Objectives: The use of Botulinum Toxin has now fully become part of the treatment of facial aging.
An evolution of this treatment is represented by its use in combination with Hyaluronic Acid at low density.
The idea is to obtain a relaxing effect on the entire face by treating the strongest muscles, such as masseters and corrugators, with only the toxin diluted in physiological solution and at the same time to inoculate the toxin combined with Hyaluronic Acid superficially at the level of the facial mimics muscles.

Introduction: Jalu-Botox is a blend of free HA and Botulinum Toxin.
Few units of Botulinum Toxin over the surface of muscle, not intra-muscolar, it work in a good way to reduce superficial contractility, finally we have a release and distension of wrinkle such Crows feet and Bar Code for example…

Materials / method: Free hyaluronic Acids low density (200 Kdalton), transport the Botulin Toxin that provide to hydrate the surface make it more stretched..
For more severe patients underwent a longer and differentiated treatment with Jalu-Botox and a mix of chemical stimulation by Amino Acid Replacement Therapy (AART).

Results: Group 1 patient (23in our series) were treated with the only meso-botox every 2 months for a period of one year. We prepare meso-botox with a mix of botulinum toxin A (8 U.I) and 1 ml of aminoacid or not cross-linked hyaluronic acid. Group 2 patients (39 in our series) underwent a longer and differentiated treatment. First of all meso-botox, with the same formulation previously described, was injected to all patients. Then, after two weeks, required to evaluate wrinkle situation, patients were treated with a mix of chemical and mechanical stimulation. Usually we apply a peeling during a needli

Conclusion: Following this my expence in the treatement of expression line over these orbicularis muscles (Peri-orbital and Peri-oral) we translate our experience over the treatments of Neck deformities: “Venere Collar” and Platisma Bands. It works in amazing way to eliminate these deformities….

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The path of the treatment with botulinumtoxin A is littered with myths. Some have been disgarded but still a lot persists.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To understand the differences between the various proprietary Botulinum toxin As (BTX-As) available in the USA.
To identify and appreciate the subtle differences between the available BTX-As that will influence how treatment injections should be performed.
To choose the proper BTX-A product in order to create the most beneficial results for individual patients.

Introduction: OnabotulinumtoxinA, brand named BOTOX, was approved for cosmetic purposes in 2002. Since then, there have been additional BTX-As developed, distributed worldwide and approved for cosmetic use in the USA by the FDA. All the available BTX-A products contain the same neurotoxin molecule, but because of different propriety accessory proteins and stabilizing molecules, the different brand named products vary in subtle ways which influence the manner in which they should be injected.

Materials / method: The BTX-As currently available in the USA will be identified and categorized according to their individual proprietary differences. These subtle variations in the BTX-A products will determine how they can be optimally utilized when injecting them for cosmetic purposes.

Results: The different BTX-A products will be differentiated by how long their results last, how easily they diffuse within the skin and muscle, how quickly the product takes effect and how reliably reproducible are their results.

Conclusion: Depending on whether one is injecting BTX-A on-label for cosmetic or therapeutic purposes or off-label for cosmetic or therapeutic purposes, selecting the appropriate BTX-A is important. All the different named BTX-As contain the same neurotoxin molecule, but because of different propriety accessory proteins and stabilizing molecules, these BTX-A products vary in subtle ways which influence the manner in which they should be injected. These differences will be identified and the injection techniques emphasized.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: The objectives of this presentation is to review the peer-reviewed literature surrounding the use of both high-dose and micro-dose injections of neurotoxins.

Introduction: Botulinum toxin has greatly changed the aesthetic and cosmetic landscape. We have used this therapy in aesthetics for many years and recently, we have seen newer techniques in dilution and delivery that has increased our armamentarium for treating our patients.

Materials / method: The use of high dose toxins as well as microinjections and nanodelivery of toxins has shown great efficacy in treating our aesthetic patients and even with some of our medical dermatology patients.

Results: Less may be better, more may be better – we will review the clinical data to help you treat your patients with these new delivery techniques.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): Allergan, Galderma, Merz, and Croma

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Allergan, Galderma, Merz, and Croma

Objectives: The objective of this work is to present the mechanisms of action and therapeutic effects of botulinum toxin type A in various dermatological pathologies involving different inflammatory and immunological processes. By analyzing its mechanisms, this study aims to assess its relevance and potential applications in treating dermatological conditions. The focus is on evaluating its efficacy beyond its well-known role in neuromuscular inhibition, exploring novel therapeutic pathways that address inflammation, immune modulation, and vascular dysfunction.

Introduction: Botulinum toxin type A is primarily recognized for its inhibitory action on the neuromuscular junction, reducing muscle contraction and dynamic wrinkles. However, over the past decade, multiple studies have highlighted its therapeutic potential in treating pathological scars, inflammatory dermatoses, and facial conditions such as eczema, psoriasis, hidradenitis suppurativa, acne, rosacea, and seborrhea. It has also proved effective in the management of androgenetic alopecia, post-herpetic neuralgia and Raynaud's phenomenon ulcers, suggesting a wider field of clinical application in dermatology

Materials / method: A systematic review of the literature was conducted using the MEDLINE (PubMed) database from January 1, 2019, to November 1, 2024. The search identified 885 articles linking dermatology with botulinum toxin type A. After applying strict inclusion and exclusion criteria, 222 articles were selected for analysis. Studies focusing exclusively on hyperhidrosis were excluded, given the well-established role of the toxin in this indication. The selected studies were analyzed to explore the toxin's mechanisms of action and therapeutic outcomes across dermatological applications.

Results: Botulinum toxin type A acts on both neuronal and non-neuronal cells, including keratinocytes, fibroblasts, sebocytes, endothelial cells, and innate and adaptive immune cells. Its mechanisms involve the inhibition of neurotransmitter and TGFB1 release, both of which play key roles in cellular signaling. Additionally, it reduces free radical production, suppresses monocyte chemotaxis, and inhibits mast cell degranulation, collectively contributing to its anti-inflammatory and immunomodulatory effects.

Conclusion: Beyond its primary role in neuromuscular synapse inhibition, botulinum toxin type A operates through multiple biological mechanisms, affecting vascular, inflammatory, and immune pathways. These additional properties open new opportunities for clinical applications in dermatology, extending beyond aesthetic indications. Its ability to modulate inflammation, immune cell activity, and vascular responses positions it as a versatile and promising therapeutic tool. Further clinical studies will solidify its place as an integral part of dermatological treatment strategies.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Toxin & ultrasound , why to combine

Introduction: The use of ultrasound in aesthetic medicine is still under discussion for those who are not used to its use.
For fillers, in the long term it will be necessary to reduce the risk of vascular complications, in order to recognise filling products. But what about toxin, a product that leaves no trace, is rarely allergenic and has a temporary effect that ultimately poses little risk.

Materials / method: The diversity of the equipment, the handling of probes, the visualisation of muscles, needles and indirectly the movement of tissues in dynamics and ultrasound guidance requires a learning curve.

Results: Ultrasound provides a precise view of the muscles without the need for a specialist.
Ultrasound is a dynamic, reproducible, non-invasive examination.
Ultrasound provides precision, safety and can save on units.

Conclusion: Why do without this tool, which is already so widely used in other specialities! For botulinum toxin injections, the discussion is more than open.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Sibus

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To encourage increased awareness around the potential issue of immunoresistance in aesthetic patients and strategies to minimise the risk.

Introduction: The Asia Pacific (APAC) region has witnessed evolving patterns in the usage of botulinum neurotoxin A (BoNT-A), with implications for immunoresistance in both therapeutic and aesthetic contexts. As off label indications increase, so do the frequencies and dosages of BoNT-A treatments, with growing numbers of patients seeking both preventative and high-dose aesthetic treatments. These trends contribute to a rise in secondary non-responsiveness due to immunogenicity, a condition where patients develop antibodies that reduce BoNT-A efficacy over time.

Materials / method: A cohort of 363 patients receiving high-dose off label aesthetic treatments were surveyed exploring their experience of symptoms related to possible immunogenicity and their injecting history.

Results: The results revealed that 92% of patients exhibited at least one symptom of declining efficiency and 49% exhibited three symptoms. These results contradict that published in the literature suggesting a 0.2% to 0.4% incidence of immune resistance in aesthetic patients. These results are discussed with insights from both patient and physician perspectives. Higher dose treatments and shorter treatment intervals are not yet routine outside the Asia Pacific region, but pre-dispose patients to a higher risk of developing BoNT-A immunoresistance.

Conclusion: Factors contributing to increased immunogenicity include higher cumulative doses, shorter intervals between treatments, and the use of non-approved indications that require elevated dosages. Ethical and clinical challenges arise as aesthetic BoNT-A treatments become more frequent and diverse, raising questions about long-term treatment planning and patient awareness.

Addressing these developments involves collaboration with clinicians, patients and regulators, underscoring the importance of educating patients and practitioners to mitigate immunoresistance risks.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): Merz Aesthetics

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Merz Aesthetics