Figure 1: Before and after treatment of neurotoxin (Onabotulinumtoxin A) injection for forehead wrinkles. (Courtesy of Dr. Jeng-Hsien Lin)

 

Besides the upper half of the face, BTA can be injected all of the face intradermally. Initially designed as a face-lifting method, some observed increased collagen synthesis effect after intradermal injection of BTA to the mid- and lower face.

 

According to the report by Dr. Shao-Ping Chang et al. from Taiwan, they reconstituted 100 U BTA with 10 mL of sterile, preservative-free saline, and a total dose of 20–25 U BTA for each person was injected by 0.02 mL per spot intradermally to the bilateral temporal areas and both cheeks from infraorbital to jaw line in a 1-cm interval through a 30-guage needle.

 

Surprisingly, there was no significant face-lifting effect but a statistical significance result in wrinkles reduction and soothing effect 4 weeks after injection, which lasted for more than 8 weeks. They proposed that the wrinkles smoothing effect was due to the blockage of BTA on the muscle fiber more than the increment of collagen synthesis, although a slight neocollagen synthesis was demonstrated histologically.

 

Currently, there are three kinds of BTA on the market in Taiwan: onabotulinumtoxin A (Botox) from U.S.A., abobotulinumtoxin A (Dysport) from U.K., and incobotulinumtoxin A (Xeomin) from Germany. Because onabotulinumtoxin A was the first to be introduced into Taiwan, this product still holds the largest market share, followed by abobotulinumtoxin A.

 

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Incobotulinumtoxin A finally got its approval from TFDA in 2016 and was launched recently. Although used interchangeably, there are still some distinct features regarding these three neurotoxins. (Table 1) It is very hard to judge which neurotoxins fit best to different patients with various skin wrinkles conditions.

 

Table 1: The different characteristics of three neurotoxins in Taiwan.

 

-To be continued.