Physician Awareness of Aesthetic and Therapeutic Crossover Usage of Botulinum Toxin Type A

Background and/or Objectives: Treatment using botulinum toxin type A (BoNT-A) is indicated for both aesthetic (Ax) and therapeutic (Tx) purposes, but aesthetic practitioners are often unaware of their patients receiving additional toxin for therapeutic indications. Unbeknownst to their healthcare providers (HCPs), some patients are receiving much higher doses. The objective of the study was to examine the discrepancy between assumed and actual BoNT-A dosage, and the potential consequences resulting from the lack of dose awareness.

Design: A survey was conducted to assess the delivery and receipt of botulinum toxin among specialist HCPs and patients, respectively.

Setting: Global, web-based survey

Participants: A total of 398 HCPs made up of specialists in aesthetics, dermatology, plastic surgery, and dentistry, responded to the survey. A consumer survey targeting an equal proportion of BoNT-A Ax-only and Ax-Tx crossover users was completed by 246 patients.

Interventions: not applicable

Main Outcome Measures: N/A

Results: 63% of HCPs did not know if patients were receiving Tx botulinum toxin treatment. Those HCPs who did know estimated that 19% of their patients have received Tx. Meanwhile, almost half of patients surveyed report that they currently receive Tx toxin. 66% of providers observe a requirement for more frequent injections or higher dosing.

Conclusions: With the rising use of BoNT-A in aesthetics, patients are being exposed to far more toxin, potentially over an order of magnitude greater, than their providers are aware. As the total dosage per patient increases, the risk of developing resistance to BoNT-A treatment grows. This can be observed as an increased required frequency or dosage of BoNT-A to achieve the same efficacy, which is an issue commonly reported by HCPs. There is a need for providers to be aware of and track the total dosage for both aesthetic and therapeutic needs, as this may affect the available lifespan of treatment for each patient.