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The Use of Botulinum Neurotoxin Type A in Aesthetics: Key Clinical Postulates

Nestor, Mark S. MD, PhD*,†; Kleinfelder, Raymond E. DO*,‡; Pickett, Andy PhD§,¶,‖

doi: 10.1097/DSS.0000000000001412
Original Article
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BACKGROUND The most common aesthetic procedure performed worldwide is the injection of botulinum neurotoxin Type A (BoNT-A). Aesthetic providers must fully comprehend the objective scientific data, theoretical mechanisms of action, and differences between brands of BoNT-A.

OBJECTIVE To determine and review the relevant clinical postulates for the use of botulinum toxin in aesthetics.

MATERIALS AND METHODS The BoNT-A clinical postulates presented here discuss how each brand of BoNT-A acts identically, how the molecular potency may vary between the different products, how patient age, gender, genetics, and muscle mass cause variation in toxin receptor number and density, and how both practitioner and patient can affect toxin distribution.

RESULTS A total of 8 clinical postulates have been identified that are key to understanding the use of botulinum toxin in aesthetics and to obtaining the best clinical results.

CONCLUSION All of these factors affect the potential efficacy of the injected toxin and hence the aesthetic results obtained.

*Center for Clinical and Cosmetic Research & Center for Cosmetic Enhancement, Aventura, Florida;

Department of Dermatology and Cutaneous Surgery and the Department of Surgery, Division of Plastic Surgery, University of Miami Leonard Miller School of Medicine, Miami, Florida;

Larkin Community Hospital, Palm Springs Campus, Hialeah, Florida;

§Toxin Science Limited, Wrexham, United Kingdom;

Botulinum Research Center, Institute of Advanced Sciences, Dartmouth, Massachusetts;

Galderma Aesthetic and Corrective Global Business Unit, Uppsala, Sweden

Address correspondence and reprint requests to: Andy Pickett, PhD, Galderma Uppsala, Seminariegatan 21, 75228 Uppsala, Sweden, or e-mail: andy@toxinscience.com

M.S. Nestor has received grants and personal fees for research and consulting from Galderma and Croma. He has also received a research grant from Evolus. The remaining authors have indicated no significant interest with commercial supporters.

The comments, statements, and opinions expressed by A. Pickett are those of the author and Toxin Science Limited only.

© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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