Objectives: Understanding why selecting a neurotoxin formulation that is as pure as possible has an impact on your patients

(This talk has been requested by Atchima Suwanchinda)

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请注明名称（个人，公司，学会等等）: Merz Aesthetics

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这项工作的完成感谢以下机构的支持： Merz Aesthetics

Objectives: Exhaustive and concrete overview of current and future toxins.
Examine the benefits and limitations of current toxins as well as the promises of future ones.

Introduction: Botulinum neurotoxins (BoNTs) have intrigued scientists and clinicians for decades due to their potency, selectivity, and duration's action. These features separate them from many other therapeutics and continue to stimulate innovation in both basic and clinical research. Since its introduction as a treatment for strabismus, botulinum toxin (BoNT) has had a phenomenal journey. Synthetic BoNTs and BoNTs from non-clostridial sources are not far from clinical use. Moreover, the study of mutations in naturally occurring toxins has led to modulation in the toxo-pharmacokinetic properties.

Materials / method: Scientific published studies overview;
Full Pubmed/Medline last publications

Results: A number of innovative BoNT formulations have been developed in the last few years. In addition to the naturally derived products, synthetic, genetically engineered products are also now studied. There are some differences in the pharmacological profile of the formulations currently available and expected... Specially in terms of target, potency or duration...

Conclusion: Currently, there are more than eight different botulinumtoxin formulations approved for clinical use, and more are in the pipeline. This review simplifies the pharmacological profiles and characteristics diferenciation of current and newer BoNTs. Physicians should be aware of this to propose the optimal BoNT "solution" regarding the aesthetics goals and and patient requirements.

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Objectives: As botulinum toxin injections have gained significant popularity over the past 20 years, many patients have now experienced multiple toxin injections. Some of them have been diagnosed with toxin resistance, even though toxin resistance is rare. Under ultrasonographic examination, muscle fibrosis has been observed. This phenomenon could clinically imply that patients diagnosed with 'toxin resistance' may not actually have true toxin resistance. My observations of the masseter muscle using ultrasonography may provide new insights into toxin resistance.

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Objectives: This study aims to compare the onset time and duration of skin lifting achieved through intradermal injections of lyophilized botulinum toxin type A (BTXA) versus liquid BTXA. Facial skin lifting was achieved by administering conventional lyophilized BTXA into the dermal layer rather than muscle tissue, leading to the rearrangement of collagen and elastic fibers. Conversely, by employing the same method with liquid toxin, we aim to clarify the differences in onset time and duration compared to lyophilized BTXA.

Introduction: Botulinum toxin type A (BTXA) is widely used to treat facial wrinkles and has recently been utilized for skin lifting. This study examines the relative efficacy and advantages of lyophilized BTXA and liquid BTXA formulations by comparing the onset time and duration of skin lifting achieved through intradermal injections.

Materials / method: Patients were injected with either lyophilized BTXA or liquid BTXA in specific facial areas, and the onset time and duration of lifting were accurately recorded using 3D camera technology.

Results: Significant differences were observed in the onset time and duration of skin lifting between the lyophilized BTXA and liquid BTXA groups (p <0.05). The lyophilized BTXA group exhibited longer onset time and shorter duration, with a tendency for less sustained skin lifting effects.

Conclusion: This study confirms the relative differences in onset time and duration of skin lifting achieved through intradermal injections of lyophilized BTXA versus liquid BTXA. Liquid BTXA demonstrated relatively shorter onset time, longer duration, and a tendency for more prolonged skin lifting effects. Further studies with larger sample sizes are warranted in the future

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Objectives: Understand the special case scenarios of tics and asymmetries and the different need for toxins on the two sides of the face .

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Objectives: While botulinum toxin injections are widely used for both cosmetic and therapeutic purposes, even common procedures can harbor unexpected side effects. This presentation delves into the lesser-known risks associated with these injections, including swallowing difficulty, allergic reactions, ophthalmic side-effects and botulism.

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