Application of botulinum toxin A in cosmetic dermatology

Yu Ruiyao 1 Professor and Chief Physician, Department of Skin and Beauty, PLA General Hospital (301); Professor, Adhesive Center for Plastic Surgery.

(Department of Skin and Beauty, PLA General Hospital, Beijing 100853)

Botulinum toxin A (BOTOX-A) is a neurotoxin, which has recently been approved for the treatment of neuromuscular spasm. In recent years, it has been widely used to treat various wrinkles in the face and neck, which is safe and effective, simple to operate and easy to popularize.

Botulinum toxin; Botulinum botulinum type a; Wrinkle removal

Application of botulinum toxin A in cosmetic dermatology

Yao

(cosmetic dermatology. PLA General Hospital, Beijing, 100853)

Abstract: Botulinum toxin A is a neurotoxin produced by Clostridium botulinum type A. Among the eight serotypes of BTX NAME D A-G (C1,C 2), botulinum toxin A is the most effective. Botox made by Allerga n. Related intramuscular injection can treat forehead wrinkles, shoulder wrinkles, orbital wrinkles and platysma wrinkles. This is very successful and safe.

The wrinkles on the skin indicate that the man is beginning to age. Wrinkles can be attributed to four reasons: 2 Benedetto av. Cosmetic Use of Botulinum Toxin A.Int Journal of Skin. : 1. Natural (that is, inherent) aging. 2. gravity. 3. Ultraviolet radiation in sunlight can lead to photoaging and photodamage of skin. 4. Expression muscles. According to the above reasons, wrinkles can be divided into the following four types: 1. Upright wrinkles. 2. Gravity wrinkles. 3. actinic wrinkles. 4. Super dynamic wrinkle map 1. Generally speaking, women begin to have wrinkles at the age of 30 ~ 35, and men begin to have wrinkles at the age of 35 ~ 40. The place where wrinkles first appeared was 1/3 on the surface. The first place where wrinkles appear is crow's feet on the outer side of the orbit, followed by forehead lines and brow lines. The nasolabial groove and the upper labial groove of the lower part of the face are again. Finally, there is the platysma muscle pattern on the extended side of the neck, commonly known as the neck of the elderly. Because it looks like a turkey, it is also called the neck of a turkey. The appearance of wrinkles obviously makes people feel that aging has come, which brings mental stress to people. There are many ways to eliminate wrinkles. All kinds of anti-wrinkle cream, anti-wrinkle cream and topical sunscreen can only improve the appearance, but will not have a big effect on eliminating wrinkles. The effective wrinkle removal method is medical collagen injection and filling, and its ability is limited. Chemical peeling, peeling, laser skin changing and facial plastic surgery are used by plastic surgeons. All patients need hospitalization, anesthesia, complicated surgery and great pain, and also need to go through a period of skin recovery and wound healing, which is very expensive. If it is not done well, there will either be regrettable pigmentation or unpleasant side effects, complications and sequelae. These treatments are of little help to platysma. Autologous fat injection will make the neck thicker and uglier. 1987 to 1992 Canadian ophthalmologist Jean Carruthers and her husband alastair carruthers 3 Carruthers A. Carutnas J. Cosmetic use of botulinum toxin A. adv De rmatol . 1997325。 4 Cathers A, Keane K, Carruthers J. Application of botulinum exotoxin in clinical dermatology. American Academy of Dermatology. 1996, 34: 788. The wrinkle removal method of Botox to A Xin injection was studied and achieved success. Introducing it into cosmetic medicine will push wrinkle treatment to a new stage, and it is likely to become the main method of wrinkle removal in 2 1 century. This paper introduces the pharmacophysiology and clinical application of botulinum toxin A injection for wrinkle removal.

Pharmacophysiology of 1 Botulinum toxin injection for wrinkle removal

1. 1 Historical review 5 Benedetto Avenue. Cosmetic use of phytotoxins A.Int Journal of Skin1999,38: 641. 6 Fagien S.Botox is used to treat facial lines and fur lines with ADHD: an auxiliary use in facial cosmetic surgery. Plaster reconstruction surgery,. 1999, 103:70 1.

Botulinum poisoning was reported as early as 1887. It is caused by eating a neurotoxin produced by Botox, causing systemic central and peripheral nerve poisoning, paralyzing the whole body symmetrical muscles and leading to death. People get sick because they eat bad sausages, that is, sausages, so they are commonly called sausage poisoning. 1895 a poisoning incident caused by eating ham was reported in Ehrmen, Belgium. He found a gram-positive anaerobic spore-producing Clostridium from corpses and ham. Under anaerobic conditions, one end of the bacteria produces spindle spores, so it is called anaerobic Clostridium botulinum. Some bacteria in Clostridium are toxic and harmful to human beings, such as gas gangrene caused by Clostridium perfringens; Tetanus caused by Clostridium tetanus; Pseudomembranous enteritis caused by Clostridium difficile is a fatal disease. Clostridium botulinum is widely distributed in soil all over the world.

1.2 bacteriology and pharmacology 7 benedetto av. Cosmetic use of phytotoxin A.Int J Pitor. 1999, 38: 64 1.8 Carrthers A, Kiene K, Carruthers J. application of botulinum toxin a exotoxin in clinical dermatology. American Journal of Dermatology 1996, 34:788.

Botulinum toxin is a kind of protein toxin with high molecular weight, and its molecular weight is 150 kDa. They have eight different antigens or serotypes, namely A, B, C 1, C2, D, E, F and G. Except C2 is cytotoxic, the others are neurotoxins. Among them, botulinum toxin A (BTX-A) has the strongest toxicity, the best stability, easy preparation and the longest storage time at low temperature, so BTX-A can be made into preparations. Followed by BTX-B and BTX-F, botulinum toxin is unstable in hot and alkaline environment, easy to be destroyed, and stable in acidic environment. It enters the stomach and is not destroyed in acidic gastric juice. It is rapidly absorbed by gastrointestinal mucosa, enters blood circulation, acts on central and peripheral nerves, and paralyzes muscles and dies. It is unstable when heated, and its variability loses its toxicity when cooked in food. When dissolved in physiological saline, its toxicity will be affected within several hours (average 4 hours). Therefore, the treatment with botulinum toxin A is a kind of treatment commonly known as "fighting poison with poison", that is, using the toxicity of toxin correctly to treat diseases.

Therapeutic effect of botulinum toxin type 65438 +0.3A 9 benedetto av. Cosmetic use of botulinum toxin A.Int Journal of Skin 1999, 38: 641.10 carruthers A, carruthers J. Cosmetic use of botulinum toxin A. adv De rmatol . 1997325。 Treat wrinkles with botulinum toxin. J Dermatol Trea t. 1999， 10:3 1

1973, Scott and others published the results of animal experiments. They injected botulinum toxin type A into the lateral muscle of the orbicularis oculi muscle of monkeys, and as a result, the muscle there was completely paralyzed, so they successfully treated eye muscle spasm in clinic. From 1978 to1989,65438+February, A.B.Scott and E.J.Schantz jointly developed and successfully developed. 1989, 1989 In February, 1989, the FDA of the United States officially approved botulinum toxin type A, the original trade name was Oculinum, and later it was changed to BOTOX(Allergan Company) for treating muscle spasms in ophthalmology, neurology, otorhinolaryngology, etc. This is the first time that FDA has approved the preparation of microbial toxin for injection. China has also successfully developed it in 1993, and it has been put into clinical trial. 1997 was officially approved by the state as "botulinum toxin type A for injection" and put on the market (97 Zhunzi (Lan) S-0 1), with the trade name "Hengli". After injection of botulinum toxin A, eye muscle spasm and other diseases take effect within 2 ~ 3 days, and the average curative effect lasts for 8 ~ 12 weeks. Nerve germination and neuromuscular conduction reconstruction failed. 1995, Pasricha volume expansion therapy for smooth muscle spasm such as cardiac spasm (also known as achalasia). The indications for botulinum toxin A injection are expanding.

Various preparations, such as 1.4A botulinum toxin12 chustecka z. New uses of Allergan Botox. Medical news. 1999,2439: 26.13 abramowiez m. the cosmetic use of botulinum toxin. Medlett.1999,41(1057): 03.14 Carruthers A. botulinum toxin update. Dermatotherapy1999,4 (5):1.

There are two kinds of botulinum toxin A products produced by American Eye Health Company: one is primary Botox, which is a purified neurotoxin complex. Each vial contains botulinum toxin type A 100u(4u/ng) and 0.5mg of human albumin. Its purpose is to increase the stability of botulinum toxin A, and it should be kept in a normal place. It has been sold and listed in more than 60 countries. 1997, American eye health company developed a new type of botulinum toxin, namely botulinum current, which has the advantages of improving neurotoxin toxicity and reducing antibody production rate. 1997 was approved by the FDA.

Botulinum toxin type A, Dysport, is produced by British Speywood Company. It should be diluted with phosphate buffer when used. Each bottle contains 500 u(40u/ng) of botulinum toxin A, which has the advantage of being stored at room temperature. Botox produced in America is five times more toxic than Dysport produced in Britain (table 1). Elan Company in Berlin, Irando has developed and produced a botulinum toxin type B with the trade name NeuroBloc, and it is still waiting for the approval of FDA. BTX-B can be used for treatment once patients develop antibodies to botulinum toxin A products and lose their efficacy.

Comparison between table 1 Botox and Dysport

botulinum toxin

Eyelid spasm 10 ~ 30 100 ~ 200

Cervical spasm 100 ~ 280875 ~ 1200

Standard unit 100500

Real unit 127 10332 6

Adjust dose

Eyelid spasm 2079

Cervical spasm 150547

Ratio 3.8

Each nanogram contains 3-440 kinds of toxic protein.

Toxicity of botulinum toxin 1.5A type. Cosmetic use of botulinum toxin A.Int Journal of Skin 1999, 38: 641.16 carruthers A, carruthers J. Cosmetic use of botulinum toxin A. adv De rmatol . 1997325。

The toxicity of botulinum toxin is expressed in biological mouse units, and the lethal dose (LD50) of a Swiss female rat with body weight 18 ~ 22g by intraperitoneal injection is one unit (U). The LD50 of monkeys should be 40u/kg. Based on this, it is speculated that the lethal dose of an adult weighing 70kg should be 2500~5000u, and the botulinum toxin A for cosmetic injection is about 25u, with the maximum not exceeding 100u, which is a trace level. Because botulinum toxin type A is selective, has strong affinity for nerve cells, and binds to nerve endings, the toxin is almost exhausted and cannot enter the blood, let alone penetrate the blood-brain barrier, so there will be no systemic adverse reactions. If a large dose of botulinum toxin A (2000u) is injected at one time, the patient may die. Botulinum toxin type A injection for cosmetic purposes is only 3% of the LD50 of human body, so it is very safe. So far, there are no reports of systemic side effects caused by injection of botulinum toxin A for cosmetic purposes. Botulinum toxin A injection is very safe in the correct and appropriate dosage.

Biochemical and physiological functions of botulinum toxin 1.6A type. Cosmetic use of botulinum toxin A.Int Journal of Dermatology1999,38: 641.18 Hallett M. Clinical application of a human botulinum toxin New Journal of Engineering Medicine1999,8:1.

The role of botulinum toxin A injection in treating diseases has been basically clear. The molecular weight of botulinum neurotoxin A is 150kDa( 150000d), which is a double-stranded polypeptide. One heavy chain is100000 kda (100000 d), which mainly plays a binding role, while the light chain is disulfide-bonded, with a molecular weight of 50 kDa(50000d), which mainly plays a toxic role. Under normal circumstances, the process of muscle contraction is: nerve impulse → acetylcholine (Ach)→ endplate potential → muscle action potential → muscle contraction as shown in Figure 2. When injecting botulinum toxin A to block neuromuscular conduction, there are three steps to paralyze muscles: 1. Binding: The injected toxin quickly binds to the receptor site of cholinergic nerve endings. The heavy chain of toxin peptide chain binds to the unmyelinated region of nerve endings. 2. Internalization (or endocytosis, also known as localization): The toxin itself enters the nerve membrane, which is endocytosis and endocytosis, which is endocytosis. 3. Paralysis: acetylcholine is blocked by light chain in cytoplasm, unable to pass through neuromuscular junction (NMJ), nerve no longer transmits medium, and muscle paralysis. Figure 5. The above process is also called chemical denervation. Under the action of acetylcholinesterase (ACh nase), the terminals of motor nerve axons grow, germinate and branch, forming onion-like enlargement (Figure 6). Finally, a new neuromuscular junction endplate is formed, where ACh is released to make the muscle contract again. It takes an average of 3 ~ 6 months for paralyzed muscles to recover their contractile function, which is consistent with the clinical observation.

1.7 antibody production after injection of botulinum toxin a. Cosmetic Use of Botulinum Toxin A.Int Journal of Skin, 1999, 38: 64 1.20. adv De rmatol . 1997325。

After 48 ~ 72 hours of injection of botulinum toxin A, the muscles began to be unable to relax, and the degree was proportional to the dose. Complete muscle paralysis occurred 1 ~ 2 weeks after injection. If the dose of one injection is too small and the effect is not good, additional injection can be made after 1 week. Botulinum toxin A itself is an immunogenic protein. In order to improve its stability, serum albumin is added, which will produce immunoglobulin G(IgG) against botulinum toxin after injection into human body. It is an antibody to botulinum toxin A. Once the antibody is produced in the body, the patient will lose the clinical effect of muscle numbness if injected with botulinum toxin A again. In clinical treatment of cervical spasm, the probability of producing IgG antibody is 3% ~ 5% by injecting 200 ~ 400 U botulinum toxin A once. If you receive multiple injections of botulinum toxin within a month or more than 200 ~ 300 U at a time, it is easy to produce antibodies. According to the statistics of foreign scholars, more than 7000 cases received botulinum toxin A injection, and only 12 cases produced antibodies in their bodies. Because only a small amount of botulinum toxin A (less than 2 digits) was injected during cosmetic surgery, antibodies were rarely produced. BTX-B or BTX-F can be used if the treatment fails due to the production of various antibodies against botulinum toxin A in patients. Because there is basically no cross between different types of botulinum toxin. Perhaps BTX-BTX-B (nerve block) developed by Iran can be used as an alternative therapy.

Dilution method of 1.8A botulinum toxin preparation. Application of botulinum toxin in cosmetics. 1999, 38: 64 1.22 Carrthersa, Kiene K, Carruthers J. application of botulinum toxin a in clinical dermatology. American Journal of Dermatology 1996, 34:788.

How to dilute botulinum toxin A is very important. Usually, the preparation should be stored in the refrigerator at -5 ~-20℃. Just take it out before use and dilute it with 1ml syringe, No.30 needle and 0.9% normal saline. Each bottle of BOTOX contains botulinum toxin A 100 u, and normal saline should be injected into the bottle as slowly as possible to prevent foaming. 100u If diluted with 1ml, every 0. 1ml contains 10u, and 0.05ml contains 5u. Such a small volume can not only paralyze the injected muscle, but also prevent the injection from spreading to other muscles and prevent side effects.

See table 2 for different dilution methods of BOTOX and Dysport.

Table 2 Different dilution methods of Botox and Dysport

botulinum toxin

BTX- The unit contained in each bottle is 100500.

1 ml diluted by 0.5ml 50250

0. 1ml 1050

0.05ml 525

2ml diluted 25250

0. 1ml525

0.05 mile 2.5 12.5

1.9 master muscle anatomy

In order to achieve a good wrinkle removal effect by injecting botulinum toxin A, it is necessary to master the anatomical structure of facial and neck muscles skillfully, and only in this way can the figure 1 be successfully drawn.

2. Botulinum toxin type A injection for wrinkle removal. Cosmetic Use of Botulinum Toxin A.Int Journal of Skin, 1999, 38: 64 1.24. Cosmetic use of botulinum toxin. Evil and fear. Age. 1999, 7:79.

Botulinum toxin A (BOTOX) injection can treat many diseases such as neurology, ophthalmology, otorhinolaryngology and so on. In recent years, it has been found that Botox injection can also treat intractable severe palmar hyperhidrosis and axillary hyperhidrosis. Shelley et al. 26 Shelley World Bank, Taran in new york, edited by Shelley. Treatment of palmar hyperhidrosis with botulinum toxin. American Academy of Dermatology. 1998, 38: 227. It was reported that the patients were treated with Botox, and each hand was injected with 50 points, each point was injected with 2u, and both palms were ***200u (. Antiperspirant 12 months, with excellent effect. However, this paper focuses on BOTOX injection wrinkle removal, especially forehead wrinkles, brow wrinkles, crow's feet wrinkles and platysma wrinkles.

2. 1 injection of forehead tattoo 27 Letessier S. Treatment of wrinkles with Botox Toixn. J Dermatol Trea T. 1999， 10: 3 1。

1/3 Botox injection on the face is the easiest way to remove the forehead lines across the forehead. Frontal muscle is vertical, it often contracts, and frequent facial expressions are prone to forehead wrinkles. When treating forehead wrinkles, patients should take a sitting position or a lying position, and those with light forehead wrinkles should be injected at 10 point. Use a thick forehead line 10 to inject 12 points. According to the patient's muscle fullness, inject 2.5 ~ 5U, at least 25u and at most 60u at each point. Special attention should be paid to the design of the injection point of forehead tattoo, and the injection point should be above 1 ~ 2 cm on the eyebrow to prevent ptosis.

2.2 injection method of botulinum exotoxin a for glagellar folds: a double-blind, placebo-controlled study using electromyography injection technique. American Journal of Dermatology 1996, 35:569.

1/3 Botulinum injection on the face is most commonly used to remove eyebrow lines. Eyebrows are vertical lines, which are produced by the cooperation of four muscles. They are the inner side of the frowning muscle, the descending eyebrow muscle, the orbicularis oculi muscle and the lower side of the frontalis muscle. Generally speaking, female muscles are thin, and four points are injected: Figure 1 1. Men are muscular. Inject 5 points. Figure 12. Inject 2.5 ~ 5U at each point and 10 ~ 22.5U at 4 ~ 5 points. Inject the lines between the eyebrows, try to stay away from the eyebrows and be slightly close to the center to avoid ptosis.

2.3 crow's feet injection method

The wrinkles on the outside of the orbit are fishtail-shaped and claw-shaped, so they are also called claw lines. It is formed by muscle contraction at the lateral edge of orbicularis oculi muscle. It belongs to the expression type and photochemical type, so it is a little difficult to treat. Botox injection still has a good effect. Generally, 3 points, each 2.5 ~ 5U, and 6 points * * * 15 ~ 30U are injected into the lateral orbit. Pay special attention to the symmetry and equidistance of injection points on both sides when injecting crow's feet. The dosage of injection should be accurate, otherwise diplopia will occur due to different degrees of muscle relaxation on both sides.

2.4 platysma injection method 29 matar asso a, Brandt fs, Bellman B. Botulinum toxin A used in the management of platysma, Plastre constsurg. 1999, 103:645.30 Kane MaC. Non-surgical treatment of platysma muscle band and injection of b otulinum toxin A.

Wrinkles of platysma are caused by wide and thin muscles attached from chin down to upper chest, sternocleidomastoid muscle and acromion. Mata rasso et al. 3 1 Mata Asso a, Brandt Fs, Bellman B. Botulinum toxin type A is used to manage Platyma zone, Plastre Constrsurg. 1999, 103: 645. The platysma is divided into four grades (Table 3). Below the platysma is the trachea and esophagus, which is almost impossible to treat. Chemical peeling, peeling and laser remodeling are all impossible. If the thick neck is formed by soft tissue breast augmentation, the cosmetic effect will be worse. Plastic surgery, postoperative compression, dressing, postoperative traction discomfort. Therefore, only Botox injection is used to remove wrinkles, which has good effect and little pain. Matarasso et al. 32 Matarasso A, Brandtfs, Bellman B. Botulinum toxin A is used to manage flat belts, Plastre Constrsurg. 1999, 103: 645. It is pointed out that Botox injection has the following seven advantages: 1 No need to do more. It can be operated under outpatient conditions without hospitalization. There is no need for general anesthesia or even local anesthesia. 4. The curative effect is quick. 5 High success rate. 6 Less complications and less risk. 7 low cost. Patients can only take sitting injection chart 14. At an injection point corresponding to the male larynx, open 1 ~ 2 cm on the left and right sides, and inject two points as shown in Figure 15, each point is 6u to the maximum of 50u, * * * 30 ~ 250U. Matarasso et al. used Botox injection to treat more than 65,438+0,500 patients with platysma, of whom 84% were women and 65,438+0.6% were men, ranging in age from 30 to 77. Most patients achieved good and excellent results. They concluded that Botox injection is a safe and effective treatment for platysma. Kane 33. Kane Mack. Non-surgical treatment of platysma by injection of botulinum toxin A. 1999, 103: 656. In recent 7 years, 50 patients with platysma were treated with Botox injection, most of them were women. They are very satisfied with the treatment effect.

Table 3 Classification of platysma

Horizontal vertical

Striped platysma muscle cord relaxes subcutaneous fat.

Injection dose of muscle fat atrophy

(u)

ⅰ The slight contraction of platysma can be seen at 30 ~ 50.

The second degree is mild, mild relaxation, and 30 ~ 75 is obvious.

Grade ⅲ moderate and moderate flaccidity was 50 ~ 100.

Ⅳ It is heavy and obviously slack. At rest, it can also be seen that the rope weight is obviously 50 ~ 250.

Matarasso proposed a dosage table for treating various wrinkles (see Table 4).

Table 4 Matarasso proposed a dosage table for treating various wrinkles.

botulinum toxin

Eyebrow line 25 ~ 40

Crow's feet 10 ~ 30 (bilateral)

Frontline 20 ~ 40

Stria platysma 30 ~ 50

Chin tattoo 5 ~ 10

2.5 Botox injection operation method

Botulinum vials should be stored in the refrigerator at -5 ~-20℃ at ordinary times. Before use, it should be taken out and diluted with 0.9% normal saline. When injecting normal saline, it should be injected slowly along the bottle wall to avoid bubbles. After dilution, it should be used up within 4 hours, otherwise it will affect the titer. Tests show that the botulinum toxin is inactivated by 44% in 12 hours and 70% in 1 ~ 2 weeks, and it is easy to be contaminated by bacteria after long-term storage. The amount of dilution should not be large, only small, and a large number of dilution injections can easily cause paralysis of surrounding muscles and cause complications. The muscles began to relax 2 ~ 3 days after Botox injection, and the muscles were completely relaxed and paralyzed in 10 ~ 14 days. The effect is best at this time. The disappearance of wrinkles can last for 3 to 6 months, with an average of 4 months, so the average injection is 3 times a year. It is best for the patient to sit or lie down when injecting. The injection site was accurately marked with gentian violet 16.

2.6 Side effects of Botox injection

Botox injection has few side effects, including mild pain, acid swelling, local mild edema, ecchymosis, temporary numbness or weakness, mild headache and nausea. It seems that the facial expression is relatively dull. Some side effects can be avoided by standardizing the correct operation. Female patients who are sensitive to pain can use local anesthetic EMLA cream (Enna, produced by Astra Company, USA, which is an emulsion composed of lidocaine and propofol). Botox injection should be slow, with a little pressure after injection, but no massage. To prevent side effects, aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and aminoglycoside antibiotics should not be taken orally for 2 weeks before Botox injection. Interestingly, Botox injection can cause side effects of headache, and neuroscientists have found that Botox injection can treat headaches in women. Cox et al. 34 Cox NH, Duffy P. Royle J. Repairing drug eruption caused by lactic acid in botulinum toxin injection. American Academy of Dermatology. 1999,40: 263. 1 case of mild fixed drug eruption caused by botulinum injection was reported.

2.7 Complications of Botox Injection

When removing forehead lines or brow lines by Botox injection, eyelid drooping occasionally occurs. It may be because the injection point is too close to the descending muscle, or because Botox is too diluted and spreads there after injection. Blepharoptosis occurred 7 ~ 10 days after injection, and returned to normal after an average of 2 ~ 4 weeks. In order to avoid the complications of ptosis, botulinum toxin should be injected above the brow 1 ~ 2 cm, away from the brow, and the injection amount should be controlled within 0.025~0.05ml.

When Botox is injected into the crow's feet outside the orbit, diplopia is easy to occur due to asymmetry of injection sites on both sides, inaccurate injection dosage or different muscle relaxation degree, so the injection point should be marked accurately and symmetrically when injecting crow's feet. The injection dose should be accurate, and only correct operation can prevent diplopia.

Botox injection is used to treat platysma. A few patients may have complications, such as neck weakness and dysphagia, but this is short-lived.

In order to prevent side effects and complications, patients should rest in the clinic for 3-4 hours after Botox injection to prevent accidents.

2.8 Contraindications for Botox Injection

2.8. 1 Patients with mental disorders and poor self-control ability.

2.8.2 People (such as actors) who can't reduce the frequent activities of facial expression muscles.

2.8.3 Patients with neuromuscular diseases such as myasthenia gravis and Lambert Eaton syndrome.

2.8.4 People who are allergic to Botox or toxins in human albumin.

2.8.52 Use aminoglycoside antibiotics (gentamicin, kanamycin, neomycin, streptomycin) and other drugs that have drug interaction with botulinum within weeks. Penicillamine, quinine, calcium ion conduction blocker, etc. , will increase the toxicity of Botox.

2.8.6 Pregnant women and lactating women should not use Botox, because it belongs to Class C drugs for pregnant women.

2.9 Botox injection wrinkle prospects

Botulinum injection therapy is only 10 years, and it has only been carried out in China for 3 years. Botox injection therapy has the following nine advantages, which are incomparable to any other treatment method. 1. The curative effect is quick and high. 2. Less side effects, light and short duration, no systemic side effects, safety and reliability. 3. The maintenance time is long, and it can last for 4 months on average after one injection. 4. The operation is convenient, and it can be carried out under outpatient conditions without hospitalization or anesthesia. 5. The patient has little pain and belongs to non-traumatic treatment. 6. The treatment cost is low and the price is low. 7. Patients are easy to accept. 8. Repeatable treatment is still effective. 9. Because of its simple operation, it is easy to popularize.

However, botulinum toxin has been approved for the treatment of diseases in neurology, ophthalmology and otolaryngology, but not for wrinkle removal. Botox is a highly toxic drug, which can be life-threatening if used improperly. In the field of beauty and medical treatment, it must be used strictly, scientifically and correctly, and must not be misused or abused, so as to better play the therapeutic role of botulinum.

(Acknowledgement: This article was revised by Professor Wang Yinchun from Lanzhou Institute of Biological Products, a domestic developer of Hengli. I want to thank you. )