Introduction

Botulinum toxin injection is currently one of the most popular minimally invasive aesthetic treatments. Botulinum toxin has various subtypes including A, B, C, D, E, F, and G, etc. Types A and B are in clinical use with type A being the most widely used.

 

Type A toxin has the highest efficacy. Its effects last 3-4 months and are completely lost by 6-7 months from treatment. Recent studies reported that repeated treatment of botulinum toxin can increase the duration of its effects.

 

In 1996, Botox, an American botulinum toxin product was first introduced in Korea. Various botulinum toxin products have since entered the market. Products that are widely used in Korea include Botox, Dysport, Xeomin, BTXA, and Myobloc, which are imported and Botulax, Medytox, and Nabota which are domestic products. Most products are available in the 100 unit vial following Probit method but Dysport, a European product, is available in the 500 unit vial following the Spearman-K rber method.

 

Comparing Botox and Dysport, two oldest products, there is a significant potency difference. One unit of Botox is equivalent to 2-3 units of Dysport. The manufacturer of Dysport claims the potency difference is 1:2.5, which would equate one 500-unit Dysport vial to two 100-unit Botox vials. In this article, for the sake of convenience, I will use Botox and Dysport dosages to describe necessary botulinum toxin doses for each facial area.

 

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In the early days, botulinum toxin was used in limited facial areas such as the forehead, glabella, eye area, and nose bridge for smoothing expression lines and on the lower jaws for masseter muscle reduction. It was also used in muscle disorders including blepharospasm, hemifacial spasm, torticollis, strabismus, and spastic dysphonia, etc. Recently, botulinum toxin has gained a wider range of indications and can be used for wrinkle removal of various parts of the face, neck and décolletage. Botulinum toxin is also widely used in hypertrophic muscle correction such as masseter and temporalis muscle reduction as well as body contouring procedures to reduce platysma and sternocleidomastoid muscle, trapezius and splenius muscles, gluteus maximus and minimus muscle, sartorius muscle, biceps and triceps muscles, and tibialis anterior, gastrocnemius and soleus muscles.

 

Botulinum toxin can be used in correcting the parotid gland hypertrophy which causes an undesired protrusion around preauricular area. Botulinum toxin can be used to correct hypertrophy of salivary gland in patients who often present a bulbous protrusion under the submandibular gland after facial bone contour correction surgery. Additionally, botulinum toxin can also improve indentation or sagging of facial tissues (eye area, eyebrow, nasal tip, around the nose, mouth corners, and neck, etc.). It reduces excess sweating by regulating sweat gland nerves and alleviates migraines.