Few would argue that Botox injections are the fastest growing non-surgical cosmetic procedure, with over 3 million administered last year in the United States alone. Type-A exotoxin, or Botox Cosmetic®, marketed by Allergan, Inc., Irvine, CA, is produced, perhaps surprisingly, by the bacterium Clostridium botulinum, the cause of botulism.
While skin researchers have demonstrated that wrinkles in the aging face are clearly related to the accumulated effects of excessive sun exposure, smoking, volume loss, and gravity, facial expressions, and animation, known as dynamic wrinkling, also play a major role in the development of many types of neck and facial lines and furrows. By binding to the junction between nerves and muscle tissue, Botox effectively blocks the release of acetylcholine, the chemical responsible for normal muscular contractions, weakening the ability of certain muscles to induce fine lines, wrinkles, frowns and furrows through their repetitive use.
Botox has an excellent safety record in humans. Since the early 1980s, it has been used to treat muscle abnormalities associated with certain tic disorders, vocal cord problems and ocular abnormalities. And in the more than twenty-five years since its introduction and FDA-approval for these indications, it has consistently proven not only safe but reliable in millions of injections.
Cosmetic Uses of Botox
While other procedures, like laser resurfacing, dermabrasion and chemical peeling deal primarily with wrinkled skin at rest (static wrinkles), Botox is considered the treatment of choice for movement-related wrinkles (dynamic wrinkles). Initially used only to treat the so-called “scowl” (frown) lines between the eyes, Botox injections have been found remarkably effective for handling a wide range of facial and necklines and furrows. Great improvement may be seen in the horizontal “worry” lines of the forehead and the “crow’s feet” lines on the sides of the eyes, which in many cases may be eliminated entirely with treatment.
Botox has been employed successfully as a chemical (nonsurgical) browlift to restore the more youthful upturning of the lateral eyebrows, to counter the “marionette” line downturning at the corners of the mouth, to soften “smoker’s” (lipstick bleeding) lines around the lips, and to reduce laugh lines. Even the so-called “bunny” lines on the sides of the nose and the “apple dumpling” chin may be addressed with Botox.
In the neck, it has been employed successfully for the vertical “chicken-neck” (“turkey gobbler”) ropelike bands on the upper neck and the horizontal “necklace” lines encircling the lower neck. And on the chest, it can mute the appearance of vertical and horizontal crinkleyness within the decollete.
The full effect of these treatments is usually appreciated somewhere between one and ten days after injection and typically last for four to six months. After several treatment periods more prolonged benefits are often enjoyed as the muscles in time become “more accustomed” to contracting forcefully.
Best Candidates for Treatment
While the “typical” Botox patient is usually a woman in her mid-forties to mid-sixties, many men and women older and younger have also been treated successfully. Individuals with neuromuscular disorders and pregnant women and nursing mothers, however, are not candidates for treatment.
What To Expect
Botox is a watery-looking substance, which is administered, for greater comfort, through a needle finer than most sewing needles. The actual number of injections and the amounts given vary with the areas being treated.
Minor complications include swelling, bruising and tenderness at the injection sites, which usually disappear in a few days; slight headache, which may last a few hours; and rarely, a slight lid drooping, which most often resolves in two weeks. There have been no reports of generalized illness from treatments with Botox.
In the past, injections of Botox were accompanied by pretty significant stinging and discomfort. Ice packs and topical anesthetics were tried, which in my experience proved of little use. Recently, however, I developed a method for reconstituting and administering Botox that has eliminated much of the pain and stinging without the need for any additional icing or topical anesthesia, speeded its onset of action, and reduced the likelihood of bruising.
Certain medications and food supplements may increase the possibility of bruising, so you should discuss with your doctor stopping them prior to treatment. These include aspirin, non-steroidal anti-inflammatory drugs (eg. Advil, Aleve), alcohol, vitamin E, ginseng and ginko biloba. It takes about fifteen minutes to treat an entire face and neck. Patients are advised to repeatedly contract the treated muscles for up to an hour afterward in order to work the material into the body of the muscles. In my office, I employ gentle microcurrent stimulation to enhance muscle uptake.
One treatment session is often sufficient, but If a touch up is needed, it is best done at least a month later to reduce the chance of inducing any resistance to the material. Prices per session vary considerably, depending upon locale and the number of sites treated. Typically they range from $500 to $2000.
Some patients fear, unreasonably, that following Botox therapy they will develop a “Kabuki-like” mask appearance, and that they will also lose skin sensation. In reality, only the treated muscles will be relaxed, leaving all else functioning intact, including sensation. In the overwhelming majority of cases, Botox recipients are delighted with their “calmer,” more relaxed, less wrinkled, less frowning look, making it the premier “lunchtime beauty fix.”
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