This document discusses non-invasive facial rejuvenation treatments using botulinum toxin type A (BoNT-A), commonly known as Botox. It provides information on the aging process, various facial rejuvenation treatments, the mechanism and effects of BoNT-A, common treatment areas, and recommended dosing. Adverse events are usually mild and temporary. BoNT-A blocks muscle contraction, improving wrinkles and other signs of aging for 3-4 months. It is the most popular cosmetic procedure due to its minimal downtime and visible results.

1. BOTOX PARTY
Dr. Pravin Shaw

2. Non-Invasive Facial Rejuvenation:
Injectables : BOTOX

3. The Aging Process on the Skin
• Collagen turnover is
decreased
• Facial fat pads fall
• Facial volume is
reduced
• Skin loses elasticity

4. The Aging Face
Matarasso et al. Plast Reconstr Surg 2006;117(3 Suppl):3S-34S

5. Facial Rejuvenation Treatments
• Botulinum toxin
• Fillers
• Lasers
• Peels
• Topical products

6. Botulinum Toxin Type A

7. Botulinum Toxin Structure
Clostridium botulinum is a gram positive, anaerobic, rod-shaped bacterium that
produces seven serologically distinct neurotoxins (A-G)1.
Non-toxic,
non-hemagglutinin
(NTNH)
Hemagglutinin (HA) 150 kD Neurotoxin
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).

8. Normal Neuromuscular Function
Arnon et al. JAMA 2001;285(8):1059-1070 (with permission).

9. Botulinum Toxin Mechanism of Action
Arnon et al. JAMA 2001;285(8):1059-1070 (with permission).

10. Manufacturing and Formulation Comparison
1BOTOX® 2DYSPORT® 3MYOBLOC®
FIRST APPROVAL • 1989 • 1991 • 2000
SEROTYPE •A •A •B
STRAIN • Hall • NCTC 2916 • Bean
RECEPTOR/TARGET • SV2/SNAP-25 • SV2/SNAP-25 • Syt II/VAMP
PROCESS • Crystallization • Chromatography • Chromatography
COMPLEX SIZE • 900 kD* • > 500 kD^ • 700 kD†
UNIFORMITY • Homogeneous • Heterogenous • Homogeneous
• HSA • HSA • HSA
EXCIPIENTS • Sodium chloride • Lactose • Sodium Succinate
• Sodium Chloride
STABILIZATION • Vacuum drying • Lyophilization • Solution
SOLUBILIZATION • Normal saline • Normal saline • N/A
pH • ~7 • ~7 • 5.6
UNITAGE (U/VIAL) • 100 • 500 • 2500, 5000, 10000
PROTEIN (ng/VIAL) • <5 • ≤12.5‡ • ~25, 50, 100
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.

11. Botulinum toxin
• 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

12. 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

13. Adverse events
• 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
1Botox Cosmetic PI

14. 1. Frontalis
2. Procerus
3. Corrugator supercilli
4. Depressor supercilli
1
5. Temporalis
5
6. Obicularis oculi 3
7. Nasalis 2
8. Levator labaii superioris 4
alaeque nasi
9. Levator labaii 6
10. Zygomaticus minor 8 7
11. Zygomaticus major 10 9
12. Obicularis oris 11
13. Modeolus 12
13
14. Masseter
14
15. Depressor anguli oris
16. Depressor labii 15
16 17
17. Mentalis

15. Facial Areas Commonly Treated with BoNT-
A
Forehead
Glabellar lines
Brow lift
Bunny lines
Crow’s feet
Perioral lines
Gummy smile Oral
commissures
Peau d’orange
Platsymal
bands

16. BoNT-A treatment: Forehead lines
Before After - Day 30
After - Day 120
Carruthers & Carruthers. Dermatol Surg 2007;33:S10-S17

17. BoNT-A treatment: Forehead lines
Before After - Day 30
Carruthers & Carruthers. Dermatol Surg 2003;29:461-67

18. X X X X
Forehead
X X X X
Units
Female:
Male:

19. BoNT-A treatment: Glabellar lines
Before After - Day 30
www.Botox.com

20. BoNT-A treatment: Glabellar lines
After - Day 30
Before After - Day 120
www.Botox.com

21. Glabella
Units
X X
Female: X X
Male: X

22. BoNT-A treatment: Brow lift
Before After
Coleman & Carruthers. Dermatol Therap 2006;19:177-88

23. Brow lift
Units
Female: X X
X X
X X
Male: X

24. BoNT-A treatment: Perioral lines
Before After
Kane. Oral Maxillofacial Surg Clin N Am 2005;17:41-49

25. Perioral lines
Units
Female:
Male:
X X X
X

26. BoNT-A treatment: Gummy smile
Before After
Kane. Oral Maxillofacial Surg Clin N Am 2005;17:41-49

27. Gummy smile
Units
Female:
Male:
X X

28. BoNT-A treatment: Oral commissures
Before After
Carruthers & Carruthers. Dermatol Surg 2003;29:468-76

29. Oral commisures
Units
Female:
Male:
X X

30. BoNT-A treatment: Peau d’orange
Before After
Kane. Oral Maxillofacial Surg Clin N Am 2005;17:41-49

31. Peau d’orange
Units
Female:
Male:
X X

32. BoNT-A treatment: Platsymal bands
Before After
Carruthers & Carruthers. Dermatol Surg 2003;29:468-76