title: Compositional differences among commercially available botulinum toxin type A.
abstract: OBJECTIVE
  Since the advent of botulinum neurotoxin (BoNT) in the facial cosmetic field, it has become the leading nonsurgical cosmetic procedure in the USA, and several different formulations are currently in use. The aim of this study is to review the major 'players' in order to help the physician understand the clinically relevant dissimilarities between the products and by that promote treatment efficacy and patient satisfaction.
  
  
  RESULTS
  The different available formulations can be classified into two groups by the existence of absence of complexing proteins. Most of the influence that was previously attributed to these proteins has been found to be less relevant clinically, the immune response being the only remaining issue with supporting evidence in the literature.
  
  
  CONCLUSIONS
  Botulinum toxin type A is widely utilized in the cosmetic field, and it seems that all available and approved formulations are both well tolerated and effective in treating facial rhytids. The treating physician must be familiar with the differences between all the products, especially the fact that they are not interchangeable in respect to their recommended dosage.
authors.affiliation: Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Zrifin, Israel.
authors.forename: Erez
authors.initials: E
authors.lastname: Bakshi
authors.forename: Morris E
authors.initials: ME
authors.lastname: Hartstein
mesh_terms: D001905:Botulinum Toxins / Q000494:pharmacology* / Q000627:therapeutic use; D003357:Cosmetic Techniques; D005260:Female; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017060:Patient Satisfaction; D015595:Skin Aging; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D009465:Neuromuscular Agents; D001905:Botulinum Toxins