Cosmetic Use of AbobotulinumtoxinA in Men: Considerations Regarding Anatomical Differences and Product Characteristics

September 2016 | Volume 15 | Issue 9 | Journal Article | 1056 | Copyright © September 2016


Jason D. Bloom MD,a Jeremy B. Green MD FAAD,b Whitney Bowe MD,c Erika von Grote PhD,d and Alessandra Nogueira MDd

aMain Line Center for Laser Surgery, Ardmore, PA
bSkin Associates of South Florida, Coral Gables, FL
cMount Sinai Medical Center, New York, NY
dGalderma Laboratories, L.P., Fort Worth, TX

Abstract
The proportion of men seeking facial rejuvenation with botulinum neurotoxin type A (BoNTA) products is increasing. The number of male patients treated in the 5-year period between 2009 and 2014 grew by 25%. There is little clinical data supporting gender-specific efficacy with regard to dosing and injection placement in men. To nurture the confidence associated with treatment of male patients, clinicians are in need of more informational materials to develop their evaluation and treatment strategies. Three BoNTA products are currently available in the United States (US) for treatment of the upper face. The varying potency of the different BoNTA formulations is reflected by disparate dose-response characteristics, meaning they are not interchangeable for injection purposes. Clinicians who are familiar with the characteristics of all the BoNTA options will be equipped with the necessary tools to provide their male patients with a desired outcome.
Among the product options available in the US, Dysport® (abobotulinumtoxinA) (Galderma Laboratories, L.P., Fort Worth, Texas) is unique in that its recommendations for reconstitution provide the clinician with 2 different final product concentrations. The flexibility provided by a variable dose may be a valuable tool for tailoring treatments to male patient-specific needs, which may include a more conservative outcome, maintaining a certain degree of muscle activity and expressivity. Achieving a conservative outcome may be the key to a positive experience for the male patient.

J Drugs Dermatol. 2016;15(9):1056-1062.

INTRODUCTION

The cosmetic use of botulinum neurotoxin type A (BoNTA) for facial rejuvenation is desirable because the treatment procedure is minimally-invasive, the effects of BoNTA are relatively fast-acting, and the procedure involves little or no patient down-time. Since 2000, BoNTA’s growth trend is reflected in a 748% increase in procedures performed in the US, and has consistently remained the most frequently performed procedure in the American Society of Plastic Surgeons (ASPS) category of minimally-invasive cosmetic procedure performed for over a decade.1,2 Men have consistently remained a smaller proportion of the patients seeking BoNTA procedures (approximately 6%), but the true number of male patients is actually substantial. The male statistic alone is reflected by a 25% increase in BoNTA procedures performed between 2009 (307,649) and 2014 (410,913).3,4 In this light, the true need for treatment strategies tailored to the male patient has become evident for cosmetic dermatologists and plastic surgeons.
Clinical data evaluating the gender-specific differences regarding safety, efficacy, and dosing for BoNTA treatment of the male patient are limited.5 In addition, development of this knowledge through practical experience can be a challenge, since men are still only a small portion of most clinician’s total patient population. The current techniques and safety considerations in place for female patients can be used as guidelines for male patients, but the cosmetic outcome for the male patients must take into account the gender-specific anatomical differences. The anatomical features that distinguish the male face should be foundational in the patient evaluation process, as well as in the treatment design to deliver desirable outcomes.
Dysport® (abobotulinumtoxinA) (Galderma Laboratories, L.P., Fort Worth, TX) is a BoNTA indicated for cosmetic use in adult patients younger than 65 years of age to temporarily improve the appearance of moderate to severe dynamic facial wrinkles (glabellar lines) produced by the underlying activity of the procerus and corrugator muscles.6 Intramuscular injection of BoNTA decreases muscle contractibility by blocking the release of acetylcholine within neuromuscular junctions.6,7
AbobotulinumtoxinA was approved by the US Food and Drug Administration in 2009 as the second of 3 BoNTAs approved for cosmetic use in the US, which also includes Botox® Cosmetic (onabotulinumtoxinA) (Allergan, Inc, Irvine, CA), approved in
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