Rapid Onset and Reliable Results: Rosalyn George, MD’s Look at TrenibotE and the Consistency of Botox

Board-certified dermatologist and founder of Wilmington Dermatology Center in Wilmington, North Carolina, Rosalyn George, MD, recently discussed emerging data on botulinum toxin innovations, focusing on TrenibotulinumtoxinE (TrenibotE) and new insights into established onabotulinumtoxinA treatment paradigms.

George, an investigator in several study abstracts presented at this year’s American Society for Dermatologic Surgery meeting in Chicago, Illinois, highlighted the unique clinical profile of TrenibotE, a novel serotype E neurotoxin characterized by rapid onset and short duration.¹ She noted that clinical effect becomes visible at approximately 8 hours, peaks at 7 days, and resolves within 2 to 3 weeks. This profile differentiates TrenibotE from traditional BoNT/A products, which have a slower onset and longer duration. According to George, TrenibotE may be especially well suited for toxin-naïve or hesitant patients who are unsure about committing to longer-lasting neuromodulation. Its “try-before-you-buy” nature may help overcome aesthetic anxiety regarding appearance changes or treatment value, potentially expanding the patient base for neurotoxin therapies.

Discussing the second abstract, a post hoc analysis evaluating onabotulinumtoxinA 64 U for simultaneous treatment of forehead, glabellar, and lateral canthal lines, George emphasized the reassuring consistency of results across 3 treatment cycles.² Patients demonstrated stable efficacy, no new safety signals, and high satisfaction when the full upper-face pattern was treated repeatedly. She underscored that these findings reinforce the long-term reliability of onabotulinumtoxinA even with repeated multi-area dosing.

Looking ahead, George anticipates substantial evolution in the neurotoxin landscape over the next 5 to 10 years. She expects continued exploration of additional toxin serotypes, potential agents with longer durability, and expanded indications, citing masseter treatment for facial shaping as one upcoming area under FDA review. As familiarity and social normalization of neuromodulator use increase across generations, she predicts the field will continue to grow rapidly.

"Are we going to have ones that maybe last longer? Are we going to have different products in the market? Will that move the price? Will this become just something that everyone does, kind of like getting your hair done? It’s just really an exciting field to be in,” George said.

She concluded with guidance for dermatologists navigating this fast-moving space: avoid complacency. George encourages ongoing education through meetings, literature, and hands-on experience, continual refinement of technique, and individualized patient assessment rather than a standardized approach. Lifelong learning, she emphasized, is essential to delivering optimal aesthetic outcomes.

“It's not a paint-by-numbers approach. You have to treat each patient individually and continue to learn from your patients,” she concluded.

References

1. George R, Rivers J, LaTowsky B. Safety and Efficacy of TrenibotulinumtoxinE for Treating Glabellar Lines in Toxin-Naïve Participants: Results from a Multicenter Phase 3 Study. Abstract. Presented at: American Society for Dermatologic Surgery Annual Meeting. November 13-16, 2025. Chicago, Illinois.

2. George R, Glaser D, Sondergaard B. Efficacy of OnabotulinumtoxinA 64U for Simultaneous Treatment of Forehead, Glabellar, and Lateral Canthal Lines: Post Hoc Analysis Insights From 3 Treatment Cycles. Abstract. Presented at: American Society for Dermatologic Surgery Annual Meeting. November 13-16, 2025. Chicago, Illinois.