When I read this newspaper article last week, I was appalled how badly researched it was and how many plainly incorrect ‘facts’ it contains.

You know that I am all for safety of cosmetic procedures (I am even a member of the Anti-Ageing Medicine Expert Group AMEC). And it’s important that patients are getting more informed about what treatments they are having, but the author of this article should really have done their research, before trying to ‘inform’ patients…

This is what I think:

Firstly it is highly misleading to suggest that the performance of Botox is so different to that of Azzalure and Bocouture. All three brands are licensed by the same regulatory authority and all are proven to be very effective treatments. The fact that they are stored differently is only one (minor) feature of each brand. This does not say anything about the effectiveness of the product whatsoever. In fact, not needing refrigeration might even be seen as an advantage, as it lowers the risk of the product encountering higher-than-optimal temperatures earlier in the distribution chain (you never know what happened to your product, before it reaches the clinic).

To suggest that the drugs are effective for different lengths of time is also misleading. There are many well controlled clinical trials that demonstrate comparability of these products, and any one can find these easily on the internet.

Also to suggest that Bocouture and Azzalure are less safe around areas such as the eyes, due to their molecule size, is simply nonsense. The ‘botulinum toxin’ molecule (i.e. the actual active ingredient in ALL three products) is exactly the same size in all products. ‘Botulinum toxin’ is the molecule that does the job, it is the active component of the medicine in all three products.

In addition to the active ingredient, there might be associated proteins in the vial (which serve no purpose in the action of the drug). As soon as the drug is injected into the skin, the associated proteins separate from the active ingredient. That brings us back to the fact that the actual active ingredient, botulinum toxin, is EXACTLY the same size in all three licensed products, 150kD to be exact. This is proven science.

To imply that everything other that the product ‘Botox’ is inferior for the patient is untrue. ‘Botox’ is just a brand name. However as Botox was the first on the market, the drug is commonly referred to as ‘Botox’, although there are now other licensed products available containing the same active ingredient. This is similar to calling all vacuum cleaners ‘Hoovers’ and saying any appliance not manufactured by the brand Hoover is inherently inferior. On a personal note, I much prefer my Dyson – updated and more modern than the original product.

It is inappropriate to suggest that patients receiving either Azzalure or Bocouture are in some way being offered suboptimal products by their practitioner. This article has either been researched extremely badly, or is making these claims knowingly, in order to mislead readers for some hidden ulterior motive. Either way the article creates anxiety which is simply unnecessary. I hope very much that this newspaper will publish a balanced, well researched report to counter this biased and inaccurate piece.

Dr Stefanie Williams, MD
Dermatologist and Medical Director of Eudelo (

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