*This article is brought to you by AAMSSA: The Aesthetic and Anti-Ageing Medicine Society of South Africa*
Find an aesthetic practitioner www.aestheticdoctors.co.za
Getting to know what form of botulinum toxin is being used by your medical practitioner is your right. Not all brands are the same. Doing your homework and asking the right questions before you proceed will avoid complications and a lack of effective results. Dr Debbie Norval
A brand name can sometimes become so popular that it inadvertently develops into a household term. In South Africa, we affectionately use names like Vaseline, Kleenex, Kreepy Krawly and Bubble Wrap without realising that they are actually trade names.
This is known in trade language as “genericisation”, which has both positive and negative ramifications. In a similar vein, we are all very familiar with the word ‘Botox’. We go to our aesthetic doctor for our top-up, we use it as an adjective to comment on our friend’s forehead, and it’s basically become a household word. Other common trade names that are used in everyday speech include Google, Band-Aid and Superglue.
In much the same way, we have a colloquial term for all neurotoxins – this despite the fact there are actually four FDA approved brands available worldwide.
These being: OnabotulinumtoxinA (Botox®, Allergan), AbobotulinumtoxinA (Dysport®, Ipsen) – both of which are available in South Africa – and Xeomin® and Jeuveau®, which are available internationally.
What is botulinum toxin?
Botulinum neurotoxin type-A is derived from the Clostridium botulinum bacterium. This toxin, in extremely diluted quantities, is used as a neuromodulator for the treatment of both medical and aesthetic conditions.
Botulinum toxin has the ability to temporarily relax muscles by blocking the release of a neurotransmitter, called acetylcholine, at peripheral nerve terminals. It is commonly used to treat muscular spasticity, facial dynamic wrinkles, certain pain syndromes and excessive sweating.
Not all products are equal
It is important that you, as the consumer, are not only aware of exactly what your doctor is injecting, but also understand the differences between the various products available.
Each brand of neurotoxin has its own unique manufacturing process, excipients (added ingredients), dosing guidelines, formulation and potency. All four FDA-approved brands have an identical active ingredient, work in the same way, and produce similar results.
What differs is the added proteins used, which affect potency and diffusion – thereby resulting in subtle differences such as the onset of action, duration of action, and spread in the tissues.
A key factor to consider is that the different types of neurotoxins are not interchangeable. Each product has its own unique potency, mixing instructions and dosing guidelines.
For example, 20 units of one neurotoxin are not equal to 20 units of another. This is why it’s vital that you find an experienced, confident aesthetic doctor who is properly trained and knows the product well. Some aesthetic doctors stock more than one form of neurotoxin, while others prefer to use a single brand that they know and trust.
Other influencing factors
The effectiveness of neurotoxin is a result of many factors – and not just product type or brand. The skin quality and extent of the patient’s wrinkles, the degree of muscle activity, gender, metabolic rate, current medications, injection technique, injector experience, cold chain, dosage, dilution and patient expectations all influence results.
Now, while resistance to neurotoxins is rare, it can still happen with any brand. Some patients, unfortunately, develop neutralising antibodies to botulinum toxin where they find the treatment less effective with time. In such instances, it is helpful to try a different form of neurotoxin, as it is believed that the antibodies have reacted to the proteins present within the toxin currently being used.
Cheap counterfeits must be avoided
The alarming reality is that it’s possible to source cheap or counterfeit ‘botulinum toxin’ products on the internet.
These are not FDA-approved and haven’t been authorised for use in South Africa by SAHPRA (the South African Health Products Regulatory Authority). SAHPRA has very strict quality, safety and efficacy controls in order to protect the consumer.
It is your right to insist that your doctor uses only the approved, legally acquired botulinum toxin products available in South Africa. If your doctor is using something different, then alarm bells should be ringing!
What’s more, the HPCSA’s ethical guidelines state that patients have a right to information about the treatment options available, including the benefits, risks, costs and consequences associated with each treatment.
In summary, the different neurotoxins work in exactly the same way, produce similar results, and last a similar amount of time.
In practice, most patients won’t even notice the difference between the brands. But, like coffee or fine wine connoisseurs, there will be some discerning patients who will genuinely feel the difference between the brands and have a definite preference.
There will also be certain patients or indications that will do better with a specific brand (in these cases, the doctor will advise).
Written by Dr Debbie Norval
MBBCh (Rand) Dip Pall, Med (UK) M Phil Pall Med, (UCT) Adv Dip Aesthetic Med (FPD)
- Founder and owner at Dr Debbie Norval Aesthetics www.drdebbienorval.com
- President of AAMSSA (Aesthetic & Anti-Ageing Society of South Africa) www.aestheticdoctors.co.za
- Actively serves on the Ethics and Professionalism Committee of the SAAHSP
To report any unsafe practice or if you have any queries please feel free to contact Karen Nel at AAMSSA firstname.lastname@example.org
Find a doctor practising aesthetic medicine in South Africa by visiting www.aestheticdoctors.co.za
A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.
This article was written by Dr Debbie Norval and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine Winter Edition (Jun-Sep 2021. Issue37).
A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing, integrative medicine, medical skincare, 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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