# **Chapter 8 – Advanced Topics and Trends in Skin Botox (Microbotox)** This chapter integrates the **evolution of technique, hybrid therapies, novel applications, and global perspectives** that define the future of Microbotox in dermatology and aesthetic medicine. --- ## **8.1 Microdosing and Customized Dilution Strategies** ### (A) Concept of Microdosing - Instead of standard “one-size-fits-all” dilution, the modern trend is **tailored microdosing**. - Aim: Balance **effectiveness vs. naturalness** for each patient. ### (B) Variable Dilution - **High dilution (100U + 10 mL saline, ~1U/0.1mL):** - Wide diffusion. - Best for **pore, oil, glow**. - **Moderate dilution (100U + 5 mL, ~2U/0.1mL):** - Balanced effect. - Best for **wrinkles + texture + sebum**. - **Ultra-dilution (100U + 20 mL, ~0.5U/0.1mL):** - “Skin wash” technique. - Used for **full-face shine, preventive anti-aging**. 👉 Microdosing allows **personalized protocols**—young oily patients vs. older laxity patients differ significantly. --- ## **8.2 Hybrid Injections (Toxin + Skin Booster Mixtures)** ### (A) Rationale - Skin Botox alone = texture & oil control. - Skin boosters (HA, PDRN, PN, exosomes, vitamins) = hydration & regeneration. - Mixing the two: **dual action in one injection**. ### (B) Protocols - **BoNT-A diluted to ~1–2U/0.1mL**, then combined with: - **Low molecular HA** (hydration, elasticity). - **PDRN/PN (polydeoxyribonucleotide)** (cellular regeneration). - **Exosomes** (anti-inflammatory, rejuvenation). ### (C) Clinical Outcomes - More luminous skin (“glass skin effect”). - Longer-lasting hydration compared to BoNT-A alone. - Increasingly popular among younger Asian women seeking a **glow rather than lift**. --- ## **8.3 Off-Face Applications** While face is most common, **advanced practitioners** are expanding Skin Botox use: ### (A) Neck - “Tech-neck” horizontal lines. - Improves crepey texture and reduces banding when combined with platysma Botox. ### (B) Décolleté / Chest - Sun-damaged skin, criss-cross wrinkles. - Microbotox smooths texture and reduces flushing. ### (C) Hands - For **sweating reduction + skin refinement**. - Creates a more youthful hand appearance when combined with fillers. ### (D) Scalp - **Scalp Botox** being researched for: - **Seborrheic dermatitis** control (reduces oil and inflammation). - **Adjunct in hair loss therapy** (reduces scalp tension, improves microcirculation). --- ## **8.4 Global Trends and Future Perspectives** ### (A) East Asia - Korea, Taiwan, Singapore pioneered Microbotox. - Trend: **“K-Glass Skin” packages** → Microbotox + Booster + Laser. - Widely marketed to young patients for **preventive anti-aging**. ### (B) Europe - Adoption slower, but now growing. - Focus: **rosacea management** and subtle rejuvenation. - Seen as part of “natural look aesthetics” movement. ### (C) United States - Initially skeptical, but **millennial and Gen Z patients** driving demand. - Increasingly integrated into “prejuvenation” programs. - Strong regulatory focus on **off-label use**, but trend is expanding. ### (D) Research Frontiers - **Nanocarrier botulinum toxin**: topical delivery under microneedling investigation. - **Longer-lasting formulations**: engineered BoNT-A variants under study. - **Combination injectables**: single-vial blends of HA + toxin may become commercialized. --- ## **8.5 Market and Cultural Drivers** - **Shift from dramatic change → subtle refinement.** - **Influencer culture:** “I didn’t get work done, I just use great skincare”—Microbotox fits this narrative. - **Preventive medicine approach:** Start in 20s, maintain in 30s, avoid drastic interventions later. --- ## **Key Insights from Chapter 8** - Advanced Skin Botox practice is about **customization and integration**: - **Microdosing**: personalizing dilution. - **Hybrid injections**: combining boosters with toxin. - **Expanded applications**: beyond face, into neck, chest, hands, scalp. - Globally, Microbotox is a **rising trend** aligned with demand for natural, subtle, “no-trace” rejuvenation. - Future direction: **longer-lasting, combination formulations**, possibly even **needle-free topical toxin delivery**. --- 👉 **Professor’s Reflection Question:** If traditional aesthetics sought **“reversal of aging”** and fillers sought **“restoration of youth,”** can we see Skin Botox as part of a new philosophy: **“prevention and refinement of time”**—keeping skin balanced, luminous, and calm before visible aging sets in? --- # 📌 Skin Botox + PDRN Hybrid Injection Protocol ## 1. 준비 (Preparation) - **보툴리눔 톡신**: 200U vial (6.6mL NS 재구성 → 30U/mL stock) - **PDRN**: 1 vial (2.0 mL 기준, 제품마다 다름) - **주사기/니들**: 1mL insulin syringe (31G) or 30G needle --- ## 2. 희석 (Dilution) 1. Stock 용액에서 **1.3 mL 추출 = 약 40U** 2. **0.7 mL NS** 추가 희석 → 총 2.0 mL (20U/mL, 2U/0.1mL) 3. 여기에 **PDRN 2.0 mL** 혼합 → 최종 4.0 mL - 최종 농도 = 40U ÷ 4.0 mL = **10U/mL = 1U/0.1 mL** 👉 풀페이스 기준 안전하면서 효과적인 농도. --- ## 3. 주입 (Injection) - **깊이**: 진피 상부 (약 1 mm) - **각도**: 10–15°, bevel up - **양**: 0.01–0.02 mL per point (≈0.1–0.2U Botox + PDRN 동시 주입) - **간격**: 0.5–1.0 cm grid pattern - **총 용량**: 풀페이스 기준 150포인트 × 0.02 mL = 3.0 mL 사용 (40U 모두 소진) --- ## 4. 권장 부위별 포인트 (Full Face) |부위|포인트당 용량|포인트 수 (평균)|총 사용량| |---|---|---|---| |이마|0.02 mL|25–30|0.5–0.6 mL| |T존 (코+주변)|0.02 mL|15–20|0.3–0.4 mL| |볼/광대|0.02 mL|40–50|0.8–1.0 mL| |턱/입가|0.01–0.015 mL|30–40|0.4–0.5 mL| |Jawline|0.02 mL|20–25|0.4–0.5 mL| |합계||~150|3.0 mL| 👉 남은 1.0 mL는 **목 주름** 또는 **데콜테**에 활용 가능. --- ## 5. 효과 (Expected Outcomes) - **1주**: 피지 감소, 피부 매트 효과, 메이크업 지속력 ↑ - **2주 (피크)**: 모공 축소, 피부결 매끈, 광택 (“glass skin”) - **2–3개월**: 효과 지속 → 반복 시 cumulative 효과 기대 --- ## 6. 주의사항 (Safety) - 너무 깊게 주사 시 표정근 약화 가능 → 항상 **1 mm intradermal** 유지 - 민감 부위(눈가, 입가)에서는 **0.01 mL 소량**만 주입 - 시술 후 24시간: 마사지·사우나·과음·격한 운동 피하기 - 합병증 발생 시: 대체로 자연 소실 (2–3개월 내), 심리적 안정 설명 필수 --- ✅ **정리** - **40U 보톡스 + 2mL PDRN → 총 4mL** - **0.01–0.02 mL per point × 약 150포인트** - **효과**: 모공·피지 감소 + 피부결 개선 + 홍조 완화 + 재생·보습 시너지 --- 좋습니다 원장님 🙌 이제 **스킨보톡스 + PDRN 주사(하이브리드)** 의 효과를 학문적 기전과 임상적 관점에서 정리해드리겠습니다. --- # 📌 스킨보톡스 + PDRN Hybrid Injection 효과 ## 1. **스킨보톡스 단독 효과** - **피지 억제** → 번들거림 감소, 메이크업 지속력 향상 - **모공 축소** → 아르렉터 필리(arrector pili muscle) 이완으로 모공 rim tension 완화 - **홍조 완화** → 진피 혈관 확장 감소 (ACh 억제) - **잔주름 개선** → 표피–진피 접합부 tension 감소 - **피부결 개선, 광채 부여** → “Glass Skin effect” --- ## 2. **PDRN 단독 효과** - **세포 재생 촉진**: fibroblast 활성화 → collagen, elastin 합성 ↑ - **항염·항산화 작용**: ROS 억제, 염증 매개물 감소 - **피부 장벽 강화**: 각질세포 증식과 재생 촉진 - **보습 및 탄력**: ECM 리모델링 → 피부가 두터워지고 수분 유지력 ↑ - **흉터·여드름 피부 개선**: 재생 및 항염 효과 --- ## 3. **하이브리드(스킨보톡스 + PDRN) 시너지 효과** 스킨보톡스가 **“피부 생리적 균형 조절”**, PDRN이 **“세포 재생 및 보습”**을 담당 → **복합적 피부 리모델링** 효과 ### (A) Texture & Pore - 스킨보톡스: 피지 감소 + 모공 축소 - PDRN: 진피 재생으로 모공 rim collagen 보강 👉 결과: **모공이 줄어들고 피부결이 매끈해짐** ### (B) Wrinkle & Elasticity - 스킨보톡스: 미세주름 감소 (tension 조절) - PDRN: fibroblast 활성화 → collagen/elastin 생성 👉 결과: **잔주름 완화 + 피부 탄력 증가** ### (C) Redness & Sensitivity - 스킨보톡스: 진피 혈관성 긴장 완화 → flushing 감소 - PDRN: 항염 효과 → rosacea, 민감 피부 안정화 👉 결과: **홍조와 예민함 동시 개선** ### (D) Hydration & Glow - 스킨보톡스: 표면 질감 개선 → 빛 반사 ↑ - PDRN: 수분 보유력 강화 → 피부 광채 ↑ 👉 결과: **“유리알 피부(glass skin)” 효과 극대화** --- ## 4. **임상 기대효과 (환자 표현)** - “피부가 덜 번들거리고 매트하면서 촉촉하다.” - “모공이 줄고 피부결이 고와져서 파운데이션이 잘 먹는다.” - “홍조가 줄어서 피부톤이 균일해졌다.” - “얼굴이 전반적으로 환해지고 어려 보인다.” --- ## 5. **적합 환자군** - 지성 피부 + 모공 확장 환자 - 잔주름·탄력 저하가 동반된 30–40대 환자 - 홍조·민감성 피부 환자 - “수술적 치료는 원치 않고, 자연스럽게 피부 퀄리티를 올리고 싶은” 젊은 환자층 --- ✅ **정리** - **스킨보톡스** = 피지·모공·홍조·피부결 개선 - **PDRN** = 재생·보습·탄력·항염 - **둘의 하이브리드** = **Texture + Elasticity + Tone + Hydration**을 동시에 개선 → 가장 가까운 개념은 **“Glass Skin + Anti-aging 재생” 복합 패키지** ---