Mark Nestor, MD, PhD, provided an in-depth update on the science of botulinum toxin type A (BoNT-A), focusing on how to select the right toxin and optimize clinical results. Dr Nestor astutely points out that understanding the clinical science of BoNT-A) injections allows providers to more accurately assess properties and differences between commercially available products. Going through the mechanism of BoNT-A, he demonstrates how molecular potency (MP), receptor binding and the role of patient-specific factors like age, muscle mass, and genetics influence toxin efficacy, onset, and duration.

Dr Nestor discussed the concept of the "Area of Clinical Effect (ACE)," which is defined by the spread of the toxin suspension multiplied by MP. He discussed how optimal injection techniques, reconstitution volumes, and the number of injection sites can maximize results while minimizing adverse effects. He concluded by emphasizing that while all type A toxins share a similar mechanism, efficacy of the BoNT-A injection depends on a range of factors that include patient attributes, MP, technique, toxin spread, optimal reconstitution, and number of injections.