• Archives of Plastic Surgery
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• v.36 no.5
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• pp.654-659
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• 2009

Purpose: A botulinum toxin type A (BoNT - A) injection has been used as a noninvasive management for lower face contouring since 2000. The aim of this study was to compare reduction rate of lower face width for a longtime according to repeated Botox$^{(R)}$ injections on masseter muscles for lower face contouring procedure. Methods: Forty - five patients were analyzed for single session of Botox$^{(R)}$ injection and 13 patients were evaluated for repeated Botox$^{(R)}$ injections for over two years. Single injection group was tracked regular intervals at 1, 3, 6, 10, 12 months after injection, and repeated injection group was measured at every injection time. Twenty - five to thirty units of Botox$^{(R)}$ was injected into each masseteric muscle at five to six points at the prominent portions of the mandibular angle. Standardized frontal view of digital photographs were analyzed by Adobe Photoshop$^{(R)}$ (version CS3) to measure an reduction rate of lower face width. Results: Reduction rate was 3.7%, 6.9%, 6.2%, 4%, 4% at 1, 3, 6, 10, 12 months post injection each other in single injection group. However, more than 8% reduction rate was found in repeated injection group persistently for more than two years. Conclusion: This study shows that effective duration of Botox$^{(R)}$ injection for lower face contouring is expected to continue over one year clinically. Moreover, repeated injections maintained lower reduction rate consistently for a long time. Therefore, repeated injections on masseter muscles at regular intervals are most effective procedure for lower face contouring.

• Proceedings of the KSLP Conference
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• 1996.11a
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• pp.86-86
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• 1996

연축성 발성장애(spasmodic dysphonia)는 아직까지 그 원인을 정확히 밝혀내지 못하고 있는 만성적인 발성장애로 과거에는 경직성 발성장애(spastic dysphonia)로 불리던 질환이다. 연축성 발성장애는 두 종류 즉, 내전형(adductor)과 외전형(abductor)으로 나누어지며 이중 내전형이 대부분이다. 외전형 연축성 발성장애는 발성도중에 성대가 갑자기 불수의적으로 외전되면서 음성이 중단되므로 원활히 대화하기가 힘든 질환이다. 이러한 질환은 국소적 근긴장이상(fecal dystonia)의 일종이다. 현재까지 연축성 발성장애의 치료법으로 사용되고 있는 것으로는 언어치료, botulium 독소주입술, 편측반회후두신경절 단술, 반회후두신경분쇄술, 상후두신경절단술, 갑상연골성형술, implantable stimulator 등이 있다. 연축성 발성장애 환자에 $Botox^{circledR}$ 주입에 관한 보고는 주로 내전형에 대해서만 보고되고 있으며 외전형에 대하여 보고된 예는 매우 적다. (중략)

• The Journal of the Korean dental association
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• v.46 no.5
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• pp.295-302
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• 2008

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.87-94
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• 2006

This study is to investigate the patients who had blepharoplasty for cosmetic purposes or facial nerve disorders. 21 patients were examined with an age from 17 to 63 years. Sixteen cases were classified as a normal group for investigation of the histopathologic change according to the age. The rest were patients of Bell's palsy(2), $Botox^{(R)}$ injection(2) and blepharospasm (1). We measured a mean diameter of myofiber and dimension's proportion of muscluar tissue per regular visual field. First, we measured a statistical significance according to the age in normal cases by grouping them into younger than 30-year-old, 30's, 40's, 50's and 60's. Second, we divided normal cases(16) into Group A and B by two bases for statistical analysis. In conclusion, although there were several differences as vacuolation, internalization of sarcolemnic nuclei between 35-year-old and 62-year-old patients in simple comparison, there was no uniform decrease according to the age. There were also no significant statistical changes in the value of a diameter of myofibers and dimension's proportion of muscular tissue according to the age in any of the two normal groups. But in $Botox^{(R)}$ injection and Bell's palsy, blepharospasm patients, two values showed remarkable difference compared to the normal group of same age.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.1
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• pp.40-46
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• 2003

Background and Objectives : The vocal fold granuloma has been associated with vocal abuse, gastroesophageal reflux, endotracheal intubation and habitual throat clearing etc.. Granuloma is benign growth of hypertrophic granulation tissue. It is usually located on the posterior third of vocal fold, in one or both vocal process of the arytenoid cartilage In spite of the voice therapy, steroid therapy, anti-reflex therapy and surgical procedure. The distinct advantage and uniform success rate of each methods have not been generally shown. Authors report that localized injection of botulinum toxin type A (BOTOX$^{\circledR}$) is the promising method both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy or who are poor surgical candidates. Materials and Method : We carried out a retrospective study of 9 patients with the diagnosis of vocal fold granuloma on the videostroboscopic examination from Jan 2000 to Mar 2003. The botulinum toxin type A was injected into one or both thyroarytenoid muscle or lateral cricoarytenoid muscle under the electromyography. The average dosage ranges from 6U to 8U per injection. Results : Unilateral vocal fold granuloma in 7 patients had been resolved completely within 2-3 months after first injection : 5 patients received th\ulcorner GER medical therapy in addition to the Botulinum toxin injections, 2 patients was resolved completely who had shown recurrence after $CO_2$ laser vaporization. 2 patients who had shown recurrence after $1^st$ injection were also completely resolved within 6 months after further injections. Conclusion : We expect that localized injection of Botulinum toxin type A can provide an alternative treatment for the refractory cases to the traditional forms of therapy and avoid the recurrence in conjunction with proper medical and voice therapy against GER and vocal abuse.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.8 no.1
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• pp.65-68
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• 1997

The mutational falsetto is failure to change from the higher pitched voice of preadolescence to the lower pitched voice of adolescence and adulthood. The one of characteristic findings is contraction of suprahyoid muscles. The large majority of young men with inappropriately high voice have excellent voice therapy prognosis. We have experienced one case of mutational falsetto treated with botulinum toxin injection on suprahyoid muscles. His suprahyoid muscles are contracted markedly simultaneously with each phonation. fundamental frequency$(F_0)$ of his vowel phonation was 332Hz. Extensive voice therapy including manual compression of thyroid notch was ineffective. Forty units of Botox$^{\circledR}$ was injected under the EMG-guidance(20U bilaterally). At seven days post-injection, his voice changed lower than before and at 40 days after procedure, his $F_0$ was 126Hz.

• Journal of Oral Medicine and Pain
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• v.30 no.3
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• pp.345-351
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• 2005

The purpose of this double-blind study was to evaluate clinical effects of botulinum toxin type A (BTX-A) injection on myofascial pain syndrome (MPS) involving upper trapezius and compare with those of lidocaine injection. 21 patients presenting with active TrP1 and/or TrP2 in the upper trapezius over 6 months were selected for this study. The subjects were randomly divided into two groups; one group injected with BTX-A (15 unit of $Botox^{(R)}$ / 0.3 ml per trigger point (TrP)) and the other group injected with 0.5% lidocaine (0.3 ml /TrP). The clinical effects were evaluated by VAS and PPT at baseline, 2, 4, 6 and 8 weeks after treatment. BTX-A group showed persistent decrease of VAS values and increase of PPT values following treatment. While there was no significant difference in VAS values between BTX-A and lidocaine groups (p=0.347), there was significant difference in PPT values after treatment between two groups (p=0.000). The subjects received BTX-A showed noticeable improvement in PPT values after treatment, suggesting more reliable effect of BTX-A injection compared with lidocaine injection. The results of this study support that the direct injection of BTX-A to a TrP is an effective and safe treatment for MPS involving upper trapezius.

• Journal of the Society of Cosmetic Scientists of Korea
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• v.29 no.2 s.43
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• pp.79-104
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• 2003

Introducing to the market place, safe and effective product is an important responsibility of clinical investigators as well as regulatory agencies in all developed countries. Products claiming to improve skin wrinkles are no exceptions. To date, Renova(R) (all-trans retinoic acid), Avage(R) (tazarotene), and Botox(R) (botulinum toxin) are the only agents FDA approved to ameliorate wrinkles associated with photoaged skin in the USA. For all three, clinical evaluation of wrinkle severity was the primary endpoint required for the approval process. No sophisticated instrument measurements of wrinkles were required, nor used in the pivotal studies. The Division of Dermatologic & Dental Products of the US FDA (Director, Jonathan Wilkin, MD) is not against the use of mechanical instruments in assessing wrinkle severity. Its position on this issue however, remains that any such device must be grounded in patients' or product users' perspective, which means that the evaluation instrument must be clinically relevant and clinically perceptible. Sophisticated devices that can detect minimal improvement, but imperceptible to the users are considered useless in the eyes of the US FDA. Two instruments that have been tried in some antiwrinkle studies in the USA are silicone replicas and Primos. Despite their sophistications, they have clear limitations; thus have never replaced clinical evaluations in these studies. At most, they have served as secondary measures to provide corroborative data on the clinical efficacy of antiwrinkle products. For the foreseeable future, at least in the USA, careful clinical assessment of wrinkles will continue to serve as the critical benchmark to determine whether an antiwrinkle product has enough efficacy to benefit its users. We must not lose sight of the fact that sophisticated devices are only to serve in generating supportive evidence, and not the primary evidence, in any clinical studies.

• Journal of Oral Medicine and Pain
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• v.32 no.3
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• pp.337-346
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• 2007

This study aimed to evaluate a relation of bruxism with clinical effects of botulinum toxin type A(BTX-A) injection. 5 bruxers and 5 nonbruxers with bilateral masseter hypertrophy were participated in this study. After injecting 25 unit of BTX-A(Allergen Inc, $Botox^{(R)}$) into each masseter muscle, the thickness of masseter(Mm) and anterior temporalis(Ta) muscles was measured by ultrasonography and the maximum bite force was evaluated during a 9-month period. Self-estimation on the recovery of occlusal force during mastication was done as well. Regardless of presence of bruxsim, all subjects showed significantly reduced Ms thickness(p<0.001) and maximum bite force at $1^{st}$ molars(p=0.027) with their peak at 3 months after injection, which then started to return. No significant difference was observed in Ta thickness and the bite force at the central incisors. While self-estimated occlusal force was the least at 2 weeks after injection and then rapidly returned to the baseline level with full recovery at the time of 6 to 9 months after injection, the maximum bite force measured by bite force recorder did not recover the original value, particularly in the nonbruxer group. It is assumed that nocturnal bruxism can influence recovery of atrophic masseter and decreased occlusal force due to BTX-A injection. These findings suggest a need of occlusal appliance to control bruxism or clenching habit for longer clinical effect of BTX-A injection.

• Journal of the Society of Cosmetic Scientists of Korea
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• v.44 no.4
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• pp.447-453
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• 2018

Acetyl hexapeptide 8 (AH8) is a synthetic peptide for anti-wrinkle cosmetics ingredient. It was developed as a mimetic of botox, patternd after N -terminal end of the protein synatosomal-associated protein 25 (SNAP25), a substrate of botulinum toxin. While AH8 has good efficacy and safety profiles, the permeation through the skin is poor. Therefore, we tried to enhance the transdermal delivery of AH8 by using of hyaluonic acid (HA), a linear polysaccharide of N-acetyl glucosamine and glucuronic acid. To investigate the effect of HA on AH8 penetration, we analyzed paraffin sections of $Micropig^{(R)}$ skin. Fluorescence labeled AH8 was applied to micropig skin with or without HA. The absorption of AH8 was limited to the stratum corneum (SC) without HA. On the other hand, AH8 penetrated to the dermis with HA. Especially, low molecular weight HA (5 kDa) was most efficient compared to 500 kDa HA and 2000 kDa HA. Experiments using fourier-transform infrared (FTIR) spectroscopy revealed that lower molecular weight HA had a tendency to increase the fluidity of the SC lipids more, which means enhancing the skin penetration. Therefore, HA could be expected to enhance the anti-wrinkle effect of AH8.