One of the most popular of all non-surgical procedures in the UK is the treatment to target wrinkles and frown lines. Worldwide, scores of patients are requesting this procedure and the market for anti-wrinkle treatment is set to register 8425 Million USD by 2025.
Botulinum toxin has been used aesthetically to treat wrinkles and frown lines since its approval by the Food and Drug Administration (FDA) in 2002 for use in the glabellar region (between the eyebrows), and in 2013 for lateral canthal lines (crow’s feet). The predominant product in the market carries the now well-known brand name Botox®, a product produced by Allergan. Whilst Botox® somewhat dominates this field; industry giant Galderma also has a popular botulinum toxin product named Azzalure®, so the question is; what’s the story?
Mode of Action
Botulinum Neurotoxin is a toxin produced by the bacterium Clostridium Botulinum. Though there are numerous types, Type A is the only kind licensed and used in aesthetics as it has the longest duration. The application of botulinum toxin in aesthetics is as an acetylcholine inhibitor at the junction between the nerves and muscles, where it binds to nerve terminals. Blocking the release of acetylcholine prevents the muscle in the area from contracting, resulting in a temporarily improved appearance of frown lines and wrinkles.
The mode of action was first discovered in 1949 by Dr. Burgen of the UK, but it wasn’t until the 1980’s that the first European botulinum neurotoxin was created. Developed by ophthalmologists in Porton Down - it was initially approved for numerous ophthalmology indications, such as blepharospasm and strabismus.
Azzalure® is a European botulinum neurotoxin type A - a purified complex derived from Dysport® and is licensed exclusively for aesthetic use. Dysport® has now had several decades of wide use for both therapeutic and aesthetic applications. The pair are collectively known as BoNT-A® and measured using Speywood Units. Like all other aesthetics applicated toxins, Azzalure® is a botulinum neurotoxin type A - the longest-lasting serotype.
All published writings on Azzalure® advise on the importance of reconstitution and injecting technique alongside sufficient practitioner experience for successful administration of this product, and ideal patient outcomes. BoNT-A® preparations have a different formulation to Botox® as well as different stabilisation and purifying methods, resulting in an entirely individual biological and chemical composition. This means that clinical guidelines for the safe use of Azzalure® are not interchangeable with that of Botox® and it is imperative individual practitioners take responsibility to acquire the knowledge and skills to inject their chosen product as required, from a reputable training academy offering robust practical training.
The maximum licensed dose for treatment with BoNT-A (s.U) in the glabellar region is 50 s.U spread evenly across 5 injection sites in the corrugator and procerus muscles (Figure 1). For lateral canthal lines, the approved maximum dose is 30-60 s.U spread across 6 injection sites in the orbicularis oculi muscles, 3 per side. Below is a further example of altered dosing used for the Crows feet or lateral canthal lines (Figure 2).