Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares a extract from the CODE association regarding different types of botox and how to mix them.
Botulinum toxin type A
Botulinum toxin type A is a protein produced by the bacterium Clostridium Botulinum which reversibly paralyses muscle to smooth and soften the wrinkles caused by dynamic or hyperfunctional muscle activity. It acts by blocking the release of acetylcholine at nerve endings thus inhibiting muscle contraction. By selective injection, the lines caused by muscle activity such as crow’s feet or frown lines can be reduced; in most cases these lines soften and become less visible within a week to 10 days. Botulinum toxin type A is generally known as ‘Botox’ but the UK formulation that has recently received a licence for cosmetic use in the glabellar region is registered as Vistabel.
Dysport (Ipsen Ltd) is another commonly used formulation of botulinum toxin type A.
Vistabel is only licensed for the treatment of glabellar lines, which are the frown lines between the eyes. Use on any other areas of the face, e.g. crow’s feet, is still ‘off-licence’. You will need to make this clear to your patients if you intend to use it in areas that are outside the licensed indication.
Botox and Dysport can also be used in these unregistered indication areas, so long as you inform the patients (this should form part of the consultation process).
Approval of Vistabel for glabellar lines, however, does mean that you can assure patients about the proven safety profile of the product and substantiate claims with scientific data from properly conducted clinical studies. Vistabel is available in 50 unit vials, licensed for single patient use only, the vials have a purple label, a red lid and the Allergan hologram on the label.
A Botox vial contains 100 units of toxin and is usually used for more than one patient. In the UK, all uses of Botox for wrinkle treatments are off-licence.
A Dysport vial contains 500 units of toxin but the dose administered is 3-5 times higher than the dose of Botox or Vistabel for each area of skin treated. The treatment of wrinkles with Dysport is also an off-licence use. The CODE AFA Board currently recommends that Dsyport is used 3:1 compared with Botox and Vistabel units. E.g. if you need to use 4 units of Botox, you would use 12 units of Dysport, see the next section for further information.
We recommend that inexperienced users should reconstitute both Botox and Dysport with the same volume of preserved saline – 2.5 ml. The volume of product used in each area of the face will then be similar. (Note that Vistabel would require 1.25 ml.) For example one way of treating the glabellar region is:
5 injection sites – 1 in Procerus, 2 in each Corrugator
Total dose is 20 units of Botox or Vistabel, 4 units per injection site (0.5ml)
Total dose is 60 units of Dysport, 12 units Dysport per injection site (0.3ml)
With experience you may use different doses and dilutions to achieve optimal effects. The use of botulinum toxin is an art as well as a science, each practitioner develops their own techniques.
For more information about botox hertfordshire, please call us on 01438 300111.