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Years of squinting and frowning can leave deep wrinkles that form between the eyebrows and may extend to the bridge of the nose. Wrinkles and frown lines also may appear across the forehead and at the corners of the eyes ("crow's feet") Dermatologists can quickly and safely inject botulinum toxin during an office visit to diminish these wrinkles and lines that create, an angry or sad look and detract from a pleasant facial appearance.
Botulinm toxin type A and botulinum toxin type B are purified substances, derived from a bacteria, that block muscular nerve signals. Injecting very small amounts into specific facial muscles blocks the muscle's impulse. This temporarily weakens the muscle and diminishes the unwanted lines.
Botulinum toxin has been used since 1980 to treat many muscle disorders such as lazy eye and uncontrolled blinking. It was pioneered by dermatologic surgeons for cosmetic use in 1987. Botulinum toxin type A is specifically indicated for the lines between the eyebrows, and it also can be effectively used for "off-label" indications in other facial areas.
Once the muscle is weakened and relaxed, it cannot contract. Since there is no way to make the undesirable facial expression, the lines gradually smooth out from disuse, and new creases are prevented from forming. Other muscles such as those needed to raise the eyebrows are not affected, so a natural expression is maintained. For optimal results, botulinum toxin therapy may be used in combination with other cosmetic skin procedures such as chemical peels, laser resurfacing, and dermal fillers. Combination therapy also can help prevent the formation of new lines and wrinkles. Botulinum toxin is less useful for the smile lines around the mouth because muscle action in this area is needed for important functions such as eating and talking.
Before treatment, the dermatologist obtains the patient's medical history, including any medications taken. Treatment involves injecting very small amounts of botulinum toxin directly into the underlying facial muscles to relax them. A tiny needle is used; the procedure is well tolerated and takes just a few minutes with no "down time" or procedure recovery period. Botulinum toxin takes effect about 3 to 7 days after treatment. The improvement generally lasts about 8 to 10 months; the effect gradually fades as muscle action returns. Patients require re-injection at various intervals.
With repeated treatments, atrophy (thinning) of the muscle may occur. This usually produces longer- lasting results.
Side effects are generally minimal, temporary, and typically relate to the local injection. Soreness or mild bruising, while uncommon, may occur around the injection site. Make up may be applied after the treatment, but care should be taken to avoid pressing or massaging the area for several hours. A temporary headache is not uncommon after the first treatment. In rare instances, patients may develop weakness of the neighbouring muscles leading to a temporary droopy brow or eyelid. All of these possible effects are mild, reversible, and self-limiting.
Hyperhydrosis (excessive sweating) can be treated with injections of a highly diluted form of botulinum toxin which is superficially injected directly into the underarm skin, skin on the palms of the hands, or on the soles of the feet. This weakens the action of the skin's sweat glands which are responsible for excessive perspiration. A single treatment session can provide months of relief, and injections, can be repeated when the excessive perspiration returns. Twitching muscles also can be treated by injecting botulinum toxin into the appropriate muscle.
Injecting minute amounts of toxin into the orbicularis oculi, corrugator, and procerus muscles thus weakens them. It slows the rate and force of blinking and effectively and safely reduces blepharospasm for the duration of the drug's action. Botulinum toxin can make a great difference in a person's life. Its, use in combination with other modalities gives successful results.
