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re‑treatment at 2 weeks with aboBTX‑A due to perceived perceived with the aboBTX‑A dose, whereas 22% had
lack of effective treatment with incoBTX‑A. During a less than expected response. Six percent of patients
follow‑up with the treating surgeon at 10‑12 weeks, had a lesser response while receiving a relatively lower
muscle paralysis was assessed to be 69.2% (± 27.3), dose (ratio of 2.5‑3:1) [Figure 1].
vs. 90.3% (± 1.8) in an equivalent time period with
aboBTX‑A (P < 0.001) [Table 2]. With regard to perceived DISCUSSION
pain on injection, 62% of patients reported equivalent
pain between the two treatments, 22% of patients Injection of botulinum toxin type A was the most commonly
reported more pain with the incoBTX‑A injection, 9% had performed cosmetic procedure in the Unites States in
less pain with incoBTX‑A, and 6% were unable to reliably 2012, with over 4 million treatments reported for the
recall. Overall satisfaction with incoBTX‑A treatment was year. Together with other injectable products, treatment
[1]
confirmed by 22 out of 32 patients among the study with botulinum toxin type A accounted for approximately
group (68%) at 2 weeks; this increased to 25/32 (78%) 2 billion dollars of Unites States spending in 2012. The
at 3 months. The most commonly cited reasons for rising number of minimally‑invasive cosmetic procedures
dissatisfaction were related to the longevity and being performed, with a 10% increase in such procedures
magnitude of incoBTX‑A’s effect. noted from 2011 to 2012, signals the long‑term impact that
At 10‑12 weeks following incoBTX‑A treatment, the injection of botulinum toxin type A and other nonsurgical
percentage of muscle activity was recorded by the procedures will have on the future of aesthetic practices.
senior surgeon in light of the dose ratio of aboBTX‑A: Reported overall patient satisfaction rates with botulinum
incoBTX‑A administered. Of the subjects that received toxin type A treatments are high [7,12] and are largely related
an incoBTX‑A dose at a ratio of 1.5‑2.5:1, only 40% had to the onset, duration, and efficacy of treatment. Given
[7]
a clinical result that was considered equivalent to the the tremendous impact of neuromodulator therapy and
original four aboBTX‑A treatment dose results. A total of the importance of patient satisfaction as a key outcome,
16% of patients had effects that were less than expected it is essential for practitioners to understand the optimal
for the hypothesized ratio. Some patients (38%) received treatment dose, re‑treatment interval, and expected
relatively more incoBTX‑A (ratio of 0.5‑1.5:1), due to outcomes associated with the various botulinum toxin A
clinical evaluation that the dose should be higher than 2:1 preparations available today.
of the original aboBTX‑A dose. Among this study group,
16% resulted in muscle attenuation that was greater than Multiple clinical studies have demonstrated the safety,
efficacy and tolerability of aboBTX‑A since its Food and
Table 1: Patient demographics Drug Administration (FDA) approval in 2009 for the
Total patients 32 treatment of glabellar frown lines. [13‑16] A prospective,
Median age in years (range) 56 (40-71) randomized control split‑face trial comparing aboBTX‑A
Number female (%) 29 (91) with onaBTX‑A found no significant differences
Length of abobotulinumtoxin A use (years), n (%) between treatment effects on muscle activity or wrinkle
< 2 6 (19) appearance, onset and duration of treatment effect,
[8]
> 2 26 (81) or diffusion characteristics of the two neurotoxins.
Median abobotulinumtoxin A dose in glabella (SD) 27.6 (± 11.7) Although one clinical trial is comparing onaBTX‑A with
Median incobotulinumtoxin A dose in glabella (SD) 17.1 (± 6.1) aboBTX‑A indicated lower rates of patient satisfaction
Average conversion rate 1.6:1 among patients treated with aboBTX‑A, satisfaction
[17]
Glabella re-treatment, n (%) (patient request) rates with aboBTX‑A treatments were high among our
No 29 (91) patient population. All our patients had previously
Yes 3 (9) received at least four consecutive treatments of aboBTX‑A
Pain versus abobotulinumtoxin A, n (%) at 4‑month intervals at a stable dose and had continued
(patient recall of abobotulinumtoxin A: questionnaire
following incobotulinumtoxin A treatment) to achieve 85‑90% elimination of dynamic glabellar frown
Equal 20 (63) lines at this dose with a reported high patient satisfaction
Greater 7 (22) rate.
Less 3 (9) Free of complexing proteins, incoBTX‑A is unique among
Can’t remember 2 (6) the botulinum toxin preparations currently available.
SD: Standard deviation The subtraction of these inactive or denatured protein

Table 2: Dose comparisons
Incobotulinumtoxin A Abobotulinumtoxin A Mean difference (SD) (95% CI) P*
Dose in the glabella 17.1 (6.1) 27.6 (11.7) -10.5 (8.6) < 0.001
20 27.5 (-13.6, -7.4)
Percentage of activity in glabella at 69.2 (27.3) 90.3 (1.8) -21.1 (27.0) < 0.001
10-12 weeks (per surgeon evaluation) 70 90 (-30.8, -11.4)
*Numbers in table are mean (SD) and median unless otherwise specified, difference calculated as incobotulinumtoxin A: abobotulinumtoxin A, P value
from paired t‑test. SD: Standard deviation, CI: Confidence interval

14 Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015