BOTULINUM TOXIN Areborncorea.com/wp-content/uploads/2019/10/2019... · PRESIDENT MD. BYUNGSUN KIM 원장 김병선 [email protected] History • In 1895, Professor Emile Van Ermengem,

PRESIDENT MD. BYUNGSUN KIM

원장 김병선 www.reborncorea.com

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BOTULINUM TOXIN A REBORN Academy Atlas Book

2019 1st Version

REBORN AESTHEICO-PLASTIC CLINIC

PRESIDENT MD. BYUNGSUN KIM 원장 김병선

www.reborncorea.com

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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



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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



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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.



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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



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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



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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.



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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



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Particulars Forehead Wrinkles

20mm 20mm

Normal Severe



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Particulars Glabella Line

Normal Severe



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Particulars Eyebrow Lifting

Normal Severe



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Particulars Upper Eyelid Wrinkle Lifting

D D

Lower Eyelid Wrinkle Lifting



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Particulars Upper Eyelid Ptosis

Crow’s Feet Wrinkle Lifting



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Particulars Bunny Line

Normal Severe



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Particulars Nose Elevation

Gummy Smile

Periosteal Layer



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Particulars Dimple

Nasolabial Folder

Dermal Layer

Deep Layer Dermal Layer



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Particulars Smokers Line

Nasolabial Folder

Dermal Layer

Deep Layer Dermal Layer



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Particulars Mouth Corner(Oral Angle)

Cobble Stone Chin

Dermal Layer

10mm

10mm



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Particulars Jowl Blunting



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Particulars Gobbler Neck



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Particulars Gobbler Neck

D : 15mm



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Particulars Masseter Muscle Hypertrophy

Deep Layer

Near Periosteum



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Particulars Bruxism

Deep Layer

Near Periosteum



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Particulars Temporal Muscle Hypertrophy

Deep Layer

Near Periosteum



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Particulars Parotid Gland Hypertrophy

Deep Layer

Inside Parotid Gland



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Particulars Neck Wrinkle



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Particulars Chest Wrinkle



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Particulars Full Face



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Particulars

Microbotox Full Face

Oily Face



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Particulars Pores Keloid



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Particulars Hyperhidrosis



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B. BOTULINUM TOXIN Particulars

Calf Muscle Hypertrophy Thigh

Normal Severe



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Particulars Trapezius, Deltoid, Triceps Muscle



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Particulars Headache, Migraine



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Particulars Back Pain



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Particulars Carpal Tunnel Syndrome



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Particulars Vaginismus

High Concentrated 50~75IU



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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



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THANKS A LOT

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Documents

BOTULINUM TOXIN Areborncorea.com/wp-content/uploads/2019/10/2019... · PRESIDENT MD. BYUNGSUN KIM 원장 김병선 [email protected] History • In 1895, Professor Emile Van Ermengem,