BOTULINUM TOXIN Areborncorea.com/wp-content/uploads/2019/10/2019... · PRESIDENT MD. BYUNGSUN KIM...
Transcript of BOTULINUM TOXIN Areborncorea.com/wp-content/uploads/2019/10/2019... · PRESIDENT MD. BYUNGSUN KIM...
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PRESIDENT MD. BYUNGSUN KIM
원장 김병선 www.reborncorea.com
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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PRESIDENT MD. BYUNGSUN KIM
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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 Masseter Muscle Hypertrophy
Deep Layer
Near Periosteum
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Particulars Bruxism
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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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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PRESIDENT MD. BYUNGSUN KIM
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THANKS A LOT
리본의원
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