BOTOX, BOCOUTURE or Azzalure?


(This is an article about the differences between BOTOX, BOCOUTURE and Azzalure, the three types of Botulinum Toxin Type A available for cosmetic use in the UK.  For information about wrinkle relaxing treatments at Clinetix please click here)

In the UK patients commonly ask for BOTOX injections for treatment for their lines and wrinkles.  BOTOX itself is the brand name for a specific form of the medicine, rather than the name of the medicine itself which is called Botulinum Toxin Type A (often abbreviated to BonTA)
BOTOX was the first Botulinum Toxin to be licensed for cosmetic use to treat glabella lines and is therefore probably the most well known, however other Botulinum Toxin Products are also available, It’s a bit similar to Hoover being synonymous with a vacuum cleaner, when Hoover is just one company that makes a vacuum cleaner.

So is there any difference between them, does it matter which brand is used

In one sentence, yes there are slight differences and no, it does not matter which brand is used.

Firstly all the forms contain the active medicine, Botulinum Toxin Type A.  This medicine is a biologically active medicine made by a process called fermentation.  It is produced by a bacteria (clostridium botulinum) and each company that produces the medicine uses the same strain of the bacteria, meaning the active part is identical between different formulations.  The differences between them are in the manufacturing process that extracts and purifies the medicine, and in the excipients (other added ingredients) in the finished product.

I’ll explain how Botulinum Toxin works in nature.  What we currently use as a medical therapeutic agent was historically known for causing food poisoning, botulism.  This is because the bacteria could survive in preserved foods and be eaten by a human host.  The toxin then produced by the bacteria would be absorbed by the human gut and produce it’s effect  (muscle weakness, paralysis and ultimately death of the host).  Now this organism is something that has co-evolved with mammals for millions of years and has evolved mechanisms to allow this process to take place.  The human gut is an acidic environment and full of enzymes.  The effect of the human gut environment is not just to break down food into smaller molecules for digestion but also to protect the human from pathogenic organisms (bacteria that can cause disease).  Most bacteria we accidentally swallow will get broken down and destroyed by the acid and enzymes.

So as the clostridium botulinum has co-evolved with us it has evolved it’s own processes to overcome the human gut.  The active molecule or drug that has it’s effect is only a small part of the toxin that is excreted by the bacteria.  The toxin complex is a mixture of the active component, surrounded by a larger number of non active proteins.  These proteins in nature act to allow the active component to survive the process of ingestion and digestion and thus the active part can reach the bloodstream undamaged.

Lets get back to the differences between the medicines, I mentioned that it is related to the manufacturing process and purification process.  What that means is the different brands, whilst having the same active component, have different amounts of the non active proteins mixed in.

The amount of the additional proteins can be measured in terms of the weight of a complex, the complex being the active molecule and its associated protiens.

For BOTOX the complex weighs  900 kD (kD stands for kilodalton, which is a measure of weight used for molecules)

For Azzaulre the medicine seems to be a combination of two different complex sizes, one of 600 kD and one of 300 kD

Bocouture weighs in at 150 kD, this is the weight of the active component itself meaning that the Bocouture preparation has no additional complexing proteins in the mix, containing only the active compound.

The other difference other than the amount of actual protein, or biological material in the vial is the excipients.  These are other things added to the vial to help maintain the stability of the medicine before it is reconstituted and injected.

BOTOX has added Human Albumin and Sodium Chloride, BOCOUTURE contains Human Albumin and Sucrose, whilst Azzalure contains Human Albumin and Lactose Monohydrate.

None of the excipients have any medical or biological activity.

So there are the differences, what about the similarities?  There have been numerous studies performed to assess the differences between the different preparations, and there is the wealth of anecdotal evidence collected as expert opinion from doctors who have performed thousands of treatments.  The duration of effect has been studied, the side effect profile, the spread, the diffusion, patient and practitioner satisfaction.  So far no signifiant reproducible difference in the clinical effect between all three preparations has been identified.

Final Summary!

For the patient, there is no significant clinical difference between the formulations, they are all good! The important thing is to make sure your practitioner is familiar with the the formulation they are currently using.  At Clinetix we have experience with all three formulations and currently use mainly BOCOUTURE as the fact it has less protein means it is theoretically less likely to cause a reaction (unlikely and uncommon with all preparations), we are happy to use another preparation at the patients request however.

If you would like to know more about the products we use at Clinetix contact us here or on info@clinetix.co.uk

ref:

Content of Botulinum Neurotoxin in Botox / Vistabel, Disport / Azzaulre, and Xeomin/Bocouture. Jurgen Frevert, Drugs R D, 2010 jul; 10(2) 67-73

The Clinetix Thread Lift


The “Clinetix Face Lift” range of non-surgical treatments including the Clientix Thread Lift, Clientix Volume Replacement Face Lift and the Clinetix Complete Non-Surgical Facelift.

Do I need a thread lift? – be honest with me doctor!

This is a very frequently asked question from patients in Clinetix and is actually quite easy to answer, at least to start with.  The first thing I point out is that practically no one actually needs a thread lift, or a face lift, or any other aesthetic procedure.  It’s an odd thing to hear from a cosmetic doctor running a successful practice but there you go.

The question that will have a more satisfying answer is not do I need, but do I want.  Do I want a thread lift?  (This applies to any cosmetic medical procedure) ask yourself will this thread lift (or any other procedure) make me feel more comfortable with my appearance, improve my confidence and help my self esteem?

Lets work on the assumption that you are concerned about your appearance and a procedure to make you look more youthful would be of benefit to you.

So back to the thread lift, what is a thread lift and what can it do? 

threads-lb-rightI’ll start with the history. Thread lifting techniques for lifting loose and sagging facial skin have been around for several decades, as surgeons and patients both try to innovate safer, less invasive and more effective treatments.  The basic principle is to insert a suture or thread through the skin around the temple area, anchor it to the loose and sagging skin and fat of the midface, and use the suture as an anchor to pull and reposition the skin.  The suture can be either attached to the deep fascias of the face, or left buried under the skin in the more superficial subcutaneous layers.  The older surgical approaches required deep anchoring and a small incision to be made however a number of newer techniques have evolved that do not require deep sutures and allow the procedures to be performed through small needle entry points.

As with any new surgical or medical innovation there were initially concerns and scepticism, as the sutures initially used had a chance of extrusion or chronic inflammation, and the techniques themselves produced less satisfying results. There has been a recent resurgence of the popularity of minimally invasive office based thread lifting procedures in the last five years with the development of two main devices.  One device called the silhouette soft thread lift uses threads with a small number of cones along it’s length designed to pull on and anchor loose skin.  The other system uses a finer thread with thousands of much smaller barbs along it’s length.

The Clinetix Face Lifting Approach

lb-threads-straight-onAt Clinetix we have experience with a wide range of thread lifting techniques and have refined our skills to develop the bespoke “Clinetix Face Lift” range of treatments that use multiple treatments to lift and reposition skin replace volume and improve skin quality to restore a more youthful appearance.

For mild to moderate sagging skin and ageing an option is the Clinetix Thread Lift.  This is a a treatment for mild to moderate facial sagging and consists of a bespoke PDO thread lift to reposition the facial skin, as well as a thread treatment to stimulate collagen and skin tightening around the jaw line for added longer lasting benefit.

The Clinetix Thread lift is the cornerstone of our non surgical face lifting procedures.  Using a combination of techniques learned from a variety of international experts together with specially selected stitches we are getting effective and long lasting results.  The treatment is performed in the clinic and typically takes about an hour.  There are some small injections for local anaesthetic but the treatment is generally painless. There may be some bruising afterwards that can last for up to a couple of weeks although most people have only slight bruising that is easily covered with make up.

For patients with loose sagging skin as well as facial volume loss the Clinetix Volume Replacement Face Lift consists of volume replacement with dermal fillers to strategic areas as well as thread lifting. The dermal fillers are placed in areas of deep facial volume loss such as the cheeks, the jaw line and the temples to provide a deeper underlying lift and a more natural rejuvenated appearance in patients with mid facial volume loss.

For patients who require skin improvement in addition to volume replacement and threads the Clinetix Complete Non-Surgical Face Lift combines all of the above with CO2 Laser Skin Resurfacing and PRP to smooth out, tighten and rejuvenate the skin.

The addition of Laser skin resurfacing means that the face can be rejuvenated in three levels.  The deep layers have volume replacement, the middle layers and the skin benefit from being repositioned by the threads and the laser resurfacing with PRP rejuvenates and tightens the skin.

As with all medical treatments we advise that you have a consultation with one of our experts in order for us to assess your anatomical needs as well as your aims and expectations.  Once we have determined what your goals are the various options can be explained. To book a consultation contact Clinetix on 01698 854 221 for our Bothwell clinic or 0141 221 0229 for our West End clinic.

Clinetix Bothwell
20 Hamilton Road, G71 8NA
01698 854 221

Clinetix Glasgow West
169 Hyndland Road Glasgow, G12 9HT
0141 221 0229

Clinetix Glasgow City
6th Floor, 14 Mitchell Lane, G1 3NU
01698 852 093

Clinetix Grampian
First Floor, 1 High St, Inverurie AB51 3QA
01467 629 892