The history of Botox® is quite remarkable, and without the persistence of certain translational scientists, might never have come to pass ….. And now a new neurotoxin has come to market, namely Dysport®, which in many ways is very similar to Botox®. For the sake of simplicity, they will be considered interchangeably on this website, unless where specified.
Botox® injections have truly revolutionized the approach to facial shaping and wrinkle reduction. Botox® treatment is a quick, relatively straightforward outpatient procedure, with minimal risk when utilized appropriately that has replaced many traditional surgical approaches to facial aging. A more youthful appearance can now be achieved in a single 15-30 minute session, and without the complications associated with traditional surgical procedures.
Botox® is the trade name for a purified protein originally used in children with spastic problems, that is now also used in extremely small doses to reduce unwanted lines of facial expression, such as the frown lines between the eyebrows. Such an appearance is common, and can portray the appearance of anger, frustration, annoyance, and so forth. These lines are caused by excessive contraction and bulking of a muscle called the “corrugator”, and the action of Botox® is to relax these muscles. Botox® is very effective for horizontal forehead creases, crow’s feet around the eyes, lines on the upper lip caused by pursing the lips, and down turned corners of the mouth.
Botox® can be used to relax muscles in pretty much any area, but the efficacy is based on its injection in the correct location. A solid understanding of facial and neck anatomy is an absolute pre-requisite. In this regard, Botox® can be used to induce a non-surgical brow lift (elevation of the eyebrows), lifting of other areas, reshaping of the face, in addition to elimination of neck wrinkles and muscular bands. Botox® will not eliminate all lifting procedures, but with the addition of various skin tightening devices, fewer people are presenting for traditional lifting procedures, and opting instead for these low key, less pricy, and temporary fixes with minimal downtime and few complications.
Many people suffer from excessive sweating (hyperhidrosis) of the hands, underarms, feet and face, and have been under-impressed with the traditional topical treatments, or would prefer to avoid complex and extensive surgical approaches. Botox® is a highly effective treatment of this problem when injected directly into the areas of sweating, producing a sweat-free environment for up to six to twelve months.
Finally, these neurotoxins are also helpful in many patients with tension or migraine headaches, and can provide months of relief with one simple treatment session.
So exactly where should this be injected?
Make a frown, and feel the corrugator muscle just above the inner part of your eyebrows as a thickening. Injecting Botox® into this muscle will gradually relax this area over the next several weeks, and as such will have a drammatic reduction in the angry, tired and confused appearance that you unintenionally give to your family and co-workers! The #11 lines between your eyes will gradually improve and may disappear completely.
Contraction of the forehead muscles will cause those horizontal forehead lines to appear, and can be seen when raising the eyebrows. Contracting the muscles around the eyes (squinting) causes a gathering of the skin in the crow’s feet region. Neck bands are caused by contraction and shortening of the platysma muscle. All these areas can be relaxed by injection of Botox, being careful to avoid the underlying structures.
Treatments with Botox® take only a few minutes; the results are noticeable in three to five days and peak in seven to ten days. Gradually, over a period of three to five months, the effects of the Botox® will wear off and the muscles will be fully contracting again. Dr Zachary tends to give repeat injections at three month intervals for the first three injections, then sees his patients every 5-6 months thereafter.
Neither Botox® or Dysport® can cause botulism. It is not possible. Botulism occurs when large amounts of the toxin are ingested, usually from eating contaminated food. Should you choose to have treatment with Botox® or Dysport®, you will be receiving anywhere from 10-200 units, far below any danger zone.
Botox® was first used for forehead wrinkles in 1989 after Jean and Alistair Carruthers had the eye-popping concept of using this for cosemtic purposes. Prior to that time, Botox® had been used since 1980 for treatment of strabismus (lazy eye) and blepharospasm (uncontrolled eye blinking).
Side effects from Botox® are minimal when it is properly administered by a physician trained in its use. There will be a little discomfort as the solution is injected at the treatment site and there is a small chance of bruising. There have been no known reports of permanent side effects with Botox®. In very rare cases, there is a temporary, slight lowering of the eyebrow or eyelid, which often goes unnoticed by the patient.
Immediately after the treatment, there may be a mild amount of redness at the injection site, but this resolves in a few hours. Bruising can occur, but is not common. Dr Zachary has performed thousands of Botox® procedures, and his style is to create a peaceful appearance with a restoration of the normal positioning of the brows, and a reduction in the bulking of muslces around the eyes, forehead and between the eyes. In conjunction with the fillers, it is the foundation of the lifting experience, without the surgical cutting. Dr Zachary is very skilled at muscular shaping with Botox, and teaches his injection techniques to residents, dermatologists and plastic surgeons around the world.
Botox® and Dysport® are useful for improving frown lines, crow’s feet, forehead wrinkles, neckbands, drooping eyebrows, furrows of the upper lip, turned down corners of the mouth and certain other wrinkles. These agents can be used successfully and synergistically along with fillers such as Juvederm, Restylane, Radiesse, Scuptra, and with lasers.
Excess sweating of the palms, face, and underarms is an embarrassing psychological and physical problem for patients. Social interactions can be adversely affected, and many patients would like to have their sweating eliminated. Botox® injections are performed in a simple 15-30 minute outpatient session in Dr Zachary’s outpatient practice. Anesthesia of the area to be treated is generally induced with local application of ice or a vibratory device. Multiple injections with a tiny needle are carefully performed into the areas of sweating.
The effect of Botox® injection begins to be apparent two to three days after the injection session, and lasts on average six to twelve months. Repeat injection sessions are performed as the initial effect begins to dissipate. There are few side effects, and include minor bruising and occasional short-term very mild hand weakness (when the palms are treated). Driving and normal activities are generally not affected.
Botox® injections for axillary (underarm), palmar (hand), and facial sweating is a very effective procedure, resulting in extremely happy patients. Though in truth, nothing is 100%, and over the years a very small percentage of our patients have had only partial improvement.
This revolutionary approach to muscle relaxation and sweating was developed by physicians and scientists at Allergan, close to the University of California, Irvine! Dr Zachary has been lecturing on the use of Botox® for many years, but is happy to see that Medicis is now has FDA approval for the use of Botox’s rival Dysport®. Competition in life is good, and should be encouraged!