Aesthetics Department: Differentiating Toxins on New Turf
Dawn P. Sagrillo BSN, RN, CPSN

Plastic Surgical Nursing
March 2011 
Volume 31  Number 1
Pages 36 - 38
  PDF Version Available!

In 2009, more than 2.5 million procedures using botulinum neurotoxin type A were performed in the United States (The American Society for Aesthetic Plastic Surgery, 2010). Despite the glabellar region being the only aesthetic indication for this neurotoxin with US Food and Drug Administration (FDA) approval, the literature is extensive with reports of successful treatments encompassing the face and neck, with and without combination therapies such as dermal fillers, laser/light-based treatments and skin care. A variety of therapeutic indications for neurotoxins also exist. The role of neurotoxins in aesthetic and therapeutic arenas has expanded along with injection approaches, facial rejuvenation modalities, and available botulinum neurtoxin type A (BoNTa) agents.In the United States today, there are two BoNTa agents approved for aesthetic indications. Botox (Allergan, Irvine, CA) was approved in 2002. In April 2009, Dysport (Medicis, Scottsdale, AZ) received FDA approval for the same aesthetic indication of temporary improvement in the appearance of moderate to severe glabellar lines.With the emergence of more neurotoxins on US turf, it is crucial for clinicians to understand the similarities and differences between these agents. In this inaugural issue of Plastic Surgical Nursing Journal's Aesthetic Department, a clinical update of each botulinum neurotoxin type A product currently FDA approved and those on the horizon will be presented.In it's innate form, botulinum neurotoxin type A complexes are a combination of a 150-kDa active moiety (the neurotoxin), surrounding hemagglutinin complexing proteins, and nontoxin nonhemagglutinin proteins that are of varying size. The complexing proteins protect the neurotoxin from the acidic environment of the stomach, when ingested orally. The complexing protein's role, when injected, is said to be unknown. Each neurotoxin has a different molecular weight, which has led to discussions and debate as to diffusion; the extent of

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