botox party

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