AAMSSA Report: Unpacking Botulinum Toxin


Botulinum toxin has been used for more than 30 years in not only aesthetic medicine, but also as a treatment for medical conditions such as excessive sweating, migraines, cerebral palsy with muscle spasms and after strokes. By Dr Cobus van Niekerk… 

The list for the use of botulinum toxin in each indication is, in fact, growing on a daily basis. In aesthetic medicine, the overwhelming use is in muscle paralysis (mainly in the face) and nerve conduction cessation (treating excessive sweating). The treatment of frown lines (relaxing but not totally obliterating) and lateral cantal lines (laugh lines and crow’s feet) is among the aesthetic uses indicated in the package insert.

Botulinum toxin is produced from refining the toxin created from the Clostridium botulinum bacterium, which causes muscle paralysis in small doses and is a safe treatment for several conditions (migraines, eye spasms, cerebral palsy, and after a stroke, to name just a few).

As per the package insert, the effects last between 12 and 16 weeks, but doctors should rather underpromise and overdeliver than the other way around.

Adhering to ethics and the law

Botulinum toxin is a Schedule 4 medication and should not be injected by anyone other than a trained medical doctor or dentist, and not by beauticians, somatologists or any layperson, according to the Ethical Rules of the Health Professions Council of South Africa and the Pharmacy Act.

Furthermore, botulinum toxin should never be advertised to the public by its tradenames in South Africa, as this is against the law. This has been reiterated by the publication of the Medicines and Related Substances Act, 1965 in the Government Gazette on 9 December 2016

We are aware of doctors not only advertising tradenames but also advertising specials/discounts on aesthetic treatments in general, which is not allowed.

There is also a growing import of illegal botulinum toxin entering the country and it remains each patient’s right and responsibility to enquire as to which product is being injected into their bodies. It is astounding that patients still allow doctors to inject products without knowing what product has been used.

Patient expectations

Patients should be extremely inquisitive and should expect, at the very least:

  1. An appointment with your doctor to discuss your concerns. A treatment plan and quotation should be mandatory so that patients know exactly what financial impact each treatment would have.
  2. Written informed consent should be obtained by your physician. Patients should be informed of alternative treatments, side effects, possible complications and the cost thereof, signed by both parties.
  3. Patients should be fully aware of which product is being injected (in South Africa, only two products are registered with the Medicines Control Council and they are produced by Allergan and Ipsenone can find out the trade names by further investigation, as we are not legally allowed to announce their names publicly for medical regulatory purposes). There are a lot of illegal products out there that can even be ordered online, so ask your doctor to see the bottle they are injecting from. If it is not one of the products above, do not go ahead with the treatment.
  4. Photographs should be taken to compare the pre- and post-treatment condition of patients.
  5. Patients should be given clear and simple post-treatment instructions and these should be closely followed by the patient.
  6. Your treating physician should give you their contact details so that you can discuss any concerns, side effects or complications to be treated immediately if they occur.
  7. Patients should be advised that the effect on each individual differs and that full effect takes up to 14 days.
  8. Patients with any concerns should follow up after two weeks so that their physician can correct any remaining concerns.
  9. Patients should be informed that there should be at least 90 days between treatments to prevent the development of antibodies, and the risk of your botulinum toxin not working in future.

It is also vitally important to obtain your physician’s qualifications, training as well as experience before committing to any aesthetic treatment.

For more aesthetic public information or to find a doctor, visit www.aestheticdoctors.co.za

A2 Disclaimer: This article is published for information purposes only, and should therefore not be taken as an endorsement or advertisement for any product or medical treatment –  nor should it be regarded as a replacement for sound medical advice. 

Issue 23 – September 2017 (Spring)

This article was written by Dr Cobus van Niekerk and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine September Spring 2017 Edition (Issue 23). 

A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing, integrative medicine, quality and medical skin care, cosmetic dentistry and cosmetic surgery in South Africa – where to go, who to see, what to expect, something new and so much more! Never miss an edition – click here for more info about where you can buy the print and/or digital copy of A2 Magazine (including back copies).

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About Author

Dr Cobus van Niekerk

Dr Cobus van Niekerk, MBChB (Pret), BMedScHons (Stell), MRCS A&E (Edinburgh). Dr Cobus van Niekerk graduated from the University of Pretoria in 1997 and received his BSCMedScHons (cum laude) from the University of Stellenbosch in 2001. He became a member of the Royal College of Surgeons of Edinburgh in 2007 but decided to return to South Africa after six years abroad. Dr Cobus is also a SAMA national councilor and serves on the Human Rights Law and Ethics (HRLE) and GP Private Practice Committee (GPPPC). He is president of AAMSSA (the Aesthetic & Anti-Ageing Medicine Society of South Africa).

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