PROMOTION
ISSUES IN AESTHETIC USES OF BOTULINUM TOXINS
Andy Pickett discusses the considerations health professionals should take when using botulinum toxins in modern-day practice
ANDY PICKETT is Director and Founder of Toxin Science Limited, dedicated to the translation of BoNT science into useful knowledge for clinical applications. He is also Adjunct Professor at the Botulinum Research Center, UMASS Dartmouth in the United States, and currently Head of Development at Q-MED, a Galderma division.
Contact information:
andy@toxinscience.com
for many countries. Surveys, such as those carried out by the American Society of Plastic Surgeons, are valuable insights into this growing use. Their most recent data show 5.4 million BoNT procedures in 2010. However, this is for one society in one country; there must be several times this figure for the worldwide aesthetic use of BoNT. Asia, Latin America and Europe are equally as important markets as the US. The world of BoNT use, mainly as a facial muscle
T
relaxant, is perhaps best shown by data presented at the recent IMCAS meeting in Paris at the end of January 2012. The industry monitor, and perhaps the organisation with the best knowledge on use of aesthetic products in the world, Medical Insights, showed interesting data of BoNT use across the world (Figure 1). The US is still apparently the largest segment, but perhaps that is because the data are more refined and readily available. A picture 5 years from now will be very interesting to see. A number of important and informative consensus
papers that clearly lay down international treatment guidelines for products are now available1–4
. These
consensus guidelines have been developed by leading clinicians across the world, generally for specific products; but the international development of these is very important. Clinicians — both experienced in the products and new to the area — can have confidence in the recommendations that come with such pedigrees. However, with this extended use comes a range of
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more modern issues — those which have not really figured in the evaluation of BoNT use until recently. These subjects can only be considered in light of contemporary data, evidence from well-designed and executed clinical trials, specifically executed to examine modern practice use of BoNT. Of these subjects, this
March 2012 |
prime-journal.com HE EVER-EXPANDING USE OF
botulinum toxin (BoNT) in a range of aesthetic treatments continues unabated. The number of injections performed worldwide each year cannot be estimated as figures do not exist
inf “A number of important and ”
ormative consensus papers that clearly lay down international
treatment guidelines for products are now available.
article will consider just three, all of which are of importance to clinicians, but one is of greatest interest to the business of BoNT — patient satisfaction.
Product characteristics There have been many tables of BoNT product characteristics published over the years. Many of these are incorrect — the data in them are simply wrong. A number of years ago the author published a plea to clinicians producing these data tables; please check the facts with the manufacturers first5
. There are no
reasons to have these data incorrectly presented or worse, blended with unimportant ‘facts’ about the BoNT products that have neither scientific support nor data. This plea seemed to have no effect. Still the data tables appeared with incorrect information about the products. As a result, we decided to collect the important data together and publish these somewhere where at least aesthetic practitioners could easily find them. This emerged in the autumn of 20106
. We
thought we had succeeded, but time has told us that we were wrong. We failed to get authors to recognise the need to check their product data, and also failed to get them to use our work. Publications have continued to emerge with incorrect data tables, some with extensive mistakes7, 8 into 2012.
. This trend has continued Included here, therefore, is a data table of the
products that is correct, current and accurate (Table 1). The parameters listed are only those that are relevant to the clinician. Aspects such as the supposed ‘complex size’ of the products are highly misleading and no longer of any relevance, based on the latest available
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