Botox Training Courses, Dermal Filler, PDO Threads Courses

Foundation
Botox training course

Your journey
 Foundation botox course – gives you the basic

knowledge and skills to start up in the new
aesthetic industry
 Advanced – further training in advanced
injectable aesthetic technique
 One2one workshops
Overview
 Signs of facial ageing

 Principles of botulinum toxin
 Indications
 Contraindications
 Injection sites and techniques
 Complications
Signs of Facial Ageing
 Active lines
 Volume lost
 Skin quality
 Sagging
Skin anatomy
During the aging process, there is an ongoing loss of collagen and elasticity in
the skin, resulting in the skin becoming lax. Collagen loss causes tissue atrophy and
thinning of the skin, with increased rhytid (wrinkle) formation.
Skin anatomy
The skin is made up broadly of 3 layers:

- Epidermis
- Dermis
- Subcutis
The ageing face
There are two types of wrinkles: dynamic wrinkles and static wrinkles.
The dynamic wrinkle is caused by animation or

muscle function. They disappear when the
patient relaxes.
Static wrinkles are seen at rest,

even on relaxation of the muscle.
The ageing face
Over many years the changes in skin laxity lead to loss of the volume and curves
of the cheeks, resulting in bony contours.
Tissue descent also causes increased nasolabial and labiomandibular folds
The ageing face
Loss of the underlying fat causes descent of the overlying structures in the ageing face.
This occurs most predominantly in the following areas;
Facial map
Pharmacology
 Neurotoxin produced by bacterium

clostridium botulinum
 Present in some food and water
 Infections cause botulism
 Type A – Botox, Dysport or Azzalure,
Bocouture or Xeomin
 Type B - Myoblock
Development of Botox
 1970 – first clinical development

blepharospasm and strabismus
 1989 – Botox FDA approval for the treatment
of strabismus and blepharospasm
 2002 – Botox FDA approval for the improval
of glabellar lines
 Botox approved in 75 countries
Bot. toxin indications
 Cosmetic
 2000 – Myobloc FDA approval for cervical dystonia
 2010 – Botox FDA approval for chronic migraines
 2014 – UK MHRA approval for lower limb spasticity associated with
stroke
 Upper motor neuron syndrome (cerebral palsy)
 Primary hyperhidrosis
 Overactive bladder
 A few small trials have found benefits in people with depression
Mode of action
1. Endplate sits upon muscle fibre
2. Neurotoxin binds to nerve terminal
3. Receptor-mediated endocytosis
4. Light chain blocks fusion of
neurotransmitter vesicle with nerve
membrane by cleaving SNAP-25
5. The resulting effect is a temporary
paralysis of the target muscles, which
takes effect within 72 hours.
6. Cholinergic re-innervation at the NMJ
occurs through new nerves prouting
which takes 3-4 months
Botulinum toxin-introduction
www.statista.com/statistics/307411/revenue-of-the-global-cosmeticsindustry/
Onset of Botox up to 2 weeks
Immunology
 Global incidence varies from 0.6% to 6%

 Patients develop IgG with repeated injections
 Secondary resistance to Botox has been
reported
 Related to small doses and increased number
of injections
 Apply the 12 WEEK RULE
Botox indication
 Eliminate or reduce dynamic facial wrinkles
 Soften static wrinkles
 Create a ‘lift’
Botox contra-indications
 Local skin infection/inflammation
 Pregnancy ot breast feeding
 Known allergic reaction to Botox
 Neuro-muscular disorders (miasthenia gravis, amyotrophic lateral
sclerosis)
 Clients taking muscle relaxants, aminoglycosides and other agents that
may interfere with neuromuscular transmission
 Aged under 18th years
 Cautions: skin disorders, bleeding disorders, anti-coagulant / anti-platelet
medication, excessive weakness or atrophy of the target muscles,
unrealistic expectations, body dysmorphia, concomitant Botulinum toxin
treatment
Reconstitution
Administration tips
Technical Tips:
 Pre-fill the syringes with air to facilitate drawing up Saline /product
 Be aware that the vacuum in the vial will draw the saline into the space
very quickly, creating bubbles. Pre-empt this effect and control flow of
saline into the vial when introducing the needle
 Avoid vigorous shaking. Gentle rotation of the vial will help prevent
bubbles
 If no vacuum is present in a new vial, do not use the product and contact
the supplier directly
Administration tips
 Position the client in a semi-upright position on the examination table and
ensure you have appropriate lighting
 Cleanse the target areas of the face using a non alcohol cleanser
 Apply EMLA cream to the target areas as needed 20 minutes prior to
treatment
 Mark out the injection sites as guided by the client’s activity lines
 Using the hand positioning and administration guides below, deliver the
product into the target areas
 Throughout the procedure, treat any bleeding points with moist gauze /
cotton pads and light pressure
 Remain receptive and aware, allowing the patient any rest breaks they
desire and providing any reassurance needed
 Provide all aftercare instructions as detailed below, including contact
details to arrange follow-up appointments
Types of Botulinum Toxin
Allergan Galderma Mertz
Product BOTOX AZZALURE BOCOUTURE

50 units per vial 125 units per vial 50 units per vial
Dilution 1 ml 0.63ml 1 ml
Concentration 50 unit/ml 125 unit/0.63ml 50 unit/ml

Botox Before and After
Botox Treatment area
1st area: Glabella complex
Key: 5 units per injection
Total dose: 25 units per side
Number of injections: 5
Treatment Tips:
• 0.5–1 cm from the upper orbital rim and
internal to the mid-pupillary lines
• Position lateral corrugator injections at
least 1cm above the supraorbital ridge
• Keep the needle bevel upward facing
and away from the orbital rim
•Deep intramuscular and
perpendicular injections to the
last third of a the needle
Glabella complex
Frontalis muscle contraction
2nd area: Frontalis muscle
Key: 1-2.5 units per injection
Total dose: 15 units in total
Number of injections: 6-10
Treatment Tips:
• Superficial intramuscular and perpendicular
injections to the middle third of an 30G
needle
• Keeping the angulation of the needle at
45 degrees will facilitate superficial
administration of the product
• Under the hairline, V-shape in women and
straight in
men, if applicable
FRONTALIS BEFORE AN
Frontalis muscleAFTER
Forehead Region
Glabella and Frontalis muscles
Crow’s feet
 The medial portion of the orbicularis is a medial brow depressor and
contributes to the glabella lines. It runs superficial to the depressor
supercilii.
 The lateral portion of the orbicularis oculi is a lateral brow depressor and
creates the wrinkling pattern known as crow’s feet.
 The orbicularis oculi muscle interdigitates with the dermis of the skin
throughout its course such that botulinium toxin injections need only be
intradermal or very superficial to achieve the desired effects.
Crow’s feet
Key: 2.5 units per injection

Total dose: 7.5 units per side
Number of injections: 3 per side, total
6 points
Treatment Tips:
• Mark out the central site at least
1.5cm lateral to the lateral canthus
• Mark out the upper and lower sites 1-
1.5cm below the central site.
•Superficial injections with
needle pointing away from
the eyes (20–30 degree angle to the
skin), to the first third of a 30G
needle
Botox injection technique
Botox aftercare instructions:
 Reiterate the potential for slight bruising and discomfort around the
injection sites. The client should seek medical attention in the event of any
major concerns
 Advise the client not lie down, fall asleep or rub / massage the treated
areas for at least 4 hours after treatment
 Gently exercising the muscles that have been treated (i.e. frowning /
smiling) can help to activate the toxin and expedite results
 Clients should avoid consuming alcohol or wearing makeup for at least 24
hours after treatment
 Advise the patient that the effects can take up to a few days to become
apparent
 Clients should be provided with your contact details in the event of
wanting a follow up assessment / further treatment
Adverse side effects:
 Anaphylaxis (see treatment algorithm on next slide)
 Haematoma
 Pain at the injection sites
 Headache
 Ptosis (3%)
 Eyelid oedema (1%)
 Diplopia
 Hyperactivity of local antagonist muscles
 To date there have been no reports of death following cosmetic
administration of Botulinum toxin
J Cutan Aesthet Surg. 2008 Jul-Dec; 1(2): 95–97. doi: 10.4103/0974-2077.44169

Rzany B, Zielke H. Mauricio de Maio and Berthold Rzany, Botulinum Toxin in Aesthetic Medicine. Berlin Heidelberg:
Springer-Verlag; 2007. Safety of botulinum toxin in aesthetic medicine; pp. 119–25
Botulinum Toxin – The Market
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Foundation

Botox training course

 Foundation botox course – gives you the basic

 Signs of facial ageing

The skin is made up broadly of 3 layers:

The dynamic wrinkle is caused by animation or

Static wrinkles are seen at rest,

 Neurotoxin produced by bacterium

 1970 – first clinical development

 Global incidence varies from 0.6% to 6%

Product BOTOX AZZALURE BOCOUTURE

Concentration 50 unit/ml 125 unit/0.63ml 50 unit/ml

Key: 2.5 units per injection

J Cutan Aesthet Surg. 2008 Jul-Dec; 1(2): 95–97. doi: 10.4103/0974-2077.44169

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