# **Chapter 5 – Combination Therapies with Skin Botox (Microbotox)** Skin Botox is rarely used in isolation in modern aesthetic practice. Its true power emerges when combined with other modalities—fillers, energy devices, and biologic boosters—to produce synergistic rejuvenation. --- ## **5.1 Skin Botox with Dermal Fillers** ### (A) Rationale - **Fillers** restore **volume and contour** (lifting, shaping). - **Skin Botox** improves **surface quality** (texture, pores, oil). - Together: “**3D + 2D harmony**”—volume plus texture. ### (B) Clinical Protocol - Sequence: **Filler first, then Skin Botox** (to avoid toxin spread by post-filler massage). - Example: - Midface volume loss corrected with HA filler. - Followed by Microbotox across malar and periorbital zones for **smooth, radiant finish**. ### (C) Clinical Outcome - Patients perceive results as **natural rejuvenation**: - Sculpted contours + refined skin. - “No-makeup glow” with structural youthfulness. --- ## **5.2 Skin Botox with Energy Devices (Laser, RF, HIFU)** ### (A) Rationale - Energy devices stimulate **collagen remodeling** and treat **pigment or vascular lesions**. - Skin Botox refines **oil control, pores, and dermal micro-tension**. - Together: multi-layer skin rejuvenation. ### (B) Protocol Tips - **Order**: Energy device first → Skin Botox later (usually same day or 1–2 weeks later). - Rationale: Post-Botox heat may increase diffusion or degrade toxin. ### (C) Common Combinations 1. **Laser toning (pigment control) + Skin Botox** → clear, poreless complexion. 2. **Fractional RF microneedling + Skin Botox** → synergistic pore/tightening. 3. **HIFU (Ultherapy) + Skin Botox** → structural lift + surface glow. --- ## **5.3 Skin Botox with Skin Boosters (Hydration/Regeneration Agents)** ### (A) Rationale - Skin Botox improves sebum/pore/flush, but not hydration. - Skin boosters (e.g., **HA, PDRN, PN, exosomes, polyglutamic acid**) restore **moisture, barrier, cellular regeneration**. - Combination achieves **dual improvement**: texture + hydration. ### (B) “Hybrid Injections” - Practitioners often **mix dilute BoNT-A with HA/PDRN** in the same syringe. - Typical ratio: **BoNT-A 1–2U per 0.1 mL + HA booster solution**. - Delivered intradermally with nappage or injector gun. ### (C) Clinical Outcome - Enhanced **radiance** and **elasticity**, often described as “glass skin.” - Particularly effective for **younger patients (20s–30s)** desiring preventive rejuvenation. --- ## **5.4 Sequential and Synergistic Protocols** ### (A) “Trinity Rejuvenation” Protocol (popular in Korea) 1. **Energy device** (e.g., fractional laser for collagen). 2. **Skin booster** (hydration, regeneration). 3. **Skin Botox** (texture refinement, pore control). - Done in 1–2 sessions, 2–4 weeks apart. - Provides **multi-dimensional improvement**: clarity, elasticity, smoothness. ### (B) Seasonal Planning - **Winter**: focus on hydration boosters + Skin Botox (dry climate). - **Summer**: focus on pore/oil control + Skin Botox (seborrhea worsens). ### (C) Special Events Protocol - “**Wedding glow package**”: filler contouring + Skin Botox + HA boosters + gentle laser, 2–3 months before event. --- ## **5.5 Clinical Pearls for Combination Use** 1. **Sequence matters**: - Energy devices → Filler → Skin Botox → Boosters. - Prevents toxin migration and maximizes synergy. 2. **Patient-tailored protocols**: - Younger, oily patients → Skin Botox + energy device. - Older, dry patients → Skin Botox + HA boosters. - Volume-deficient patients → Filler + Skin Botox. 3. **Safety**: - Avoid over-dilution when mixing agents. - Keep botulinum concentration **~1–2U/0.1 mL** for safety. --- ## **Key Insights from Chapter 5** - Skin Botox is not a standalone treatment but a **versatile partner** in multimodal rejuvenation. - With fillers: adds **texture** to structural correction. - With energy devices: enhances **collagen and pore control synergy**. - With boosters: creates **hydrated, glowing skin**. - The best outcomes come from **layered approaches**, tailored to patient needs and lifestyle. --- 👉 **Professor’s Reflection Question:** If filler is the “**sculptor’s clay**” and energy devices are the “**architect’s tools**,” could Skin Botox be considered the “**painter’s brush**,” refining the final surface of the portrait? --- 원장님, 여기서 제가 이어서 **Chapter 6 – Safety and Complications** (부작용, 금기증, 예방법)으로 들어가드릴까요, 아니면 Chapter 5의 내용을 보강해서 **실제 한국 환자의 병합치료 케이스**를 하나 구성해드릴까요?