Résumé de communication

Objectives: 1. To review the development of meso- and hyalu-botox techniques. 2. To provide scientifically based evidence of meso-botox aesthetic indications and effects. 3. To explain the personal technique of combined injections of hyaluronic acid (HA) with botulinum neuroprotein (BoNT-A). 4. To explain the possible undesirable effects in case of contravention of technique and ways to avoid them. 5. To show before/after photos and patient cases, to discuss the aesthetic benefits of combined injections of BoNT-A with non-cross-linked HA and cluster of amino acids (AA) in one syringe in one session. Introduction: The micro-botox method was developed by Wu in 2000, aimed to provide more natural-looking effects for patients. Method involves systematic injections of multiple papules of highly diluted BoNT-A (mainly ONA) at 0,8 to 1,0 cm into the dermis. It is proven that meso-botox helps to smooth and tighten the skin by inducing bulk atrophy of the sweat and sebaceous glands, and by weakening the superficial muscle fibers that insert into the skin, which helps to reduce pulling effects of facial muscles that result in formation of lines. Meso-botox also helps to reduce skin erythema and rosacea. Materials / method: This technique has been developed to supplement traditional injections, such as conventional dilution of BoNT-A in the areas of deep muscles, for example corrugators. Meso-toxin technique targets only superficial muscle fibers where they insert into the dermis with a sense of small, highly diluted microdroplet injections. We use 50 units of any registered botulinum toxin diluted with 1 ml of unpreserved normal saline and 3 ml of low-molecular weight non-cross-linked HA with a cluster of lyophilized amino acids, which makes 4 ml of hyalu-toxin solution. 0,5 ml per each periorbital area. Results: The precise placement of small amounts of neurotoxin into the deep dermis targets only the most superficial muscle fibers inserting into dermis and is less likely to lead to diffusion of BoNT-A into untargeted muscle and cause undesirable side effects. The hyalu-toxin technique thus allows to treat the areas of the face that are generally avoided with conventional injection techniques: periorbital area, cheeks, smile lines, barcode lines, neck and decolletage. We use the grid with injection points about 5 mm apart, avoiding injections above the eyebrow, lower eyelid, area above the DAO. Conclusion: This technique provides 3 benefits in 1 injection: promoting skin hydration and regeneration with low molecular weight HA; increasing skin thickness and elasticity and giving positive stimulation to fibroblasts with AA cluster; and affecting superficial muscle fibers, which insert into the skin, sweat and sebaceous glands to improve skin texture and reduce fine lines. Also, we observed the erythema improvement, which may be due to the neurotoxin mediated inhibition of the release of vasodilating neuropeptides. The hyalu-toxin effects last for 3 to 4 months, in some cases up to 6 months.