Expanding treatment options for neuromodulators: an introduction to incobotulinumtoxinA.

In the early 21st century, members of the medical community have been both witnesses to and participants in significant changes in the field of aesthetic surgery and medicine, including nonsurgical facial rejuvenation. Although some of dermal fillers were available prior to 2000, their indications were primarily therapeutic. Now, various categories of dermal fillers exist, including hyaluronic acid, poly-L-lactic acid, polymethylmethacrylate, calcium hydroxylapatite, and patients’ own fibroblasts. Neuromodulators (ie, botulinum toxin type A [BoNTA] formulations) were first approved for therapeutic purposes but quickly gained popularity for aesthetic applications. According to the American Society for Aesthetic Plastic Surgery, in 2010, more than 2.4 million patients received treatment with a BoNTA product. Clearly, BoNTA injections have been widely adopted in aesthetic practice, beginning with the approval of onabotulinumtoxinA (Botox; Allergan, Irvine, California) in 2002 by the US Food and Drug Administration (FDA) for the temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adults 65 years or younger. Off-label applications in areas such as horizontal forehead lines, “crow’s feet,” and the perioral area followed. A new neuromodulator, abobotulinumtoxinA, was introduced in 2009, expanding the treatment options for physicians. AbobotulinumtoxinA (Dysport; Medicis Aesthetics, Scottsdale, Arizona) was approved by the FDA for the treatment of cervical dystonia in adults and for the aesthetic treatment of moderate to severe glabellar lines associated with procerus and corrugator muscle activity in adults 65 years or younger. As was the case with onabotulinumtoxinA, the applications for abobotulinumtoxinA quickly expanded to include off-label uses. One year later, another BoNTA product was officially introduced into the US health care market. IncobotulinumtoxinA (Xeomin; distributed by Merz Aesthetics Inc and Merz Pharmaceuticals LLC, Greensboro, NC. Xeomin is also known by the tradename Bocouture for aesthetics use outside of the US) was approved in 2010 for the treatment of blepharospasm and in July 2011 for the correction of glabellar lines. Years prior to its introduction in North America, incobotulinumtoxinA was approved in Europe (2005); more than 260 000 patients have been treated with the neuromodulator in 20 countries, according to manufacturers of the product. With a tripling of neuromodulator treatment options in 10 years, inevitable questions about safety, efficacy, duration, and comparability have arisen in the medical community. To that end, a cross-specialty group of physicians representing dermatology, facial plastic surgery, plastic surgery, and oculoplastic surgery convened for a 1-day meeting in New York Expanding Treatment Options for Neuromodulators: An Introduction to IncobotulinumtoxinA