*Sponsored post: Austell Pharmaceuticals*
Disclaimer: For medical regulatory reasons, we are unable to publish the brand name of the Incobotulinum Toxin Type A mentioned in this article, manufactured by Merz Aesthetics and distributed exclusively in South Africa by Austell Pharmaceuticals. Please consult your doctor for more information. If you are a healthcare provider, contact Austell Pharmaceuticals directly: info@austell.co.za | +27 11 611 1400
Incobotulinum toxin type A is presented by Merz Aesthetics and exclusively distributed by Austell Pharmaceuticals in South Africa. This offering is guided by Austell’s motto: “Medicine with a Conscience”. Merz Aesthetics South Africa key opinion leader Dr Cobus van Niekerk provides an insightful overview of the unique features, benefits, and ethical considerations of incobotulinum toxin type A, highlighting its significance in both aesthetic and medical applications.
Having administered botulinum toxin type A for over 15 years, I’ve witnessed the transformative evolution and impact of aesthetic treatments in South Africa. Until mid-2023, only two brands of botulinum toxin were available. Now, the introduction of incobotulinum toxin type A, a Schedule 4 medicine, marks a significant advancement.
The botulinum toxin landscape in South Africa
Three primary botulinum toxins are approved for use in South Africa:
- Incobotulinum toxin type A by German company Merz Aesthetics
- Onabotulinum toxin type A
- Abobotulinum toxin type A

Legal and safe use
The Medicines and Related Substances Amendment Act 14 of 2015 prohibits the advertising of Schedule 2 and above substances to the public by brand or trade names. Companies and medical professionals are only allowed to advertise Schedule 0 and 1 Substances. All varieties of botulinum toxin type A, regardless of brand name, are Schedule 4 medicines.
Patients may of course inform themselves by researching these products online, as informed patients are empowered patients.
A new addition: Incobotulinum toxin type A
In mid-2023, incobotulinum toxin type A arrived on the South African scene, developed by German company Merz Aesthetics, a global leader in aesthetic and cosmetic medicine.
All legal botulinum toxins in South Africa must be registered with the South African Health Products Regulatory Authority (SAHPRA). It is valuable to know that medicines are not automatically approved, even if they are approved elsewhere, for example by the US Food and Drug Administration (FDA), or Europe’s health, safety and environmental protection body, Conformité Européenne (CE).
Obtaining SAHPRA registration is a lengthy process requiring extensive paperwork, as well as significant time and effort. Incobotulinum toxin type A is exclusively distributed by Austell Pharmaceuticals South Africa. Any other product not classed as inco-, ona-, or abobotulinum toxin type A is not approved or registered by SAHPRA. These products are illegal and may be dangerous to your health.

Ethical administration
In South Africa, only doctors and dentists registered with the Health Professions Council of South Africa (HPCSA) can administer botulinum toxin and other aesthetic injectables. When going through the consent procedure, it is your right to know what is injected into your body. Don’t allow yourself to be injected by anyone apart from a doctor or dentist, in an appropriate setting, who is fully trained in the use of a reputable product, with full consent signed by both of you. You should only allow injection after:
- Adequate information has been provided
- A quotation has been received
- A considered decision has been made
- Coercion has not been involved
- The product of your choice has been chosen
- The conditions or surroundings are deemed appropriate
- You’ve confirmed the physician is trained in the use of the product
If your physician does not offer a specific product, ask them to either order it in, or ask to be referred to someone who does.
Medical and aesthetic applications
Botulinum toxin type A is widely recognised as a proverbial cornerstone of aesthetic medicine. Beyond its aesthetic applications for smoothing wrinkles and fine lines, it also addresses medical concerns such as excessive sweating, blepharospasm, hemifacial spasms, muscle dystonia, and migraines – to mention only a few indications.
According to the American Society of Plastic Surgery, botulinum toxin procedures topped the list of minimally invasive cosmetic procedures in 2022, with over 8.7 million treatments performed in the USA alone (up 73% from 2019).

Mechanism of action
All botulinum toxin type A formulations are developed through various techniques using the bacterium called Clostridium botulinum.
Botulinum toxin type A works by blocking the release of acetylcholine at nerve endings, preventing muscle contractions. This leads to smoother skin and a reduction in fine lines and wrinkles, as well as preventing new ones from forming, when expertly and precisely injected into targeted muscles.
Each toxin has its own unique properties and benefits, and a head-to-head comparison proves not only difficult, but also goes beyond the scope of this article.
Understanding incobotulinum toxin type A
Incobotulinum toxin type A has numerous unique features, which include the following:
- Purity: It is a refined formulation and currently the only product free from C. botulinum complexing proteins. It contains only 150 kD of the active neurotoxin, 1 mg of albumin, and a small amount of sucrose.
- Low immunogenic potential: The absence of complexing proteins reduces the risk of neutralising antibodies, minimising the chance of resistance and treatment failure.
- Registrations: It is an FDA, CE, and SAHPRA registered product.
- Extended stability: It is stable for up to three years at room temperature, eliminating the need for a cold chain, which is a logistical issue in South Africa, where power outages are frequent. Once reconstituted, it must be refrigerated.
- Rapid onset of action occurs between 2–3 days for the glabella (frown lines), while the lateral canthal lines (laughter lines) and frontalis lines (horizontal forehead lines) may take up to 7 days. Follow-up is advised after 14 days, with maximum effect at 30 days after injection.
- Duration of action is 3–4 months; however, this differs from patient to patient.
- Favourable diffusion properties: It remains in the targeted muscle if injected at the correct dosage, correct dilution, and correct technique, ensuring precise and predictable outcomes for patients.
- Well tolerated: It boasts a well-tolerated safety profile.
Conclusion
The introduction of incobotulinum toxin type A broadens the options available for aesthetic and medical treatments in South Africa.
Its unique features – such as the absence of complexing proteins, a prolonged shelf life, and requiring no cold chain – make it a new option to choose from for both patients and medical professionals looking to expand their treatment offering.
Recognising that treatments are not a one-size-fits-all is essential. By staying informed and considering the unique advantages of each product, medical professionals can deliver optimal outcomes for their patients with more tailored and effective solutions.
As the aesthetic industry evolves, innovative products like incobotulinum toxin type A ensure that both cosmetic and medical needs are met with the highest standards of care.
References available upon request.
MBChB (Pret), BSCMedScHons (Stell)(Cum Laude), Advanced Dip. Aesthetic Medicine (FPD)(Cum Laude)
Dr Cobus van Niekerk is a General Practitioner with a focus on aesthetic medicine, pro-aging medicine, wellness and ethics. He is the founder of Wellnessthetics in Johannesburg, South Africa. He is also the Vice President of the Aesthetic & Anti-Aging Medicine Society of South Africa (AAMSSA), where he oversees the Medico-legal, Ethics, and Social Media portfolios.
Dr van Niekerk graduated from the University of Pretoria in 1997 and the University of Stellenbosch in 2001 with a BScMedScHons degree (Cum Laude) in Reproductive Biology. He then worked in Internal Medicine, Emergency Medicine, Trauma, and Intensive Care in the United Kingdom. He became a member of the Royal College of Surgeons of Edinburgh in 2007. Dr van Niekerk also contributes to the medical landscape as a member of the Scientific Committee of the Aesthetic Medicine Congress of South Africa (AMCSA), underscoring his commitment to fostering innovation and collaboration in Aesthetic Medicine.
Dr van Niekerk is a skilled speaker and a distinguished graduate of the Advanced Diploma of Aesthetic Medicine (ADAM), graduating cum laude. He is committed to the fields of Wellness, Aesthetics, Pro-aging, and Ethics, and he enriches the medical landscape with his expertise and dedication.