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Toxin Talk


Aspen, Colo. – When it comes to neuromodulators, to paraphrase Eric Clapton, “It’s in the way that you use it.” That’s what Steven Fagien, M.D., told attendees at this summer’s edition of The Cosmetic Bootcamp (CBC). He is a Boca Raton, Florida-based oculoplastic surgeon.

With the plethora of neuromodulators available, and plenty more to come, he said, “The big question is, can you make them work the same? Can you use one toxin just like another?”

The key, said Dr. Fagien, is reconstitution. Everybody has their own biases here, he said, “And some are BS.” Whether a speaker touts the 1 cc or 4 cc dilution, he or she swears it’s the best.  “I frankly have a hard time reconstituting 1 cc, and then being precise because getting those small volumes in areas where you want precision isn’t so easy sometimes. And if you double your volume, you double the amount of neurotoxin. I tend to use a 4 cc dilution when I use Botox. Not that I’m right and everybody else is wrong – it’s just what works well in my practice.”

Dosing and technique also help alter the effect of neuromodulators, he said. “We all use our fillers differently. Why wouldn’t it make sense to use neuromodulators differently? Why do you have to use the exact same technique when you switch from one neuromodulator to another? I believe there are techniques that lend themselves to certain neuromodulators.” Whether diffusion is good or bad depends on the area you’re treating and the effect you want, he added.

“I believe you can manipulate most of the products to get a pretty similar result (in terms of longevity) if you understand the nature of the products. And it’s not just did about botulinum toxin. Manufacturers are using everything – from tetanus toxoid to scorpion venom. Why? It’s a huge business. Everybody wants in.”

CBC is running a training program for core physician extenders in Las Vegas on October 14. For additional details or to register for future CBC events, please contact:

Karen Dennis

CBC/Meeting Designs, LLC

Phone: 877-809-7525

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