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Botulinum toxin formulation enhances, expands tx options


Botulinum toxin is used worldwide to treat patients suffering from hemifacial spasm, hyperhidrosis, blepharospasm, as well as lines and wrinkles in skin aging. Now, it is helping in the treatment of cutaneous wounds, minimizing scar formation, according to one expert.

Key Points

Buffalo, N.Y. - Ever since the advent of the cosmetic use of botulinum toxin, patients have regularly visited their aesthetic physicians to treat frown lines between the eyebrows, forehead wrinkles and crow's feet.

David A. Sherris M.D., professor and chairman, department of otolaryngology, University of Buffalo, reviews injection techniques for and new developments concerning this invaluable cosmetic tool.

Dr. Sherris tells Dermatology Times that botulinum toxin is approved by the Food and Drug Administration (FDA) for a variety of disorders including voice disorders, hemifacial spasm and the cosmetic treatment of facial wrinkles. It has been proven to be safe and effective for treating facial muscles and works by inducing a temporary paralysis of the striated musculature, with an onset of two to three days and a duration of approximately two to four months.

"The major disadvantage of botulinum toxin is its lack of immediate action as well as possible local absorption," Dr. Sherris says.

He adds that this drawback leads to the need for reinjection, increasing the possibility of complications. However, a new formulation of the toxin can solve this problem.

"By reconstituting botulinum toxin with 1 percent lidocaine and 1:100,000 epinephrine, any eventual complication can be circumvented," Dr. Sherris says.

New formulation

Dr. Sherris says that the new formulation of botulinum toxin provides immediate feedback to the physician, which is especially useful when treating new sites as well as in new uses of the toxin.

Another benefit is that it is capable of reducing pain immediately following the injection. According to Dr. Sherris, the new formula may aid in decreasing local diffusion.

Another relatively new and innovative cosmetic use for botulinum toxin A is to help heal cutaneous facial wounds, directly resulting in significantly less scar tissue. Botulinum toxin A is injected into the underlying musculature of cutaneous wounds, temporarily paralyzing them, which immobilizes the wounds and improves the cosmetic appearance of the resulting scar.

This is a technique that Dr. Sherris helped to develop and perfect along with Holger Gassner, M.D., over the past few years at the Mayo Clinic, Rochester, Minn.

"Wide scars are the result of the local underlying muscles pulling the wound apart from below during the healing phase. I target the surrounding muscles with botulinum toxin, temporarily weakening them and paralyzing them, thereby lessening the pull and traction on the wound during the acute healing phase," Dr. Sherris says.

"This novel implementation of botulinum toxin is very exciting, and it is the first medication found to help reduce unsightly scar tissue in the wounds of patients. We can almost 'beat the scar to the punch' by allowing the tissue to heal without any tractional forces from below."

He says that the next step is to get FDA approval for the use of botulinum toxin for scar tissue reduction, but as Botox (Allergan Medical) is approved for other uses in the face, physicians can offer this technique to their patients as a safe, off-label use.

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