INTRODUCTION
The demand for cosmetic surgical procedures has continued to increase in recent years. Compared with pre-pandemic statistics, the overall number of procedures increased by 19% from 2019 to 2022.1 Among minimally invasive procedures, the injection of neuromodulators has been by far the most prevalent and shown the greatest change, increasing from 5,043,057 procedures in 2018 to 8,736,591 in 2022, a 73% increase.1 The use of neuromodulators for cosmetic purposes has a remarkable safety record. Serious adverse events from approved products, such as suspected toxin-related anaphylaxis are extremely rare,2 and reports of toxin spread,3 or iatrogenic botulism, have only been associated with medical uses, such as cervical dystonia.4,5 Nevertheless, unwanted effects can and do sometimes occur when neurotoxins are used for facial rejuvenation, such as neutralizing antibodies,6 facial flaccidity,7 and eyelid ptosis.8
Objectives
The objectives of the roundtable discussion were to describe the most commonly reported complications from neurotoxins; consider manufacturing and product differences of the most popular neurotoxins and how this may influence the safe use for aesthetic treatments; discuss effective communication channels, styles, and listening skills for patients experiencing complications; and summarize considerations for reducing the risk of complications.
Objectives
The objectives of the roundtable discussion were to describe the most commonly reported complications from neurotoxins; consider manufacturing and product differences of the most popular neurotoxins and how this may influence the safe use for aesthetic treatments; discuss effective communication channels, styles, and listening skills for patients experiencing complications; and summarize considerations for reducing the risk of complications.
MATERIALS AND METHODS
A roundtable discussion was held by this manuscript's authors, 5 notable experts in their field during a special addition of the Thriving in Diversity webinar series on Thursday, February 15, 2024.9 Three presenters were provided an opportunity to share their knowledge while they and other experts responded to audience questions. This activity was planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of FabDay LLC and Advancing Knowledge in Healthcare (AKH, Inc.), which provided activity accreditation.
DISCUSSION
Neutralizing Antibodies
The injection of neuromodulators is by far the most prevalent among minimally invasive procedures1 and, while it has an undisputed safety record, treatment failures occasionally occur. The successful use of aesthetic botulinum toxin injections is occasionally hindered by immunogenic and non-immunogenic causes. Reasons for non-immunogenic treatment failure include underdosing, poor injection technique, and over-aggressive product reconstitution;10,11 while immunogenic treatment failure is caused by neutralizing antibodies that have formed against the active toxin or associated complexing proteins.12 The roundtable discussion began with a presentation by one
The injection of neuromodulators is by far the most prevalent among minimally invasive procedures1 and, while it has an undisputed safety record, treatment failures occasionally occur. The successful use of aesthetic botulinum toxin injections is occasionally hindered by immunogenic and non-immunogenic causes. Reasons for non-immunogenic treatment failure include underdosing, poor injection technique, and over-aggressive product reconstitution;10,11 while immunogenic treatment failure is caused by neutralizing antibodies that have formed against the active toxin or associated complexing proteins.12 The roundtable discussion began with a presentation by one
