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The Effect of Albumin and Platelet-Poor Plasma Supplemented Botulinum A Toxin on Bioavaliability: An Experimental Rabbit Model

Sibar, Serhat MD; Findikcioglu, Kemal MD; Zinnuroglu, Murat MD; Cenetoglu, Seyhan MD

doi: 10.1097/SAP.0000000000000957
Peripheral Nerve Surgery and Research

Today, botulinum toxin is commonly used for cosmetic purposes throughout the world. Despite various agents reducing the efficiency of toxin are well defined, the studies related to increasing the bioavailability are limited. The purpose of our study is to assess the effect of the preparation of toxin by diluting with platelet-poor plasma (PPP) and/or albumin instead of standard dilution (saline) on bioavailability in cosmetic-purpose botulinum toxin applications.

In the study, 24 New Zealand rabbits were used. Right anterior auricular muscle was preferred for toxin injections. Subjects were divided in 4 groups and in every group; botulinum A toxin (BTxA) that was prepared by different dilution methods was injected. 2.5 U saline-diluted BTxA was injected to the subjects in group 1, 2.5 U ready-to-use rabbit albumin-diluted BTxA was injected to group 2 and 2.5 U autologous PPP-diluted BTxA was injected to group 3 and pure saline was injected to group 4.

Before the injection (0th week) and in the second, sixth, and 12th weeks after the injection, visual and electroneuromyographic evaluations of the ears of the subjects were performed.

In the second week, median amplitude levels in group 2 were significantly found lower than other groups.

In the sixth week, median amplitude levels in group 1 were significantly found lower than other groups.

In 12th week, no significant difference was found among all the groups in terms of median amplitude levels.

Visual findings were also correlated with electroneuromyographic findings.

It was observed that the dilution of BTxA with albumin had caused a stronger paralysis when compared to dilution with saline or PPP at the beginning (second week); however, in the following weeks (sixth week), it was seen that dilution with saline had maintained paralysis better when compared with other dilution methods.

In cosmetic BTxA applications, dilution of the toxin with albumin or PPP instead of standard dilution has no positive effect on bioavailability and such modifications regarding this kind of dilution are found unsuitable. Further studies are needed to directly relate the results with clinical applications.

From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Duzce Ataturk State Hospital, Duzce; †Department of Plastic, Reconstructive and Aesthetic Surgery, and ‡Department of Physical Therapy and Rehabilitation, Gazi University Hospital, Ankara, Turkey.

Received August 6, 2016, and accepted for publication, after revision October 24, 2016.

Conflicts of interest and sources of funding: none declared.

Reprints: Serhat Sibar, MD, Department of Plastic, Reconstructive and Aesthetic Surgery, Duzce Ataturk State Hospital, Aziziye Mh., Merkez, 81010 Duzce, Turkey. E-mail:

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