# **Chapter 1 – Introduction to Skin Botox**
---
## **1.1 Definition**
**Skin Botox** (often termed **Microbotox** or **Intradermal Botox**) is a **cosmetic injection technique** in which **botulinum toxin type A** is administered in **very dilute concentrations** and delivered **superficially into the dermis or the dermal-epidermal junction**, rather than deep into muscles.
- **Traditional Botox**: targets **neuromuscular junctions** → reduces muscle contractions → softens dynamic wrinkles (e.g., crow’s feet, forehead lines).
- **Skin Botox**: targets **sebaceous glands, arrector pili muscles, dermal microvasculature, and superficial dermal neuromodulation** → improves **skin texture, pore size, seborrhea, fine lines, and overall luminosity**.
Key Point:
It is **not primarily for expression wrinkles** but for creating a **“glass skin” effect**—smooth, poreless, radiant skin that is highly desired in East Asia and increasingly worldwide.
---
## **1.2 History and Evolution**
- **1990s**: Botulinum toxin A became widely used in aesthetic medicine for muscle-related wrinkles.
- **Early 2000s (Korea & Taiwan)**: Physicians observed that very **diluted intradermal injections** had surprising benefits beyond muscle relaxation, such as **reduced facial oiliness** and **refined skin texture**.
- **2001**: Dr. Woffles Wu (Singapore) formally described the technique of **Microbotox**, using a **“multiple microinjection grid pattern”** across the face.
- **2000s–2010s**: Rapid adoption in Asia, especially in Korea, where the cultural ideal of **clear, porcelain-like skin** fueled demand.
- **2020s–Present**: Western practices began incorporating Skin Botox, often in combination protocols (e.g., **Skin Booster + Toxin**), as patients sought **subtle, natural rejuvenation** rather than dramatic changes.
Evolution highlights:
- From **wrinkle treatment → skin quality enhancement**.
- From **focal injections → full-face protocols**.
- From **toxin alone → hybrid treatments with fillers, HA, exosomes**.
---
## **1.3 Indications and Patient Selection**
Skin Botox is not for everyone. **Proper patient selection is crucial** for both efficacy and safety.
### (A) Indications
1. **Skin Texture Improvement**
- Fine static wrinkles (especially under eyes, lateral cheeks).
- Rough or uneven skin surface.
2. **Sebum and Pore Control**
- Oily skin, enlarged pores, seborrhea.
- Acne-prone patients (adjuvant therapy).
3. **Redness / Rosacea**
- Facial flushing, persistent erythema due to dermal vascular hyperactivity.
4. **Early Skin Laxity**
- Mild sagging, particularly in jawline and neck.
- Creates a **subtle lifting effect** via dermal tightening.
5. **Preventive Rejuvenation**
- Younger patients in their 20s–30s who do not yet have deep wrinkles but desire **“baby face” glow and poreless skin**.
6. **Special Sites**
- **Neck (platysmal bands, “tech-neck” lines).**
- **Décolleté (sun-damaged skin, fine crêpey wrinkles).**
- **Hands (improves skin texture, reduces sweating).**
---
### (B) Patient Profiles
- **Ideal Candidate**:
- 25–45 years old.
- Complains of oily skin, large pores, early fine lines, or loss of skin glow.
- Prefers **subtle, natural rejuvenation** without obvious “Botox face.”
- **Not Ideal / Contraindicated**:
- Patients seeking correction of **deep dynamic wrinkles** (they need traditional Botox or fillers).
- Patients with **excess skin laxity** (better suited for energy-based devices or surgery).
- Patients with **neuromuscular disorders** (e.g., myasthenia gravis, Lambert-Eaton).
- **Pregnant or breastfeeding** women.
---
### (C) Setting Patient Expectations
- **Results are subtle, not dramatic**: Patients must understand this is not a facelift substitute.
- **Duration is shorter**: 2–3 months vs. 4–6 months for traditional Botox.
- **Requires maintenance**: Treatments often repeated 3–4 times per year.
- **Recovery is minimal**: Mild redness/swelling, usually resolves within 24–48 hours.
---
## **Key Insights from Chapter 1**
- Skin Botox represents a **paradigm shift in Botox use**: from wrinkle-erasing to **skin-quality optimization**.
- It was pioneered in **Asia (Singapore, Korea, Taiwan)** and is now becoming a **global trend**.
- The **best candidates** are patients with oily skin, enlarged pores, and fine lines, seeking **natural radiance rather than frozen expressions**.
- **Expectation management is crucial**: short-lived results, but high satisfaction when patients desire “refinement” instead of radical change.
---
# 📌 케이스 스터디: 스킨보톡스
### 환자 프로필
- **성별/나이**: 32세 여성
- **직업**: 광고회사 마케터 (대인 접촉 많음, 촬영·미팅 잦음)
- **주호소**:
- 오후만 되면 피부가 **번들거리고 화장이 무너짐**
- 최근 들어 **모공이 커지고, 피부결이 거칠어짐**
- “피부가 탁해 보이고, 생기가 없다”는 이야기를 주변에서 듣는다고 호소
---
### 병력 청취
- **피부 타입**: 지성 피부, 피지 분비 많음
- **과거력**: 특이사항 없음 (임신·수유 아님)
- **치료 경험**: 주기적인 레이저 토닝과 스킨부스터 시술 경험 → 일시적 개선 있으나 피지 조절 효과는 미흡
---
### 진단
- **Seborrheic skin + Enlarged pores + Fine wrinkles**
- 적합한 적응증: **스킨보톡스**
---
### 시술 계획
1. **보톡스 용량**: 40U (희석 후 사용)
2. **주입 방법**:
- 30G 니들 사용, 표피-진피 경계(약 1mm 깊이)에 0.01cc씩 다점 주입
- 부위: T-zone(이마·콧등·코 옆), 볼 중앙, 턱선 주변
3. **보조치료**: 2주 후 LDM 초음파(피부 진정·보습 강화) 추가
---
### 시술 후 경과
- **1주 후**: 오후 번들거림 감소, 피부 표면 매트(matte)해짐
- **3주 후**: 모공 크기 눈에 띄게 감소, 화장 지속력 개선
- **2개월 후**: 효과 점차 감소, 환자가 재시술 원함
---
### 환자 만족도
- 환자 표현: “예전에는 점심만 지나면 기름종이가 필수였는데, 이제는 오후에도 피부가 산뜻해요. 모공도 덜 보이고 피부가 맑아 보인다는 말을 들어서 만족합니다.”
---
### 의학적 포인트
- 이 환자는 **피지 조절 + 모공 축소 + 피부결 개선**이라는 **스킨보톡스의 대표적 장점**을 잘 보여주는 케이스.
- 단, 환자에게 **효과 지속 기간(2~3개월)** 과 **반복 시술 필요성**을 반드시 설명해야 함.
- 기대치 관리가 잘 되었기 때문에 **만족도가 높고 재방문율이 높다**는 점이 핵심.
---