madman
Super Moderator
Abstract
Background: Botulinum neurotoxin is one of the most versatile and widely used medical products in the world.
Aims: The review's focus is the plastic and dermatologic uses of botulinum neurotoxin currently supported by published data.
Methods: Relevant clinical articles regarding botulinum neurotoxin use in plastic surgery, dermatology, and general esthetic literature were searched and reviewed.
Results: The search yielded 258 studies. Two hundred articles were excluded following title and abstract review. Twenty-one studies were excluded following full-text screening. A total of 37 studies remained and were discussed in this review.
Conclusions: Botulinum neurotoxin is widely used for numerous off-label indications from head to toe. Some uses are well documented, and their safety has been demonstrated in controlled trials, yet most remain poorly researched.
1 | INTRODUCTION
Botulinum neurotoxin (BTX) is derived from the gram-positive, rodshaped, spore-forming bacterium Clostridium botulinum. Seven different toxins (A to G) originate from different strains of C. botulinum. Types A, B, E, and F are most commonly associated with human disease.1 Types A and B are available for commercial use, and since type A is the most potent form, it is the most frequently used clinically.2
The first published use of the toxin clinically was made in 1980 by Alan B. Scott, an ophthalmologist using botulinum toxin to treat strabismus. Scott used the type A formulation to weaken the muscle responsible for the strabismus.3 He called the drug Oculinum (now known as BOTOX®) and later sold the formulation to Allergan. In 1992, Jean and Alastair Carruthers published their clinical trial of botulinum neurotoxin's first cosmetic use, showing the reduction in the glabellar lines.4 The Food and Drug Administration (FDA) officially approved Allergan's BOTOX® (Allergan, Inc.) in 2002 to treat glabellar furrows after a study of 264 patients ushered in the cosmetic trend of botulinum neurotoxin use.5
*The BTX mechanism of action involves blocking the neurotransmitter acetylcholine (ACh) release into the neuromuscular junction by interfering with the synaptic neural associated protein (SNAP25).6 Currently, many formulations of the neurotoxin are available in the United States and Europe. Most use the BTX type A formulation but differ in production.6 This review describes the current trends of BTX use by anatomical region.
3.1 | Hair
3.2 | Face
3.3 | Head
3.4 | Eyes
3.5 | Midface
3.6 | The lower third of the face
3.7 | Perioral area
3.8 | Chin
3.10 | Axilla
3.11 | Palmar and plantar areas
3.12 | Breast
3.13 | Calf
4 | DISCUSSION
Today, BTX is FDA-approved for 11 therapeutic indications, including blepharospasm, overactive bladder, chronic migraine, incontinence due to a neurologic condition, cervical dystonia, spasticity, and severe axillary hyperhidrosis in addition to cosmetic indications such as severe glabellar and moderate to severe lateral canthal lines. Off-label uses of BTX are often indicated as well. In some cases, effects are not entirely understood, as is the point in androgenetic alopecia and rosacea, which demands further investigation and studies with larger samples.7,19
5 | CONCLUSION
Botulinum neurotoxin is one of the most versatile and widely used medical products in the world. Our review focused on the plastic and dermatological uses of botulinum neurotoxin currently supported by published data. Even so, for some of the more recent applications, quality data are lacking. Further research is needed.
Background: Botulinum neurotoxin is one of the most versatile and widely used medical products in the world.
Aims: The review's focus is the plastic and dermatologic uses of botulinum neurotoxin currently supported by published data.
Methods: Relevant clinical articles regarding botulinum neurotoxin use in plastic surgery, dermatology, and general esthetic literature were searched and reviewed.
Results: The search yielded 258 studies. Two hundred articles were excluded following title and abstract review. Twenty-one studies were excluded following full-text screening. A total of 37 studies remained and were discussed in this review.
Conclusions: Botulinum neurotoxin is widely used for numerous off-label indications from head to toe. Some uses are well documented, and their safety has been demonstrated in controlled trials, yet most remain poorly researched.
1 | INTRODUCTION
Botulinum neurotoxin (BTX) is derived from the gram-positive, rodshaped, spore-forming bacterium Clostridium botulinum. Seven different toxins (A to G) originate from different strains of C. botulinum. Types A, B, E, and F are most commonly associated with human disease.1 Types A and B are available for commercial use, and since type A is the most potent form, it is the most frequently used clinically.2
The first published use of the toxin clinically was made in 1980 by Alan B. Scott, an ophthalmologist using botulinum toxin to treat strabismus. Scott used the type A formulation to weaken the muscle responsible for the strabismus.3 He called the drug Oculinum (now known as BOTOX®) and later sold the formulation to Allergan. In 1992, Jean and Alastair Carruthers published their clinical trial of botulinum neurotoxin's first cosmetic use, showing the reduction in the glabellar lines.4 The Food and Drug Administration (FDA) officially approved Allergan's BOTOX® (Allergan, Inc.) in 2002 to treat glabellar furrows after a study of 264 patients ushered in the cosmetic trend of botulinum neurotoxin use.5
*The BTX mechanism of action involves blocking the neurotransmitter acetylcholine (ACh) release into the neuromuscular junction by interfering with the synaptic neural associated protein (SNAP25).6 Currently, many formulations of the neurotoxin are available in the United States and Europe. Most use the BTX type A formulation but differ in production.6 This review describes the current trends of BTX use by anatomical region.
3.1 | Hair
3.2 | Face
3.3 | Head
3.4 | Eyes
3.5 | Midface
3.6 | The lower third of the face
3.7 | Perioral area
3.8 | Chin
3.10 | Axilla
3.11 | Palmar and plantar areas
3.12 | Breast
3.13 | Calf
4 | DISCUSSION
Today, BTX is FDA-approved for 11 therapeutic indications, including blepharospasm, overactive bladder, chronic migraine, incontinence due to a neurologic condition, cervical dystonia, spasticity, and severe axillary hyperhidrosis in addition to cosmetic indications such as severe glabellar and moderate to severe lateral canthal lines. Off-label uses of BTX are often indicated as well. In some cases, effects are not entirely understood, as is the point in androgenetic alopecia and rosacea, which demands further investigation and studies with larger samples.7,19
5 | CONCLUSION
Botulinum neurotoxin is one of the most versatile and widely used medical products in the world. Our review focused on the plastic and dermatological uses of botulinum neurotoxin currently supported by published data. Even so, for some of the more recent applications, quality data are lacking. Further research is needed.
