Cosmetic Botulinum Toxin Injection
The use of botulinum toxin on humans was pioneered in the 1980s. It’s use to treat wrinkles, rhytids, is now widespread and it is by far the most commonly performed cosmetic procedure. Botulinum toxin injections are not only used to approve cosmetic appearance but also to treat conditions of muscle spasticity. The toxin injected is taken from bacteria Clostridium Botulinum, the cause of medical condition Botulism, still seen in the developing world.
When processed for medical use, a small amount of botulinum toxin is injected directly into the muscle, blocking the release of neurotransmitters from the nerve endings, and prohibiting the treated muscle from contracting. For application in the treatment of facial aging, this causes relaxation of the desired muscle, keeping it from contracting and causing dynamic wrinkles. Almost any wrinkling of the face can be at least partially treated by botulinum toxin injection. After injection, it may several days to see the maximum effect, and results can last from 3 to 6 months.
Treatment of Facial Wrinkles
Treatments for facial aging have been sought after for centuries and are wide-ranging; anything from make-up to invasive surgical procedures. Some are commercially available but the most effective treatments must come from a doctor. These treatments are best tailored to the individual and the patient’s specific concerns. Very small fines lines are wrinkles that may be best treated by retinol creams or chemical peels. Dyspigmentation can also be treated with creams, chemical peels, or laser therapies.
Dynamic rhytids, those produced by squinting the eyes or raising the eyebrows may be best treated by injection of botulinum toxin. Deep rhytids or static rhytids, those that you see in a relaxed face, may best be treated by a browlift or facelift, also known as rhytidectomy. Sagging and excess skin around the eyes may be removed, called blephroplasty, and skin laxity on the cheeks, jowls and neck can be improved with a facelift. Fat atrophy around the cheeks and eyes can be treated with the direct injection of fat, called fat grafting, or fillers. Fillers may also be used for enhancing the appearance of the lips, filling fine lines, and smoothing lines such as the nasolabial crease.
Aging Face (wrinkles)
Changes in a person’s appearance occur over many years and are both universal and inevitable. Wrinkles appear and are commonly found on the forehead, around the eyes, and around the lips. The medical term for a wrinkle is rhytid, and these are caused by a decrease in the elastic tissue in our skin as we age. Over time the muscles of our face contract and relax, causing stretching of the skin.
As our skin becomes less elastic, it doesn’t contract back into place, but rather is stretched out and then bunches up, causing a wrinkle. These occur in very familiar patters and are associated with the underlaying muscles, most commonly: the frontalis muscle for the forehead, the corregator and procerus muscles at the brow, and the orbicularis oculi for the “crows feet”. Other signs of aging include sagging skin around the eyes, jowls, and neck. The layers of the skin become thinner. Additionally, the loss of fat, or fat atrophy, can cause a sunken-in appearance of the face. Sun exposure also causes skin changes and discoloration over time, known as dyspigmenation.
BOTOX is derived from the toxin of the Clostridium Botulinum bacteria and results in muscle paralysis at the site of injection. It was initially approved in the United States for injection in 1989. It is the most common cosmetic procedure performed in the United States. In addition to cosmetic applications, it is also approved to treat conditions such as muscle spasticity, overactive bladder, and migraine headache. It is packaged in a vacuum dried vial containing the toxin, and must be mixed with a small amount of saline before injection.
For treatment of wrinkles, a small syringe is used along with a very fine needle. BOTOX is then injected into the muscle underlaying the wrinkles, typically the frontalis (forehead), procerus and corregators (frown lines), and/ or the orbicularis oculi (crows feet). Multiple areas may be treated at the same time. There is minimal pain or bruising with the procedure. Afterwards, full effect will be seen in about 7 days and will last for 3-6 months. Most effect will be seen on dynamic wrinkles, though there is typically improvement in deep, static wrinkles as well.