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Aesthetic Use of Neurotoxins: Avoiding and Managing Complications

  • Authors: Joel L. Cohen, MD
  • CME/CE Released: 6/27/2011
  • Valid for credit through: 6/27/2012, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for dermatologists, plastic surgeons, primary care providers, and nurses who are involved in aesthetic procedures.

The goal of this activity is to review the safety data and established best practices associated with the aesthetic use of neurotoxins.

Upon completion of this activity, participants will be able to:

  1. Describe and apply the safety practices established through consensus publications, clinical trials, and practice experience for the use of neurotoxins in aesthetic medicine  
  2. Develop injection strategies for the safe and effective use of neurotoxins in aesthetic treatment 


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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Joel L. Cohen, MD

    Associate Clinical Professor, Department of Dermatology, University of Colorado, Denver; Director, AboutSkin Dermatology and DermSurgery; Director, The Skin Cancer Center at Swedish Medical Center, Englewood, Colorado


    Disclosure: Joel L. Cohen, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Allergan, Inc.; DUSA Pharmaceuticals, Inc.; Biopelle, Inc.; Photocure, Inc.
    Served as a speaker or a member of a speakers bureau for: Allergan, Inc.; DUSA Pharmaceuticals Inc.; Biopelle, Inc.; Graceway Pharmaceuticals, LLC
    Received grants for clinical research from: Allergan, Inc.; Biopelle, Inc.; Photocure, Inc; SkinMedica, Inc.

    Dr. Cohen does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

    Dr. Cohen does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.


  • Kristin M. Richardson

    Scientific Director, Medscape, LLC


    Disclosure: Kristin M. Richardson has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Laurie E. Scudder, DNP, NP

    Nurse Planner, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC


    Disclosure: Laurie E. Scudder, DNP, NP, has disclosed no relevant financial relationships.

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  • Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Awarded 1.00 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.

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Aesthetic Use of Neurotoxins: Avoiding and Managing Complications

Authors: Joel L. Cohen, MDFaculty and Disclosures

CME/CE Released: 6/27/2011

Valid for credit through: 6/27/2012, 11:59 PM EST


Editor's Note:
The botulinum neurotoxin type A (BoNTA) products available in the United States for aesthetic use are approved by the US Food and Drug Administration for temporary improvement in the appearance of moderate-to-severe glabellar lines associated with procerus and corrugator muscle activity. This program discusses off-label uses of BoNTA products.


Botulinum toxin type A (BoNTA) injection is routinely the most common procedure reported in the American Society for Aesthetic Plastic Surgery annual survey of cosmetic procedures.[1] Its ease of use, predictable results, and minimal recovery time are key drivers of the great demand. The widespread successful use of this agent in the United States and worldwide may lead some to trivialize the technique and skill involved in successful BoNTA injections. BoNTA is an important clinical agent, and its use in aesthetic treatment should be approached by educated clinicians who have the requisite knowledge of the complex interplay of anatomy, physiology, and aesthetic principles in order to ensure optimal outcomes.

Commercially Available BoNTA Formulations

At present, 2 injectable BoNTA formulations are approved by the US Food and Drug Administration (FDA) for aesthetic use: onabotulinumtoxinA (Botox Cosmetic®; Allergan, Inc; Irvine, California) and abobotulinumtoxinA (Dysport®; Medicis Aesthetics Inc.; Scottsdale, Arizona). IncobotulinumtoxinA (Xeomin®; Merz Pharmaceuticals, LLC; Greensboro, North Carolina), an injectable BoNTA formulated without complexing proteins (a "core neurotoxin" agent sometimes referred to as a "naked toxin"), has been approved for therapeutic use in the United States and will likely receive aesthetic approval in the near future. A novel topical BoNTA product (RT001; Revance Therapeutics; Newark, California) is in clinical trials for aesthetic use in the periorbital area. Although BoNTA options in the United States are expanding, this review will focus on the safety data and established best practices associated with the aesthetic use of onabotulinumtoxinA and abobotulinumtoxinA.

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