Botulinium Toxin Therapy (registered as Botox®, Biocouture®, Dysport® and Azzalure®)

Introduction

Dynamic lines and wrinkles are caused by contractions of the delicate underlying muscles every time we smile, laugh or frown. The more emotion we show the deeper these lines and wrinkles are likely to be. Over the years however, constant and even sustained contraction of these muscles, may lead to more permanent lines and creases developing. While we may have earned every one of our worry or laughter lines, the prospect of these permanent creases in the skin may not appeal to everyone. With the advent of an approved drug, dynamic lines can be dramatically softened. The procedure, which uses a purified toxin produced by the bacterium Clostridium botulinum (Botox), is also termed cosmetic denervation. Although the toxin is the same as the one that causes a serious form of food poisoning (Botulism), the amount used in cosmetic surgery is so minute that no systemic or general reaction is likely to be seen.

Botulinum toxin has been used very safely and successfully since 1982 by ophthalmologists to treat nervous twitching of the eyelid and lazy eye. In fact, each year thousands of patients receive Botox treatments for a variety of other conditions but over the last 10 years it has become quite a popular treatment for reversing the visible signs of ageing. Although celebrated in the media mainly as a line remover Botox has more recently been used successfully to combat a whole host of other problems such as the problem of excessive sweating of the underarms, palms and even soles, headaches, muscle spasms, bladder dysfunctions etc.

What types of Toxin are available?

There are several different types of Botulinum toxins (A, B, C, E, F).The Botulinum Toxin used for cosmetic purposes is the Type A Botulinum or BTX-A. Botulinum Toxin of type A is marketed under the names of Botox®, Botox-Cosmetic (USA) and Vistabel® (Europe) by Allergan Laboratories and under the name of Dysport® by the Ipsen-Biotech Laboratory. Botox®and Dysport®are the specialities used in medical indications (ophthalmology, neurology, and otorhinolaryngology). Vistabel® and Botox-Cosmetic are the specialities of the Allergan laboratory which obtained the marketing authorization (A.M.M and FDA approvals) for wrinkle correction but their action is exactly identical to that of Botox®.

Am I a suitable candidate?

Obviously only a consultation will be able to establish this. Generally speaking if you have lines around the face which are due to muscle contraction, i.e. in the frown area between your eyebrows, then Botox will help smooth this. Depending on how deep the line is, Botox will undoubtedly help and most times smooth it away. However if the line is very deep, sometimes further treatment with an injectable skin filler is required in order to get total smoothing of the skin.

Its important to understand that whilst Botox is well tolerated by most people, patients who are pregnant or have neurologic or muscle disease should not be treated.

I am worried I'll get a Frozen look. Will this happen?

At our clinic we are acutely aware of the ability that Botox has to "freeze" ones face and erase all expression. Which is why experience has taught us that in fact less is more. This is to say that our aim is not to freeze or immobilise all your facial muscles, because doing so would make you look extremely strange. What we want to do is selectively address the problem areas, whilst allowing other facial muscles to still operate. Basically our philosophy is to soften the lines while maintaining normal movements to a degree. In fact we like to call our treatments "Soft Botox", because it doesn't lead to that harsh or stiff frozen look.

How does it work?

When injected into a given area Botox, which is the trade name of Botulinum toxin type A, reversibly blocks the impulses from the nerves to the tiny facial muscles that are related to expression lines. By doing this, the muscles cannot contract or move well enough and therefore tend to relax. When muscles relax, the overlying skin remains smooth and unwrinkled while the untreated facial muscles continue to contract in a normal fashion, allowing normal facial expression to be unaffected.

What areas can be treated?

Any muscle activity on the body can be targeted with botox. However it is most commonly performed in the upper face. The most common areas requested are the forehead lines, vertical frown lines between the eyebrows, and crows feet or laughter lines radiating away from the eyes. Whilst it does work around the mouth, chin and neck area, the benefits must always outweigh any possible weakness of the mouth muscles. This of course will be discussed with you prior to any treatment. Smile lines are usually best dealt with either by injectable fillers, or laser resurfacing.

How is it done and does it hurt?

The procedure itself is simple and safe. Your facial movements and expressions will be assessed prior to treatment and of course you will be asked which areas are of concern to you. Depending on the areas, we will endeavour to explain to you how effective the treatment will be. Very deep ingrained lines sometimes require an injectable skin filler after a couple of weeks, in order to get the skin completely smooth. We will advise you accordingly.

Botox is injected with a very tiny needle into the desired area. Depending on the areas treated, between 4-12 injections are necessary. Because the needle is so fine and only a small amount of liquid is used the pain is usually minor, like a sting for a few seconds. Once the injection is complete there is usually no discomfort also you might perceive a slight sensitivity in the area for the next 12-24 hours which settles on its own.

No sedation or local anaesthesia is required and as no recovery is required, you can resume normal activities immediately. You can even drive yourself home or back to the office. Very occasionally some patients experience a slight temporary bruising or redness at the injection site. This can be covered with makeup as necessary.

When will I see the results?

Typically Botox treatments start to take effect from about the 3rd day after the injections. It may or may not be associated with some very minor tingling which disappears within a day or so. However you must understand that it may take up to 10 days for the full effects of your treatment to be seen.

How long does it last?

The full effects of Botox treatment are not apparent for three to ten days. As mentioned the effects are temporary in that the toxin is slowly metabolised by the body in approximately three to six months. As most patients are quite happy with the effects of Botox, a top up injection will be required after this period of time to maintain the skin smoothing effects.

Are there any risks or side effects ?

There are very few side effects to this procedure. While allergy to any medicine is possible, it is rare indeed with Botox. While a very small amount of brow drooping can occur when injected in this area, this can usually be avoided by not treating the 1-cm area just above the eyebrows. Despite precautions however in exceptionally rare circumstances this can still occur. However due to the non-permanent nature of Botox this is always temporary. In these unlikely circumstances if a droop were to occur, it usually lasts about 2-3 weeks(much less than the full dose of Botox lasts). Of course as with any injected substance, slight bruising can sometimes occur, however this can usually be covered with make-up.

Can Botox be combined with any other treatments?

Yes Botox can be combined with other treatments such as injectable fillers to other areas of the face. However we generally like to wait a couple of weeks before deciding whether any injectable skin filler is also required to further improve any lines treated by botox. We will be able to discuss this with you at your visit.

Botox for excessive sweating

Excessive sweating (hyperhidrosis) can be socially as well as professionally disruptive and many times leads to considerable emotional stress and embarrassment. Whilst some patients who suffer with generalised excessive sweating may require regular medication to bring this under control, patients who suffer with localised excessive sweating of the underarms, palms and soles can be successfully treated with Botox injections.

When injected locally into the skin of a problem area, Botulin toxin type A potently blocks the nerve fibres used to stimulate sweat glands, resulting in almost complete cessation of sweat production from that area. As the toxin is injected only within the skin, there is no risk of affecting deeper muscle structures and therefore their function. The procedure is similar to that described above for line removal. The effects of the Botox treatment takes three to seven days to be demonstrated, and the sweat free effects last between 3 and 12 months. Repeat injections produce similar results. The treatment is well tolerated and is void of any adverse side effects.


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