BOTULINUM TOXIN A 2019 1 st Version REBORN

BOTULINUM TOXIN A 2019 1 st Version REBORN AESTHEICO-PLASTIC CLINIC www. reborncorea. com reborncorea@gmail. com REBORN Academy Atlas Book PRESIDENT MD. BYUNGSUN KIM 원장 김병선

HISTORY 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 (Bo. NT-A) as a stable acid precipitate. • In 1973, Dr. Alan B. Scott, of Smith-Kettlewell Eye Research Institute, used Bo. NT-A in monkey experiments; in 1980, he used Bo. NT-A for the first time in humans to treat strabismus. KOREA • In 1989, Bo. NT-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. www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Bo. NT/A CHEMICAL STRUCTURE • • Characteristics ORIGIN: Clostridum Botulinum and Clostrium species Character : Aminoacids Polymer(1, 251~1, 296), 900 k. Da(149 k. Da) 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. www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Bo. NT/A FUNCTION www. reborncorea. com reborncorea@gmail. com Characteristics 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 PRESIDENT neurotransmitter, MD. BYUNGSUN KIM botulinum toxin causes its 원장 김병선

INDICATION • Focal dystonias - Involuntary, sustained, or spasmodic patterned muscle activity. Cervical 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 activity. Hemifacial 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 www. reborncorea. com reborncorea@gmail. com General Info • Chronic pain and disorders of localized muscle spasms. Chronic 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 disorders. Neurogenic 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 use. Hyperkinetic facial lines (glabellar frown lines, crow's feet) • Hypertrophic platysma muscle bands • Sweating, salivary, and allergy disorders. Axillary 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

General Info POTENCY. EFFICACY. FORMULAR • The potency of Bo. NT-A is measured in mouse units (MU). One MU of Bo. NT-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 (LD 50). • 1 U of Bo. NT-A is equal to approximately 0. 05 nanogram of the toxin • LD 50 of Bo. NT-A for a 70 -kg adult male has been calculated to be 2500 -3000 U (35 -40 U/kg). • Minimum lethal dose of Bo. NT-B in monkeys is 2400 U/kg. • The Efficacy Terms is less than 6 months(usually 4 months). • Maximum Effect is 3 weeks after injection(usually 2~3 weeks). • 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. ADVERSE EFFECTS • • Respiratory problems Dysphagia Seizure Flulike syndrome Facial and other muscle weakness Ptosis Skin and injection site reactions www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

General Info PREPARATION • Storage term is the less than 36 months in refrigerator(2~8 o. C) before reconstitution. • Storage term is the less than 4 months in refrigerator(2~8 o. C) after reconstitution. • Diluent of 100 U of Bo. NT-A is reconstituted with preservative-free normal saline (1 -5 m. L). • Handling : N-S, Do not make foam. • Needle : 30 G ~32 G Needle. RECOMMEND • 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 Bo. NT cases, which were usually less serious. • Most of the adverse effects linked to local tissue diffusion of Bo. NT. • Careful attention to drug dose, dilution, handling, storage, and site of injection are required for optimal treatment outcome and to minimize adverse effects. www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

LEGENDS Particulars Micro. Bo. NTA 0. 1 U : 100 U/10 ml 1 U : 100 U/1 ml 1 U : 100 U/2. 5 ml 2 U : 100 U/1 ml 2 U : 100 U/2. 5 ml 3 U : 100 U/2. 5 ml 4 U : 100 U/2. 5 ml 5 U : 100 U/2. 5 ml 10 U : 100 U/2. 5 ml Key Line www. reborncorea. com reborncorea@gmail. com Distance mm Injection Layer E: Epidermis D: Dermis S: Sub. Q : IM PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Forehead Wrinkles Particulars 20 mm www. reborncorea. com reborncorea@gmail. com Normal 20 mm Severe PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Glabella Line www. reborncorea. com reborncorea@gmail. com Particulars Normal Severe PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Particulars Eyebrow Lifting www. reborncorea. com reborncorea@gmail. com Normal Severe PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Upper Eyelid Wrinkle Lifting Particulars Lower Eyelid Wrinkle Lifting D www. reborncorea. com reborncorea@gmail. com D PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Upper Eyelid Ptosis Particulars Crow’s Feet Wrinkle Lifting www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Bunny Line www. reborncorea. com reborncorea@gmail. com Particulars Normal Severe PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Particulars Nose Elevation Gummy Smile Periosteal Layer www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Dimple Particulars Nasolabial Folder Dermal Layer www. reborncorea. com reborncorea@gmail. com Deep Layer PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Smokers Line Particulars Nasolabial Folder Dermal Layer www. reborncorea. com reborncorea@gmail. com Deep Layer PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Mouth Corner(Oral Angle) Particulars Cobble Stone Chin Dermal Layer 10 mm www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Jowl Blunting www. reborncorea. com reborncorea@gmail. com Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Gobbler Neck www. reborncorea. com reborncorea@gmail. com Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Gobbler Neck Particulars D : 15 mm www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Masseter Muscle Hypertrophy Particulars Deep Layer Near Periosteum www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Bruxism Particulars Deep Layer Near Periosteum www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Particulars Bruxism Deep Layer Near Periosteum www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Temporal Muscle Hypertrophy Particulars Deep Layer Near Periosteum www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Parotid Gland Hypertrophy Particulars Deep Layer Inside Parotid Gland www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Neck Wrinkle www. reborncorea. com reborncorea@gmail. com Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Chest Wrinkle www. reborncorea. com reborncorea@gmail. com Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Full Face www. reborncorea. com reborncorea@gmail. com Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Oily Face Particulars Microbotox Full Face www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Pores www. reborncorea. com reborncorea@gmail. com Keloid Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Hyperhidrosis www. reborncorea. com reborncorea@gmail. com Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

B. BOTULINUM TOXIN Particulars Calf Muscle Hypertrophy www. reborncorea. com reborncorea@gmail. com Normal Thigh Severe PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Trapezius, Deltoid, Triceps Muscle www. reborncorea. com reborncorea@gmail. com Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Headache, Migraine www. reborncorea. com reborncorea@gmail. com Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Back Pain www. reborncorea. com reborncorea@gmail. com Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Carpal Tunnel Syndrome www. reborncorea. com reborncorea@gmail. com Particulars PRESIDENT MD. BYUNGSUN KIM 원장 김병선

Vaginismus Particulars High Concentrated 50~75 IU www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

TIPS Tips • MEDITOXIN and BOTULAX Titer is 115% Stronger than BOTOX • I mix 100 U MEDITOXIN & BOTULAX with 1 ml NSS for High Concentrated Bo. TNA • I mix 100 U MEDITOXIN & BOTULAX with 3 ml NSS for Normal Bo. TNA • I mix 100 U MEDITOXIN & BOTULAX with 6 ml NSS for Micro Bo. TNA • I make 20 bullas by 0. 1 ml for Micro Bo. TNA • I mix Bo. TNA with Buffered Lidocain Solution • 10 ml Buffered Lidocain Solution Formula is 2% Lidocain 4 ml+Sodium Bicarnonate 1 ml+NSS 5 ml=10 ml www. reborncorea. com reborncorea@gmail. com PRESIDENT MD. BYUNGSUN KIM 원장 김병선

THANKS A LOT 리본의원 www. reborncorea. com reborncorea@gmail. com www. reborncorea. com PRESIDENT MD. BYUNGSUN KIM reborncorea@gmail. com 원장 김병선