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A new non-surgical approach for the treatment of wrinkles of expression is now widely used among Dermatologists and Plastic Surgeons. This medication was originally used and approved for the treatment of various neuromuscular and ophthalmologic disorders including eye spasm and strabismus. Botox, manufactured by Allergan, is a purified toxin derived from a bacteria, Clostridium Botulinum. The original studies with this toxin began in the late 1960’s with the work of Alan B. Scott, MD, of the Smith-Kettlewell Eye Research Foundation and Edward J. Schantz, Ph.D., director of food microbiology and toxicology at the University of Wisconsin.
These are creases secondary to the contraction of the underlying muscles of the skin pulling on the overlying sun damaged skin. The wrinkles treated with Botox are mainly those that are associated with expression (Smiling, Frowning, etc.)
The toxin works by interfering with the contraction of muscles that cause wrinkling especially of the forehead, crow’s feet, and the neck. Typically a normal nerve impulse that stimulates a muscle to contract triggers a release of acetycholine at the end of the nerve. This chemical substance causes the muscle to contract and pull on the skin causing wrinkles. Botox blocks the release of acetycholine effectively causing the muscle to stay in a rested non contracted state. This results in loss of wrinkles that are secondary to this muscle contraction. Therefore wrinkles of expression are reduced or eliminated.
The areas that best respond are the glabellar furrows (the wrinkles between the eyebrows), forehead wrinkles, and crow's feet. Newer treatments are also performed on smile lines, wrinkles of the chin, and neck folds.
The Botox is injected directly into the muscles around the area of crow’s feet or into the forehead or folds of neck.
The area to be treated is dependent on the patients needs and expectations.
The patient is in a seated position and usually no anesthesia is necessary.
The clinical effects of Botox may be seen after the first week. Initially there may be gradually loss of tone of the target muscle and eventual total or partial relaxation.
The length of duration of muscle relaxation is variable with an average of 3-6 months.
It may be longer after multiple treatments over time.
Repeat treatments are then performed at appropriate intervals to
maintain the desired amount of muscle relaxation and resultant wrinkle reduction .
Are there any precautions? The patient is instructed to remain in an upright position for several hours after the injections. The patient is then told not to manipulate the area for several hours.
If any other problems arise the patient should notify the office immediately.
There may be associated symptoms with the injections themselves including bruising and mild stinging. There can also be associated drooping or elevation of the eyebrows, eyelids, lips, or smile lines. This may last weeks to several months but it gradually goes away. Future uses of Botox: Recent studies in the use of Botox has shown several other promising areas including in the treatment of Migraine headaches and most recently in the treatment of hyperhydrosis. This is a condition in which there is excess sweating of either the palms or soles or armpits. Small amounts of the Botox is injected into the target areas and there is usually a decrease in the amount of sweating within hours to days. The effects of this treatment last for about 4-6 months.
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