XEOMIN incobotulinumtoxinA is supposedly the next generation in the treatment of frown lines. Relatively new in Australia we recently had an opportunity to have a chat with Dr Torsten Walker, who is the Lead Field Clinical Specialist & Quality Control of Merz Aesthetics. He has been using Xeomin for 7 years in Germany, who answered a few of our questions.
Why is Xeomin considered next generation in treating frown lines?
Xeomin Incobotulinum toxin type A (preparation) which is free from complexing proteins and other impurities like inactive neurotoxins, so that gives you the highest safety standards, the highest safety profile with the same clinical outcome, like other competitors or other companies on the market. It’s the purified product so you only inject what you need and it’s very easy to handle. That means the product is very stable, you can store it at room temperature and up to 60 degrees, you can carry it with you and it’s stable for three years and reconstituted.
What is the active ingredient?
The active ingredient is a neurotoxin a 150 kDa protein which is produced by Clostridium botulinum, it’s a protein, a very happy protein. This gives you the clinical outcome that you need to smooth the wrinkle.
Why Xeomin over Botox?
That’s a difficult question to be honest, because I wouldn’t say over Botox. Everyone has their preferential, I would like to be honest and fair and say. I would say in my opinion Xeomin is better because you don’t have to store it in the fridge, which makes it easier to use and enhances its safety profile as you do not need to know if it has been kept consistently cool like botox.
Clinically it’s the same, the potency is one to one, so its one to one exchangeable.
Storage wise Xeomin in my opinion is superior because it is much easier and effective.
And could you explain again why Xeomin doesn’t need to be refrigerated?
You know when we saw this protein came up on the market 25 years ago, the Botox we thought we needed the complexing protein to make the neurotoxin itself stable. But from further development and research we now know we do not need this complexing protein, and by manufacturing it they made this protein stable, this means you do not have to refrigerate it and you can store it for up to 3 years! And that’s what makes it next generation.
And of course all regulatory authorities have proved that. After it is reconsitituted, after you put the saline in of course it has to be used within 24 hours for hygienic reasons.
How do we know Xeomin is safe?
There have been so many studies, you know it’s been available for almost ten years in Europe, so many safety standards have been done, so many studies have been completed and many patients have been treated worldwide. So we know it is a very safe product, we can safely say that because all the impurities have been removed.
FDA approved, through this process the FDA have conducted their own studies on Xeomin, which included trips to Germany where Xeomin is manufactured. They have checked the manufacturing lines, they have checked the factory, and their guarantee proves that we have the highest safety standards.
A further big advantage is the additional safety aspect. So far no antibody formulation has been detected in Xeomin-only treated patients. Complexing proteins can stimulate the immune system which might result in antibody formation. As a consequence the BTX A product is not effective at all. To avoid the risk of antibody formation should be a goal of each injector. As Xeomin doesn’t contain complexing proteins, the risk is much lower. Almost 0″.
Is Xeomin suitable for everyone?
Yes of course, but that is up to the patient. Not everybody likes botulinumtoxin because they are afraid of toxins, by name.
Some wrinkles might be too deep; some patients might be too old so that is in the hand of the physician, but everybody can use it. Though you should not use it when you are on macrolide antibiotics because it may interfere with any botulinumtoxin on the market. You shouldn’t use it if you have severe disorders, just for safety.
How much does it migrate compared to your Dysport and Botox?
Same, what we know from the studies of course which is discussed a little bit controversially sometimes, is that depending on so many influences for example it depends on the injector – not everybody injects the same way. It depends on the speed that the solution is injected – if you are a very high-speed injector of course it spreads more. If a higher volume is used to dissolve it -more saline means the product will spread more.
So this really depends on the individual physicians habits. But from the studies we have an objective. The diffusion or the spreading of all the toxins are the same, but it is a little bit different with Dysport – which is otherwise measured which means you have a conversion rate of 1 to 2.5. So that means if you are injecting 1 Xeomin units you have to inject 2.5 of Dysport units. So if you work it out that the injection of the units are right then the spreading will be the same.
When does Xeomin start to lose strength?
That is really individual, with 7 years experience of my own, I was not one of the first to start in Germany with Xeomin but the more repetitive patients use it, the longer it lasts. Which is great but bad for me because they don’t come back as often! But I have seen patients that have lasted the affects up to a year but I would say generally 4-6 months.
Can you use it for the lips?
Normally for the lips it is something, which requires filler, if you combine the filler with the minimal amount of toxin (incobotulinumtoxinA) you can make the filler longer lasting. So you can do it but you have to be aware if you overdose then you cannot speak, you cannot smile, you cannot drink. It has to be very carefully balanced.
Minimal amount of the protein plus the filler in the top lip gives a nice result.
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