyelid pouch aggravation. 5 Lower eyelid injections for wrinkle types I.III and II should be carefully performed to balance the orbicularis oculi muscle between the eyelid and the orbital and septal regions and reduce the impact on the anterior orbicularis oculi muscle (Figure 1), as these regions are very close to the lacrimal groove ligament complex. Otherwise, the lower eyelid is flattened, which loses aesthetic value.…”

“…4 Most existing techniques for periocular wrinkle reduction target only a portion of the periocular wrinkles, such as the "crow's feet," but fail to treat the inner canthus and lower eyelid wrinkles. 5 These techniques are exceedingly homogeneous, featuring few injection sites in a fixed location, many single-site injections, and a lack of individualized treatment options for patients, especially in East Asian populations. [6][7][8][9][10] This article describes a modified classification of periorbital wrinkles that considers all of the participating muscles.…”