gms | German Medical Science

43. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen e. V. (DGPRÄC), 17. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen e. V. (VDÄPC)

13.09. - 15.09.2012, Bremen

Modern botulinum toxin myths in aesthetics

Meeting Abstract

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  • presenting/speaker A.M. Pickett - Toxin Science Ltd., Wrexham, Germany

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und ─sthetischen Chirurgen. Vereinigung der Deutschen ─sthetisch-Plastischen Chirurgen. 43. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und ─sthetischen Chirurgen (DGPR─C), 17. Jahrestagung der Vereinigung der Deutschen ─sthetisch-Plastischen Chirurgen (VD─PC). Bremen, 13.-15.09.2012. DŘsseldorf: German Medical Science GMS Publishing House; 2012. DocFTIIP07

doi: 10.3205/12dgpraec147, urn:nbn:de:0183-12dgpraec1477

Published: September 10, 2012

© 2012 Pickett.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



The continual increase in the use of botulinum toxin (BoNT) for aesthetic treatments has seen extraordinary growth over the last years. There are probably 6 million treatments in the Unites States each year alone and estimates for the world exceed 10 million each year. Yet there are still commentaries and statements made about the BoNT products used aesthetically that are based on no science or clinical evidence – they are simply incorrect. Generally, they have been used as marketing “facts” to try and convince clinicians of the benefits of some products and the issues related to others. Even worse is that these “facts” are still published today within articles and reviews as though they were clear science and clinical evidence. Yet they are not.

The incorrect speculation about diffusion differences between the products after injection continues to be made. Various properties of the products are invoked to support these claims but, in all cases, these have been shown to be incorrect. Modern data have provided us with explanations that there is no such thing as a “toxin complex effect” on diffusion since the products are already free neurotoxins in the vial before injection. There are no product differences in respect of diffusion, only dose differences in the clinical trials that are cited.

BoNT dose is the most important factor affecting the results that can be obtained aesthetically, closely followed by knowledge of anatomy and the products being used. Claims that the volume of injection is also important cannot yet be supported as data exist from clinical studies that also show volume of injection has no influence on the results obtained.

There are very few reports on patients who have developed neutralising antibodies to BoNT after aesthetic treatments, only 6 in total for all products worldwide for all the years of product use. Formation of antibodies does not therefore appear to be any issue of significance. But patients do stop responding to aesthetic treatments and do have high demands on the quality of the results that they expect. Why is this?

The presentation will focus on several of these modern myths and look at the explanations from the world of toxin and BoNT product science. Patient satisfaction will also be looked at as one of the key issues and challenges for BoNT use aesthetically.