APR 2014

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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Surgery Center in Wayne, New Jersey. Dr. Kassir is a national trainer for Medicis; the other two authors have no disclosures. Results showed that for a higher percentage of par- ticipants, effects of Dysport appeared sooner and lasted longer: 83% injected with Dysport had continuing effects after three months compared to 48% injected with Bo- tox; 65% showed continuing effects with Dysport after four months compared to 47% with Botox. Participants received 10 units of Botox Cosmetic on one side of the face and 30 units of Dysport on the other. Our panel isn't convinced. All three doctors say there is no signifi cant difference in duration of effect in their practices. They note that the physician's skill with using the neurotoxin is more important than the slight differ- ences in the products themselves. "You really must master each neurotoxin," says Dr. Narurkar. "You can't just switch back and forth. I've tried them all and believe you can get the desired results with any of them, but I've used Botox for more than 10 years and feel I've really refi ned the techniques with this product." Dr. Cohen adds: "The differences are often related to understanding dosages and injection volumes. Diffusion can be dose related or related to the reconstitution vol- ume. In our practice, we have been taking care of some of our patients for many years, and many are returning specifi cally for a similar treatment to what they had in the Botox, and we continue those folks, in most cases, on their desired aesthetic treatment that has worked well for them in the past. We also have patients who come in asking for Dysport and more recently Xeomin as well...and we like being able to offer patients what they come in asking for." More to Come Stocking three neurotoxins to satisfy patients isn't a bur- den for most practices but when the options extend to six or seven, practice administrators will feel the need to make choices. Purtox (Mentor, has completed Phase 3 clinical trials and is awaiting FDA ap- proval for its highly refi ned type A botulinum toxin. Like Xeomin, it is a pure toxin with no complexing proteins. According to the company, it shares the same potency units as Botox, so there will be no difference in dosing. Although Medicis distributes Dysport in the U.S., it is made in Europe by Ipsen ( Ipsen has an- nounced that it is proceeding with Phase 3 clinical trials on the fi rst-ever ready-to-use liquid toxin A, called Dys- port Next Generation (DNG). Clinical trials indicate it will be similar to Dysport in effect and longevity. Evosyal is produced by Daewoong Pharmaceutical in South Korea. The injectable neurotoxin was approved by the Korean Ministry of Food and Drug Safety in Novem- ber 2013 and will be marketed in that country under the trade name Nabota. ALPHAEON ( has exclusive rights to market the neurotoxin in the U.S. "This is a botulinum toxin type A, similar to the other neurotoxins that are being used in aesthetic procedures. It has 900kDa protein, which is identical to Botox," says Christpher Marmo, PhD, CEO of Evolus, which was acquired in 2013 by ALPHAEON. "The biggest benefi t we have is a 1:1 dosing equivalent to Botox Cosmetic." "It is important to have another option available on the market that is the same molecule size as the market leader right now," says Robert Grant, CEO of ALPHAEON. "I strongly believe that the market for patients who can afford neurotoxins and/or dermal fi llers is only 10% penetrated. Having more options for doctors to minister to those patients is positive for the market, and we are very excited about the potential of this product." The company is currently working with the FDA to set up clinical trials and hopes to bring Evosyal to market in 2017. "Most of the products in the injectable neurotoxin aesthetic pipeline don't seem to offer major advantages over those we already have in terms of predictability THE POWER OF THREE Many physicians and consumers are eagerly awaiting approval of topical botulinum toxins. The main differentiating point for Xeomin is that it does not require refrigeration. 40 APRIL 2014 | Med Esthetics continued on page 71 P o w e r o f T h r e e / A d I n d e x M E D 4 1 4 . i n d d 4 0 Power of Three/Ad Index MED414.indd 40 3 / 1 8 / 1 4 1 2 : 4 1 P M 3/18/14 12:41 PM

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