CME/CE: ABOUT FACE: Navigating Neuromodulators and Injection Techniques for Optimal Results

April 2020 | Volume 19 | Issue 4 | Supplement Individual Articles | 300 | Copyright © April 2020

Published online March 31, 2020

Steve G. Yoelin , Shino Bay Aguilera , Joel L. Cohen , Michael H. Gold , Joely Kaufman , Corey S. Maas

aSteve Yoelin, MD, Medical Associates, Newport Beach, CA
bShino Bay Cosmetic Dermatology and Laser Institute, Fort Lauderdale, FL
cAboutSkin Dermatology and DermSurgery, AboutSkin Research, Greenwood Village and Lone Tree, CO; University of California, Irvine, Irvine, CA
dGold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN
eSkin Associates of South Florida; University of Miami Miller School of Medicine, Coral Gables, FL
fThe Maas Clinic Facial Plastic and Aesthetic Surgery, San Francisco and Lake Tahoe, CA; University of California, San Francisco, San Francisco, CA


Dr Yoelin: What conversion ratios do you use for switching among the BTXA products?

Dr Gold: I was an investigator in the US Food and Drug Administration clinical trials for incoBTXA and aboBTXA and have always used the ratios of 1:1 for incoBTXA:onaBTXA and 2.5:1 for aboBTXA:onaBTXA that were used to determine dosing for aboBTXA and incoBTXA in the clinical trials.

The 1:1 ratio for incoBTXA:onaBTXA is supported by the results of a multicenter, randomized, blinded clinical trial in which I participated.16 In this 4-month trial, we compared the 2 neuromodulators for treating glabellar frown lines. We used a 20-U dose of both products and found they had similar efficacy at 1 month, which was the primary end point, and at subsequent monthly follow-up visits.

Dr Kaufman: I use a conversion ratio of between 2:1 and 3:1 for aboBTXA:onaBTXA and 1.5:1 for incoBTXA:onaBTXA.

Dr Aguilera: My conversion ratios are the same as Dr Kaufman’s.

Dr Maas: I use a conversion ratio of 3:1 for aboBTXA:onaBTXA and 1.2:1 or 1.25:1 for incoBTXA:onaBTXA. I think it is important to emphasize that although the use of these conversion ratios results in a higher dose of incoBTXA or aboBTXA than onaBTXA, the difference in total dose does not mean that incoBTXA or aboBTXA is weaker or less effective than onaBTXA.


Table 2 lists the recommended diluent volumes for BTXA product reconstitution.1,3,5,6,17,18 Table 3 lists reconstitution.