# **Chapter 4 – Clinical Effects of Skin Botox (Microbotox)** Here we will analyze what happens **clinically and aesthetically** after intradermal botulinum toxin injections: the visible improvements, biological rationale, onset and duration, and how patients perceive outcomes. --- ## **4.1 Skin Texture and Fine Wrinkle Reduction** - **Primary effect**: Microbotox smooths the **superficial skin surface**. - **Mechanism**: - Relaxation of dermal micro-musculature (arrector pili, superficial SMAS fibers). - Reduction in neurogenic inflammation → less dermal roughness. - Indirect modulation of fibroblasts → improved collagen support. - **Clinical outcome**: - Fine static wrinkles (especially periorbital, perioral, and malar fine lines) soften. - Patients describe skin as **“polished” or “airbrushed.”** --- ## **4.2 Pore Size and Sebum Control** - One of the **most distinctive features** of Skin Botox. - **Sebaceous glands** are cholinergically regulated → BoNT-A blocks acetylcholine → sebum output decreases. - **Arrector pili relaxation** reduces pore rim tension → visually smaller pores. - **Clinical outcome**: - Less oiliness by week 1. - Pores appear finer, particularly in T-zone and cheeks. - Makeup longevity improved. --- ## **4.3 Redness and Flushing Reduction** - Intradermal BoNT-A reduces vasodilation mediated by acetylcholine and neuropeptides (Substance P, CGRP). - Particularly useful in **rosacea patients** or those with chronic facial flushing. - **Clinical outcome**: - Erythema reduced. - Patients report “calmer skin,” less prone to sudden redness. --- ## **4.4 Subtle Lifting and Firming Effects** - Microbotox can create a **“Nefertiti effect”** when applied along jawline and neck. - **Mechanism**: - Dermal tightening through micro-muscle relaxation. - Redistribution of skin tension → more defined contours. - **Clinical outcome**: - Jawline sharper, neck smoother. - Not as dramatic as HIFU or threads, but contributes to youthful contour. --- ## **4.5 Duration of Results** - **Onset**: 3–5 days (patients first notice oil/sebum reduction). - **Peak**: 2 weeks (smooth skin, pore refinement, glow most visible). - **Duration**: - **2–3 months** (shorter than muscle Botox, which lasts 4–6 months). - Variable: faster metabolism in younger/oily patients, longer in older/dry skin. 👉 Because of shorter duration, many patients schedule **3–4 treatments per year** for maintenance. --- ## **4.6 Patient-Reported Outcomes** - **High satisfaction** when expectations are set properly. - Key improvements patients often verbalize: - “My skin looks clearer and brighter.” - “I don’t need blotting papers anymore.” - “Makeup lasts longer and looks smoother.” - “People say I look healthier, not frozen.” - **Psychological effect**: More confidence, natural radiance, “refreshed but not done” look. --- ## **4.7 Comparative Clinical Notes** - **Compared to fillers**: Fillers restore volume; Skin Botox refines texture. - **Compared to lasers**: Lasers target pigment/vascularity; Skin Botox targets oil/pore/flush. - **Compared to classic Botox**: Classic Botox = wrinkle softening via muscle paralysis; Skin Botox = overall **skin quality enhancement** without altering expression. --- ## **4.8 Long-term Effects with Repeated Treatments** - Clinical reports suggest **cumulative benefits**: - Sebaceous glands down-regulated over time → more balanced skin baseline. - Dermal fibroblast stimulation → subtle improvement in elasticity. - Repeated flushing control in rosacea patients → fewer flare-ups. - Thus, long-term patients often appear **consistently “fresh-faced.”** --- ## **Key Insights from Chapter 4** - Skin Botox is less about **erasing lines** and more about **elevating skin quality**. - Major benefits: 1. **Fine wrinkle smoothing** 2. **Pore and oil control** 3. **Flushing reduction** 4. **Subtle lift** - Duration is shorter, but satisfaction is high because results are **natural, noticeable, but not obvious**. - Patients describe the effect as a **“glow-up”** rather than a “Botox look.” --- 👉 **Professor’s Reflection Question**: If conventional Botox represents **“anti-aging through motion control,”** can we think of Skin Botox as **“anti-aging through skin ecology control”**—balancing glands, micro-muscles, and vasculature for harmony? --- # 📌 케이스 스터디: 스킨보톡스 임상 효과 ### 환자 프로필 - **나이/성별**: 29세 여성 - **직업**: 아나운서 지망생 (카메라 앞에 자주 서는 상황) - **주호소**: - “얼굴이 항상 번들거려 보인다.” - “모공이 커서 HD 카메라에 잡히면 피부가 거칠어 보인다.” - “화장이 오후만 되면 무너져서 방송 준비가 어렵다.” --- ### 시술 전 평가 - **피부 타입**: 전형적인 지성 피부 + T존 피지 과다 - **피부 상태**: - 볼과 콧망울 주변 **확장된 모공** - 미세한 **광대 잔주름** - 가끔 붉어지는 **홍조 반응** - **환자 기대치**: 피부가 **매끈해 보이고**, “광택(글로우)”이 돌며, **모공이 작아져 카메라에 자신감**을 가질 수 있기를 원함. --- ### 시술 계획 - **보톡스 용량/희석**: - 100U 보톡스 + 5mL 생리식염수 (2U/0.1mL) - 40U 사용 예정 - **시술 방법**: - 30G needle, 표피-진피 경계에 0.01–0.02mL씩 다점 주입 - 부위: T-zone (이마·코·콧망울), 광대 잔주름, 볼 중앙 모공 부위 - Grid pattern, 약 50포인트 주사 - **보조치료**: 시술 2주 후 LDM 초음파로 피부 장벽 회복 강화 --- ### 시술 후 경과 - **1주 후**: 오후 번들거림 현저히 감소, 파우더 사용량 줄어듦. - **2주 후 (피크)**: - 모공이 눈에 띄게 축소 - 피부에 **은은한 광택**이 생겨 “카메라발”이 좋아짐 - 홍조 반응도 줄어 들어 메이크업 유지력 개선 - **2개월 후**: 효과 점차 감소, 환자 본인이 재시술 원함. --- ### 환자 만족도 - 환자 표현: - “피부가 정말 매끈해져서, 카메라에 잡힐 때 자신감이 생겼어요.” - “예전에는 무조건 파우더로 두껍게 덮었는데, 이제는 가볍게만 해도 촬영 준비가 됩니다.” --- ### 의학적 포인트 - **지성 피부 + 모공 확장 + 홍조**라는 **스킨보톡스 적응증의 전형적인 환자**. - 짧은 지속기간(2~3개월)을 사전에 설명했기 때문에, 환자는 **효과가 줄어드는 시점에도 긍정적인 태도**를 유지하며 주기적 재시술을 원함. - 결과적으로 **환자 만족도와 재방문율이 높은 시술 패턴**. ---