Bocouture Provides Advantages of

Bocouture Provides Advantages of
Pure Neurotoxin Free from Complexing Proteins
Before Tx
After Bocouture Tx
Photos courtesy of Tatjana Pavicic, M.D.
Before Tx
Six weeks after Bocouture Tx
Photos courtesy of Tatjana Pavicic, M.D.
2 THE European Aesthetic Guide Spring 2011 www.miinews.com
By Ilya Petrou, M.D., Contributing Editor
A unique product called Bocouture ®
from Merz Aesthetics (Frankfurt,
Germany), is improving the treatment
of fine lines and wrinkles associated
with aging due to facial muscle movement.
In clinical studies and daily
commercial practice, Bocouture has
demonstrated that it is highly effective
and well tolerated in the treatment of
glabellar frown lines.*
Based on a combination of foresight
and engineering advancements,
Bocouture is a pure neuromodulator
formulation containing only active neurotoxin,
free from complexing proteins.
This pure composition could reduce the
risk of non- or decreased response, especially
for patients undergoing longterm
treatments.
Clinical studies in therapeutic indications
1 , along with case reports in
aesthetic indications 2 , have shown conventional
neurotoxin complex products
may have a higher risk of generating
neutralizing antibodies. Subseqently,
this may result in a loss of efficacy of
the neurotoxin product over time.
Though this may be less likely in the
aesthetic treatment of facial wrinkles
and lines, the continued efficacy of a
neurotoxin may be crucial for a patient
who needs long-term or repeated treatments
of a therapeutic indication such
as spasticity after a stroke. In this potential
case, it would be vital for the
patient to remain sensitive and responsive
to botulinum toxin therapy.
“Today’s cosmetic patients start their
aesthetic treatments at increasingly
younger ages and not only for a single
indication, resulting in increased frequency
of neurotoxin use, as well as a
larger total amount of neurotoxin use
over a lifetime,” noted Tatjana Pavicic,
M.D., a dermatologist and allergist at
the Clinic for Dermatology and Allergology,
Ludwig-Maximilians-Universität
in Munich, Germany. “Therefore, it is
important to consider what product to
use for the long-term management of
facial lines.”
Tatjana Pavicic, M.D.
Dermatologist / Allergist
Clinic for Dermatology and Allergology
Ludwig-Maximilians-Universität
Munich, Germany
The standard dosage for treating
glabellar frown lines with Bocouture is
20 units; however, it can be increased
to up to 30 units if required by the individual
patient. According to Dr.
Pavicic, “every individual patient differs
in their muscle anatomy and mimic
activity, as well as their desired
treatment outcome. For this reason it is
essential to examine every patient at
rest and at maximum frown before deciding
which muscles should be injected
and with how many units of
Bocouture.” Dr. Pavicic also noted that
each patient should have their own
individualized treatment plan and the
aesthetic result should be a natural,
relaxed outcome, not a frozen face.
Efficacy of treatment, including duration
of effect and tolerability, has a
strong influence on patient satisfaction.
These factors depend on the individual
patient, but also on the product
used. Clinical studies have demonstrated
that Bocouture attains comparable
response rates, longevity and
tolerability 3 , as well as a comparable
diffusion profile 4 to market leader
Vistabel from Allergan (Marlow, Bucks,
U.K.). This allows physicians to use
Bocouture without having to change

36 year old female before Tx
36 year old female two weeks after Bocouture Tx
Photos courtesy of David Eccleston, M.D., M.B., Ch.B.,
M.B.A.C.D., M.S.C.P.S.
36 year old female before Tx
36 year old female two weeks after Bocouture Tx
Photos courtesy of David Eccleston, M.D., M.B., Ch.B.,
M.B.A.C.D., M.S.C.P.S.
3 THE European Aesthetic Guide Spring 2011 www.miinews.com
treatment regimes. “You can’t have a
1:1 conversion with other neurotoxin
products, and there is no fixed dosage
conversion ratio,” explained
David Eccleston, M.D., M.B., Ch.B.,
M.B.A.C.D., M.S.C.P.S., clinical director
of MediZen, Ltd. (Mere Green,
Sutton Coldfield, U.K.). “Most physicians
are using a 2.5:1 or 3:1 ratio
with other neurotoxins versus Bocouture
or Vistabel. There is no proven
equivalence.”
David Eccleston, M.D., M.B.,
Ch.B., M.B.A.C.D., M.S.C.P.S.
Clinical Director
MediZen, Ltd.
Mere Green, Sutton Coldfield, U.K.
Dr. Eccleston also noted that an experienced
injector can easily begin using
Bocouture and can expect results
similar to those achieved with other
neurotoxins on the market. “I’ve been
using neurotoxins for 16 years and I
believe that Bocouture is a useful tool
to have in my arsenal. In my opinion, it
delivers equivalent efficacy and tolerability
to Vistabel; therefore, I believe
Bocouture is here to stay,” he said.
Other advantages of Bocouture include
a fast onset of effect from day
one onwards. 3 As well; its ability to
maintain stability at room temperature
for three years means that it does not
require a cold chain and does not
have to be stored in a refrigerator.
To date, for aesthetic use, Bocouture
is marketed in Germany, the U.K.,
France, Spain, Italy, the Netherlands
and Belgium. The product is marketed
as Xeomin in Russia and Argentina,
and as Xeomeen in Mexico. Botulinum
toxin type A preparations from Merz
have been used in therapeutic and aesthetic
indications in more than 120,000
patients worldwide and in more than
1,500 patients in clinical trials. Safety
and efficacy have been successfully
demonstrated in both indications.
According to experts there is a
growing trend for full-face treatments 5 .
This trend is supported by the Merz
Aesthetics Face Value Beauty Survey
conducted by Harris Interactive among
2,900 women 6 located in France, Italy,
Spain, Russia and the U.K. The survey
revealed that patients most often see
their physician for multiple problem areas.
Additionally, approximately one in
two patients decided to treat other areas
after consulting with their physician
or aesthetic practitioner.
Given that nearly half of women want
to improve or change wrinkles around
their eyes, mouth or in their forehead,
it can be expected that botulinum toxin
will maintain its position as a core
tool in aesthetics with interest also
continuing to increase in other therapeutic
areas.
*Bocouture is indicated for the temporary
improvement in the appearance of moderate
to severe vertical lines between the eye brow
seen at frown, in adults