View
0
Download
0
Category
Preview:
Citation preview
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
BOTULINUM TOXIN A REBORN Academy Atlas Book
2019 1st Version
REBORN AESTHEICO-PLASTIC CLINIC
PRESIDENT MD. BYUNGSUN KIM 원장 김병선
www.reborncorea.com
reborncorea@gmail.com
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
History
• In 1895, Professor Emile Van Ermengem, of Belgium, first isolated the bacterium Clostridium botulinum.
• In 1928, Dr. Herman Sommer, at the University of California, San Francisco, first isolated in purified
form botulinum toxin type A (BoNT-A) as a stable acid precipitate.
• In 1973, Dr. Alan B. Scott, of Smith-Kettlewell Eye Research Institute, used BoNT-A in monkey
experiments; in 1980, he used BoNT-A for the first time in humans to treat strabismus.
• In 1989, BoNT-A (BOTOX® ) was approved by the US FDA
• 2006 Meditoxin was approved with KFDA in domestic market.
• 2009 Botulax was approved with KFDA in domestic market.
• 2013 Nabota was approved with KMFDS in domestic market.
• 2016 Hutoxin was approved with KMFDS in foreign market.
KOREA
HISTORY
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Characteristics
• ORIGIN: Clostridum Botulinum and Clostrium species
• Character : Aminoacids Polymer(1,251~1,296),900kDa(149kDa)
• Type: 7(A~G) Subtype
• Each botulinum toxin molecule is comprised of a heavy chain and of a light chain, connected by a disulfide bond.
BoNT/A CHEMICAL STRUCTURE
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Characteristics BoNT/A FUNCTION
Botulinum toxin is a "blocking agent"
preventing the release of
certain neurotransmitters,
specifically Acetylcholine, from the
endings of the motor nerves.
Botulinum toxin has a light chain and a
heavy chain, each of which contributes
to the toxicity. The heavy chain allows
the protein to bind to and enter
a neuron. After the heavy chain allows
entry, the light chain acts like a protease
and cleaves proteins that would
normally allow neurotransmitters to
leave the cell. This is essentially a
disruption of exocytosis or the release of
neurotransmitters The blocked
neurotransmitter, Acetylcholine],
normally transmits a nerve impulse to a
muscle, signaling the muscle to contract.
By blocking this neurotransmitter,
botulinum toxin causes its characteristic
flaccid paralysis.
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
General Info INDICATION
• Focal dystonias - Involuntary, sustained, or spasmodic patterned muscle
activityCervical dystonia (spasmodic torticollis)
• Blepharospasm (eyelid closure)
• Laryngeal dystonia (spasmodic dysphonia)
• Limb dystonia (writer's cramp)
• Oromandibular dystonia
• Orolingual dystonia
• Truncal dystonia
• Spasticity - Velocity-dependent increase in muscle tonestroke.
• Traumatic brain injury
• Cerebral palsy
• Multiple sclerosis
• Spinal cord injury
• Nondystonic disorders of involuntary muscle activityHemifacial spasm
• Tremor
• Tics
• Myokymia and synkinesis
• Tinnitus (due to myoclonus of stapedius muscle & tensor veli palatini muscle )
• Hereditary muscle cramps
• Nocturnal bruxism
• Trismus
• Anismus
• Strabismus (disorder of conjugate eye movement) and nystagmus
• Chronic pain and disorders of localized muscle spasmsChronic low back pain
• Myofascial pain syndrome
• Tension headache
• Chronic migraine headache
• Medication overuse headache
• Lateral epicondylitis
• Knee pain
• Shoulder pain
• Neuropathic pain
• Smooth muscle hyperactive disordersNeurogenic bladder – Detrusor hyperreflexia
• Detrusor-sphincter dyssynergia
• Benign prostatic hypertrophy
• Achalasia cardia
• Hirschsprung disease
• Sphincter of Oddi dysfunctions
• Hemorrhoids
• Chronic anal fissures
• Raynaud's Phenomenon
• Cosmetic useHyperkinetic facial lines (glabellar frown lines, crow's feet)
• Hypertrophic platysma muscle bands
• Sweating, salivary, and allergy disordersAxillary and palmar hyperhidrosis
• Frey syndrome, also known as auriculotemporal syndrome (gustatory sweating of
the cheek after parotid surgery)
• Drooling in cerebral palsy and other neurological disorders
• Nasal allergy and allergic rhinitis
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
General Info
• The potency of BoNT-A is measured in mouse units (MU). One MU of BoNT-A is equivalent to the amount of toxin that kills 50% of a group
of 20 g Swiss-Webster mice within 3 days of intraperitoneal injection (LD50).
• 1 U of BoNT-A is equal to approximately 0.05 nanogram of the toxin
• LD50 of BoNT-A for a 70-kg adult male has been calculated to be 2500-3000 U (35-40 U/kg).
• Minimum lethal dose of BoNT-B in monkeys is 2400 U/kg.
• The Efficacy Terms is less than 6months(usually 4months).
• Maximum Effect is 3weeks after injection(usually 2~3weeks).
• BOTOX® , BOTULAX® and MEDITOXIN® vials contain sodium chloride (0.9 mg) and human albumin (0.5 mg), and the protein load is 5
ng/100 units.
POTENCY . EFFICACY. FORMULAR
• Respiratory problems
• Dysphagia
• Seizure
• Flulike syndrome
• Facial and other muscle weakness
• Ptosis
• Skin and injection site reactions
ADVERSE EFFECTS
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
General Info
PREPARATION
RECOMMEND
• Storage term is the less than 36months in refrigerator(2~8oC) before reconstitution.
• Storage term is the less than 4months in refrigerator(2~8oC) after reconstitution.
• Diluent of 100 U of BoNT-A is reconstituted with preservative-free normal saline (1-5 mL).
• Handling : N-S, Do not make foam.
• Needle : 30G ~32G Needle.
• Of the 406 reports related to therapeutic use, 217 met the FDA's definition of serious, with 28 deaths and 17 seizures reported.
• Clinical characteristics submitted to the FDA for therapeutic cases differed from those of cosmetic BoNT cases, which were usually less
serious.
• Most of the adverse effects linked to local tissue diffusion of BoNT.
• Careful attention to drug dose, dilution, handling, storage, and site of injection are required for optimal treatment outcome and to minimize
adverse effects.
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars LEGENDS
MicroBoNTA
1U :100U/1ml
Key Line
mm Distance
E: Epidermis D: Dermis S: SubQ :IM
Injection Layer
1U :100U/2.5ml
2U :100U/1ml
2U :100U/2.5ml
3U :100U/2.5ml
4U :100U/2.5ml
5U :100U/2.5ml
10U :100U/2.5ml
0.1U :100U/10ml
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Forehead Wrinkles
20mm 20mm
Normal Severe
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Glabella Line
Normal Severe
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Eyebrow Lifting
Normal Severe
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Upper Eyelid Wrinkle Lifting
D D
Lower Eyelid Wrinkle Lifting
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Upper Eyelid Ptosis
Crow’s Feet Wrinkle Lifting
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Bunny Line
Normal Severe
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Nose Elevation
Gummy Smile
Periosteal Layer
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Dimple
Nasolabial Folder
Dermal Layer
Deep Layer Dermal Layer
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Smokers Line
Nasolabial Folder
Dermal Layer
Deep Layer Dermal Layer
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Mouth Corner(Oral Angle)
Cobble Stone Chin
Dermal Layer
10mm
10mm
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Jowl Blunting
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Gobbler Neck
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Gobbler Neck
D : 15mm
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Masseter Muscle Hypertrophy
Deep Layer
Near Periosteum
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Masseter Muscle Hypertrophy
Deep Layer
Near Periosteum
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Bruxism
Deep Layer
Near Periosteum
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Bruxism
Deep Layer
Near Periosteum
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Temporal Muscle Hypertrophy
Deep Layer
Near Periosteum
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Parotid Gland Hypertrophy
Deep Layer
Inside Parotid Gland
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Neck Wrinkle
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Chest Wrinkle
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Full Face
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars
Microbotox Full Face
Oily Face
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Pores Keloid
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Hyperhidrosis
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
B. BOTULINUM TOXIN Particulars
Calf Muscle Hypertrophy Thigh
Normal Severe
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Trapezius, Deltoid, Triceps Muscle
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Headache, Migraine
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Back Pain
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Carpal Tunnel Syndrome
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Vaginismus
High Concentrated 50~75IU
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Particulars Vaginismus
High Concentrated 50~75IU
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
Tips
• MEDITOXIN and BOTULAX Titer is 115% Stronger than BOTOX
• I mix 100U MEDITOXIN & BOTULAX with 1ml NSS for High Concentrated BoTNA
• I mix 100U MEDITOXIN & BOTULAX with 3ml NSS for Normal BoTNA
• I mix 100U MEDITOXIN & BOTULAX with 6ml NSS for Micro BoTNA
• I make 20 bullas by 0.1ml for Micro BoTNA
• I mix BoTNA with Buffered Lidocain Solution
• 10ml Buffered Lidocain Solution Formula is
2% Lidocain 4ml+Sodium Bicarnonate 1ml+NSS5ml=10ml
TIPS
PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
reborncorea@gmail.com
THANKS A LOT
리본의원
www.reborncorea.com
reborncorea@gmail.com
Recommended