Clinical Use of Botulinum Toxin Song, Min-Seok

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Introduction Botulinum Toxin acts by blocking ACH release from nerve terminals at the neuromuscular junction Discovery in 1897 Therapeutic agent in 1977 Today, versatile clinical tool

History Botulus, Greek Van Ermengen in 1895 Alan Scott in the late 1960s Human volunteers in 1977 FDA approval in 1989 Expanded use in late 2000

Basic Science Produced by bacteria (exotoxin of Clostridium Botulinum, G(+), anaerobic, spore-forming) 8 serotypes(A-G) Similar structure - light chain linked by a disulfide bond to a heavy chain Type A is available

Mechanism Binding Internalization Membane Translocation Protease activity Recovery

Preparation Botulinum Toxin Type A 1) Botox(Allergan) 2) Dysport(Ipsen) Myobloc Botulinum Toxin type B(Elan)

Reconstitution Sterile unpreserved saline 1 ½ -inch 25G needle ½ -inch 30G needle inj.

Storage 2-8(degree) Celsius 12 Hours up to 30 days

Indication Aesthetic Glabellar complex Orbicularis oculi Frontalis Platysma Other facial muscles Combined with other procedure

Other Soft ts. Augmentation Facial N. disorders Parotid G. fistula Headache Hyperhidrosis Frey s syndrome

Investigative Wound healing

Contraindication Hypersensitvity to Albumin Neuromuscular ds. Pt. Treated with aminogycosides, penicillamine, quinine, Ca channel blockers Preg./Lactation Pt. On anticoagulation therapy Poor psychological adjustment

Complication Local Immunologic Systemic

Facial rejuvenation; loss of facial expression incomplete m. paralysis unwanted m. paralysis

Therapeutic failure presence of circulating neutralizing antibodies ; correlated with numbers of inj., length of Tx., total cumulative dose Psychological ; unprepared to the paralysis and changes of face

Cinical Use Rhytides Facial Contour Body Contour Hyperhidrosis Etc.

Consideration Muscular anatomy Potential Complication Injection Technique

Facial Contouring Gonial Angle Bigonial Distance Prominent Zygoma Bony Prominence Bony Asymmetry Unrealistic Expectation

Facial Rhytides Frontalis Grabella Crow s feet Etc.

Summary Transient and nondestructive Graded by varying dose and frequency of injections Safety Autonomic disorders and control of pain are being explored Primarily treatment of hyperfunctional muscle disorder No standard dose and injection strategy

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