Dr. Je Young Park, Medical Director of the Apkoo-Jung Department of the Oracle Dermatology & Plastic Surgery Center in Apgujeong, South Korea, was recently invited to share his knowledge at the International Master Course on Aging Science Asia 2022 – an annual academic conference on surgery, reconstruction, and aesthetic science that took place in Bangkok this year.
Together with a group of leading doctors who are part of the Aesthetic Council for Ethical Use of Neurotoxin Delivery (ASCEND), Dr. Park discussed beauty trends that were rapidly gaining popularity around Asia with specific focus on Botulinum Neurotoxin A (BoNT-A) injections, also known as ‘Botox‘. He revealed the challenges of growing drug resistance in the Asia-Pacific region, offering insight into how patients can reduce these risks as part of a panel that was hosted with the support of Merz Aesthetics Thailand Ltd.
Dr. Park is a certified dermatologist who practices in South Korea. He attended Seoul National University’s College of Medicine and completed his studies with honours in 1999. He then graduated with a specialisation in the field of dermatology from Seoul National University’s Medical Center in 2004.
Since completing his studies he has honed his skills over the years, going on to become the Medical Director of Apkoo-Jung Oracle Dermatology & Plastic Surgery Center in Apgujeong, South Korea. Recognised as one of the most popular places to seek out aesthetic treatments, this catapulted Dr. Park to become recognised as a leader in the field of dermatology in both Korea and the further Asia-Pacific region.
Beyond his practice, Dr. Park is a lecturer on extensive topics related to aesthetic procedures, including the topic of lifting the face using injections instead of surgery. He has served as a medical consultant for several leading aesthetic medicine companies and also received an award from Ulthera Inc. Arizona in 2011 for becoming the first Korean dermatologist to perform 1,000 Ulthera treatments.
Dr. Park is an Assistant Programme and Policy Executive at the Korean Dermatological Association (KDA) and the Academic Director of the Korean Anti-Aging Dermatology Association (KAAD). He is also an international recipient of the American Academy of Dermatology (AAD) grant from the American Society for Dermatologic Surgery (ASDS) and is a member of the Laser Society and American Society for Laser Medicine and Surgery (ASLMS).
During a conversation with Prestige, Dr. Park shared that his interest in dermatology began with a fascination with anti-aging treatments. “It seemed very rewarding to be able to help people look better, and to help them improve their confidence and self-esteem,” he said.
A lot of making sure a patient looks and feels their best is rooted in prioritising ethicality. As Dr. Park explains it, “As health care practitioners, we know that patients look to us as a trusted source of information on their treatment options, including any risks that they should be aware of.
“My view for any procedure in aesthetic dermatology is that we must carefully consider a patient’s treatment history. This can potentially be very complex as it includes multiple indications treated at different practices, so we must weigh out the implications of specific treatment choices throughout a patient’s medical history. Only through this approach can healthcare professionals support patients in helping them understand understand the impact of a treatment on their overall long-term health, rather than only on specific treatment outcomes.”
This focus on ethicality and caring for each patient is one of the reasons Dr. Park has been able to find so much success in his career. Another reason is his commitment to keeping a finger on the pulse of beauty trends. In 2022, South Korea saw a shift in customer attitudes towards wellness, beauty, and healthy aging. “This has increased awareness and acceptance of aesthetics, generating demand from new patient segments, including men and younger consumers,” said Dr. Park.
“With information readily available on the internet, younger patients tend to do their own research on procedures, paying particular attention to the safety and quality standards of each product. Younger patients nowadays are also very interested in treatments that improve overall skin quality such as intradermal injections of Botulinum Neurotoxin A (BoNT-A), in addition to conventional aesthetic procedures that reduce wrinkles or enhance specific facial features.”
Dr. Park explains that throughout the Asia-Pacific region, the trend of injectables continues to grow as the years go on. “Historically, the aesthetics injectables market has grown by more than 10 per cent a year. Since 1999, Botulinum Neurotoxin A (BoNT-A) has been the most frequently performed aesthetic procedure in the world. It is also a first line treatment option for various medical conditions,” he explains.
“Beyond the smoothing of wrinkles or fine lines around the eyes, the range of BoNT-A applications has now expanded to include off-label aesthetic indications, which is when an approved product is used for an unapproved indication. This includes facial and jawline slimming, and more recently, body contouring on the shoulders, thighs and calves. Intradermal injection is very popular amongst younger patients and is typically used to achieve better skin quality because of the way it can aid with sebum control and pore size reduction.”
Although aesthetic treatments are becoming more widely accepted worldwide, the Asian region is a consistent frontrunner when it comes to popularising certain treatments such as intradermal injections. But the question is why? Dr. Park explains that this is a result of multiple factors, such as the aging population, increasing trend of younger aesthetics patients, and the growing consumer purchasing power in emerging markets like Thailand has also accelerated the growth of aesthetic procedures.
“These days, many clinics in Korea use SNS promotions to reach out to new consumers. These types of promotions, as well as YouTube and Instagram, all contribute to a relatively young clientele,” he reveals.
Botulinum Neurotoxin A injections are popular because of certain advantages. “A major advantage is its accessibility. It is a financially viable option for many patients and the procedure itself is fast, allowing patients to fit it in around their busy lives. It is also less invasive than other cosmetic surgery treatments with no to minimal downtime,” Dr. Park divulges.
“However, as treatments typically last 4-6 months, patients need to continue treatment at regular intervals to maintain the desired effect. This increases the potential risk of developing immunoresistance, which is when patients develop neutralising antibodies (NAb) against the BoNT-A, resulting in patients experiencing a partial or complete loss of response to the treatment with repeated injections.
“Typical signs of resistance to BoNT-A include a gradual decline in efficacy and the need for higher doses or shorter injection intervals for patients to achieve the same treatment outcomes as before. Ultimately, this increases their risk of progressing to complete treatment failure. The clinical implications can potentially be quite serious in that they may limit treatment options or lead to suboptimal outcomes if the patient develops a chronic medical or neurological condition that requires BoNT-A treatment in the future.
“In Korea, our local FDA has issued BoNT-A-specific advisories to raise consumer awareness on the potential risk factors of NAb formation and encourage prudent use of BoNT-A in aesthetics. I’d say that this has been a success in terms of patient education, as the majority of Korean patients are now aware of the concept of BoNT-A immunoresistance. In Thailand, health authorities should adopt a similar approach to raising awareness on BoNT-A immunoresistance.”
Healthcare professionals raising awareness about the growing concern over BoNT-A immunoresistance is only part of the battle. It is also important for patients seeking this procedure to become familiar with how they can remain safe and avoid complications.
“It is important that consumers and doctors look beyond the short-term benefits of their aesthetic treatments, and to consider the potential longer-term implications that their treatment decisions today might have on their health in the future.
“The potential risks can be minimised through informed decision-making, and my role as a doctor is to take a holistic view of my patients’ health so I can educate them on the potential benefits and risks of BoNT-A treatment, including the development of immunoresistance,” says Dr. Park.
“Where efficacy and safety are comparable, a highly purified BoNT-A formulation with the lowest immunogenicity should be considered as first-line therapy. Patients should consult their doctors on the potential risk of immunogenicity, its potential implications, and available treatment and product choices.”
Although Dr. Park and the other doctors who make up the Aesthetic Council for Ethical Use of Neurotoxin Delivery (ASCEND) have ignited this important conversation about immunoresistance, there remains a lot of research to be conducted about the issue.
“In terms of botulinum toxin treatment, long term follow-up studies on botulinum toxin resistance and greater access to antibody tests in the aesthetic field are needed to fill the knowledge gap between real-world clinical experience and what has been published in medical literature, says Dr. Park, who aims to commit the coming months to exploring these concerns further.