What You Should Know About Ingredients in FDA-Approved Neuromodulators

Next Steps in Derm, in partnership with ODAC Dermatology, Aesthetic & Surgical Conference, interviewed Dr. Terrance Keaney, assistant clinical faculty of dermatology at GW School of Medicine and Health Sciences, and Howard University. Dr. Keaney says there’s more to neuromodulators than the active protein — other proteins in the vials could play a role in treatment effectiveness. Could even the syringe play a role? Find out what you need to know from a neurotoxin expert.

Further Reading

If you want to read more about using neuromodulators, check out the following articles published in the Journal of Drugs in Dermatology:

Beyond Muscle: A Narrative Review of Onabotulinum Toxin A for Skin Quality


Background: Onabotulinum toxin A’s (BoNTA’s) popularity is centered on its quick, predictable, and safe ability to improve clinically apparent rhytides. While this remains the only FDA indication for BoNTA, recent research suggests that BoNTA may have a much wider use for the improvement of overall skin quality.
Objective: This review will focus on the various evidence and uses of BoNTA for improvement of skin quality.
Materials and Methods: This review considered published journal articles (clinical trials, case studies, scientific reviews). Studies were identified by searching the PubMed database and reference lists of respective articles. Only articles available in English were considered for this review.
Results: Intramuscular and intradermal injections of BoNTA decrease sebum production, pore size, facial erythema and flushing, and resting lines. BoNTA induces neocollagenesis and restores the extracellular matrix.
Conclusion: The literature provides both in vivo and in vitro evidence that BoNTA enhances skin quality beyond its well-studied neuromuscular effect.

Needle Manufacturing, Quality Control, and Optimization for Patient Comfort


Introduction: There is an increasing rise of cosmetic injectables. We sought to understand the manufacturing, quality control process, and needle selection of hypodermic needles for fillers.
Objective: To understand the process of manufacturing and quality control of hypodermic needles and the relevance to an aesthetic clinician.
Methods: We conducted a search of the internet and contacted medical device companies to understand the manufacturing process. We then collaborated with the Executive director of global pharmaceutical technology from Abbvie as well as the packaging and device engineer at Galderma and summarized our findings. Finally, we reviewed the literature and summarized existing recommendations on techniques to minimize pain related to injection.
Results: Hypodermic needles undergo an extensive manufacturing and regulatory process. Many considerations are taken into account in needle manufacturing as well as the selection process with commercially available hyaluronic acid filler products. Needle manufacturers are held to universal standards though the International Organization for Standardization (ISO). Filler companies perform their own testing to evaluate suitability of needles for their product including leakage force, penetration force, extrusion force, etc. Finally, parameters such as needle length, needle diameter, and wall thickness are considered for selection of needle/hub with individual filler viscosity.
Conclusion: There is extensive consideration that goes into needle manufacturing, quality control, and optimization for hyaluronic acid filler. Understanding the technical process helps inform the clinician and guide patient care for maximum comfort.

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