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31-03-2010 | Article

Consensus recommendations for BoNT-A products released


Free abstract

MedWire News: International consensus recommendations have been developed for the esthetic use of specific botulinum neurotoxin type (BoNT-)A products for upper facial wrinkles.

The guidance applies to the products Azzalure (Galderma SA, Lausanne, Switzerland) and Dysport (Ipsen Pharma, Boulogne-Billancourt, France).

Azzalure and Dysport are both measured using Speywood Units (s.U), named after the company that originally developed the product.

The consensus team of nine dermatologists and plastic surgeons emphasizes that only these two products are covered by the recommendations.

Their advice covers product reconstitution, choice of syringe and needle, and patient management and selection, as well as a brief review of each upper face indication and the recommended injection points, dose, and technique.

The authors explain that BoNT-A blocks the release of the neurotransmitter acetylcholine when injected into muscles, which helps smooth out wrinkles. They recommend a final concentration of 200 s.U/ml (10 s.U/0.05 ml) for each product after reconstitution.

Five injection points are recommended for glabellar lines with 10 s.U per point. For forehead wrinkles, four to six injections are advised into the frontalis, with 5 to 10 s.U per point.

When treating crow’s feet, the recommendations suggest three injections per side with between 5 and 10 s.U per point at the lateral part of the orbicularis oculi.

For lateral eyebrow lift, Benjamin Ascher (Clinique de Chirurgie Esthétique Iéna, Paris, France) and colleagues recommend one point at each eyebrow tail and an additional one in each side of the frontalis with between 5 and 10 s.U per point.

They say: “The consensus recommendations help to ensure the maximal treatment safety and effectiveness, and serve as a starting point for further adaptations among individuals in clinical practice.”

The guidelines are published in the Journal of the European Academy of Dermatology and Venereology.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Anita Wilkinson