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.

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 .