Session provides botulinum toxin updates

The last two decades have ushered in a wide array of botulinum toxins, raising the bar in aesthetics and safety. The Annual Meeting 2022 session on March 27, F075 – Botulinum Toxins: The Latest Updates, took a look at what’s available.

One of the highlights of the informative two-hour session was discussion of the clinical use of FDA-approved neuromodulators. Session moderator and Miami dermatologist Joely Kaufman-Janette, MD, FAAD, said these products afford dermatologists the opportunity to understand the “nuances of injections in different areas, including dose, dilution, and injection depth, and pattern.”

“Platysma and masseter are new indications that we are looking forward to being able to teach,” Dr. Kaufman-Janette said. “The standard five-point glabellar injection technique is now antiquated and needs to be revisited. Injection patterns should be individualized, taking into account both the strength of the muscle and the anatomy.”

Customized treatment

That individual approach was underscored by Vince Bertucci, MD, FAAD, a dermatologist in Toronto, and co-director of the University of Toronto dermatologic laser surgery and aesthetic dermatology fellowship, who presented new insights into neuromodulator assessment and treatment.

“Cookie-cutter injection patterns are out,” Dr. Bertucci said. “Natural, aesthetically superior results are best obtained through customized neuromodulator placement based on detailed patient assessment. New insights into functional anatomy are transforming traditional injection patterns.”

Understanding the importance of anatomical assessment is critical, he said. For example, he offered these injection location tips to achieve maximum efficacy:

• Injection of the procerus muscle on bone at its origin over the nasal root is more likely to give a better brow lift and avoid medial brow ptosis.
• Deep, diagonal injection of the most medial portion of the corrugator at the superciliary arch of the frontal bone is ideal to reduce vertical glabellar lines.
• Superficial injection of the horizontal portion of the orbicularis oculi muscle (sometimes referred to as the depressor supercilii muscle) at the upper margin of the brow will reduce medial movement along the horizontal access, while sparing the frontalis muscle.

Expect something new

Dr. Kaufman-Janette said several new toxins will likely be introduced this year, including letibotulinum toxin, a type-A toxin already approved in more than 25 countries and the number-one botulinum toxin in South Korea. Dermatologists are also eagerly awaiting the approval of daxibotulinum, which is a new toxin with an associate proprietary peptide.

“This peptide seems to assist with preventing the active botulinum toxin molecules from sticking together, allowing for more toxin to bind and possibly lead to longer duration,” she said.

Ultimately, Dr. Kaufman-Janette said the progress of the last 20 years has broadened dermatologists’ knowledge of the wide-ranging potential for botulinum toxin treatments.

“Anatomy is crucial to being able to provide the best and safest results. Tailor your injection to the individual patient. And we have more coming — new toxins, new formulations — each with its own individual ‘flavor,’” she said.

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