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Botulinum Neurotoxin

This course has been designed to introduce you to Botulinum Neurotoxin taking heed of the HEE guidelines.  It will provide you with sound a basic knowledge of Botulinum Neurotoxin and is useful for those wishing to increase their own personal knowledge. It is particularly helpful for individuals interested in learning before deciding whether to commit to hands-on training, which may be quite expensive.

The Botulinum Neurotoxin module has been written by Mr Miles Berry MS, FRCS (Plast) who has published on the subject (find the paper on the JPRAS website here) and has many years’ experience administering Botulinum Neurotoxin in his own private practice. He was a Lecturer in Surgery at one of London’s most prestigious Medical Schools and is an active hands-on trainer of hundreds of candidates.

The course has been complied in module format allowing you to work around a busy lifestyle and continue your learning at a time which best suits.  The learning component of the module is assessed at the end with an examination. A pass mark of 90% is required to receive a certificate and a repeat is permitted if the required level is not achieved first time.  3 CME hours are available as a digital certificate on satisfactory completion of the course and exam.

Following is a list of the content for this module on Botulinum Neurotoxin: an introduction

Course Title Botulinum Neurotoxin: An Introduction
Course Author Mr Miles Berry MS, FRCS (Plast)
Estimated course length (hours) 3
CME awarded (hours) 3
Pass mark required % 90
Examination attempts 3
Certificate Yes
Exam results and certificate issued 24-48 hours


Section 1Botulinum Neurotoxin Basics
Lecture 1What is Botulinum Neurotoxin?Free Preview

What is Botulinum Neurotoxin

Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum. It is a somewhat fragile protein that blocks communication of nerves with their target muscles thereby leading to a flaccid paralysis. Despite being highly toxic, very low doses have shown great benefit in numerous muscular disorders and particularly in aesthetic medicine for the reduction of facial wrinkles.

Immunologically speaking, Botulinum Neurotoxin (generally abbreviated as BTX or BoNT) has been subdivided into eight types: A, B, C [C1, C2], D, E, F and G Of these, A, B, E and, in rare cases, type F have been known to cause botulism in humans, while types C and D cause illness in other mammals, birds and fish. Whilst type G has been isolated from soil in Argentina, no outbreaks of this serological subtype have yet been identified.

Samples from a child suffering from botulism in 2013 yielded what was thought to be a novel subtype, type H. Initially the specific DNA sequence was withheld, there being no known antidote, but later researchers cast doubt, reporting susceptibility to existing antitoxins.

The two with longest duration, A and B were selected for clinical use and A is preferred as it lasts considerably longer. It is also the most potent, most stable and easily produced in culture. We have type B available for the small proportion of people who develop and immunity, anti-body-mediated, to type A. The remainder of this module will therefore focus on Botulinum Neurotoxin A, BTX-A, BoNT-A.

Figure 1: a 3D representation of the molecular structure of BoNT-A reminding us that nature is capable of great beauty along with danger

It is important to be aware that a vial of cosmetic Botulinum Neurotoxin contains 50 or 100 units compared to the lethal dose of 2800 units. In over 20 years of cosmetic usage, there has yet to be a single death from Botulinum Neurotoxin injections (J Cutan Aesthet Surg. 2008 Jul-Dec; 1(2): 95–97. Botulinum Neurotoxin Deaths: What is the Fact? Omprakash HM and Rajendran SC)

Lecture 2The history of Botulinum Neurotoxin
Lecture 3Mechanism of action
Lecture 4Facial anatomy - Skin / Muscles
Lecture 5Aging of patient
Lecture 6Static and dynamic
Lecture 7Contraindications
Lecture 8Best indications / patient selection and pre-operative preparation
Lecture 9Post injection advice
Lecture 10Management of complications
Lecture 11Summary of facts
Final Quiz