Introduction to Botulinum Toxin
Several factors are able to define appearance and age of an individual, but two are the most important at the first sight: eyes and facial wrinkles.
Botulinum toxin opens the glance, lifts the eyebrows, minimizes frontal wrinkles and frown lines, acting precisely on these factors that determine an old appearance, giving a relaxed and young look.
The injection of Botulinum toxin, commonly called "Botox", is the most common procedure Aesthetic Medicine. According to the American Society of Plastic Surgery (ASPS), the injection of botulinum toxin type A annually records 6.3 million procedures only in the United States.
Botulinum toxin is produced by Clostridium botulinum bacteria. This toxin is able to block the release of neurotransmitters from the axon (mainly acetylcholine) and to produce a temporary paralysis of the muscles. This substance has been authorized for use in aesthetic medicine in 2002 by the Federal Drug Administration (FDA).
A prolonged contraction of facial muscles is able to produce facial wrinkles and lines, especially in the frontal and glabellar region where they are more visible. In severe cases the contraction becomes even involuntary, producing deeper wrinkles, called furrows.
Botulinum toxin is able to act on both types of wrinkles in the upper third of the face, those given by a voluntary contraction and those given by a chronic involuntary contraction. Injection of Botulinum toxin is able to minimizes "voluntary" wrinkles and widely reduce "involuntary" ones. However, a long-term and targeted treatment is able to eliminate wrinkles and furrows by involuntary contraction.
Botulinum toxin is labeled for the treatment of glabellar and frontal wrinkles. In selected cases it could be applied for crow’s feet with remarkable results.
Treatment: Indications and modalities
Treatment is indicated for wrinkles in the upper third of the face: forehead, glabellar region, eyebrow and lateral canthal region. Botox can raise the eyebrow, if desired by the patient, thus giving the appearance of a look more open, relaxed and youthful.
The treatment lasts about 20 minutes. After the treatment you may see a slight redness that can last a couple of hours. The effect on wrinkles becomes visible 4-6 days after treatment. The paralysis of the targeted muscles persists for about 4-6 months depending on the subject and the injected dose. When the treatment is performed by a board certified Plastic Surgeon, complications are rare. These consist in a mild swelling in the treated region and small ecchymoses that resorb in few days.
In some individuals a small asymmetry of facial muscles and wrinkles could be observed. In these patients one or more treatments could be necessary to correct this defect and restore symmetry.
In some cases, Botox may cause headache, that can last for few hours or the entire day in severe cases. Headache commonly regress without any symptom and treatment.
Particular indications: spastic paralysis and excessive sweating
The use of Botulinum toxin is not limited to Aesthetic Medicine but find indications in several diseases characterized by spasm or involuntary muscle contraction (e.g. spastic paralyses).
Botulinum toxin is also indicated in case of excessive and localized sweating, e.g. the underarm region, the palm of the hands and / or feet. In these cases even a single treatment is able to provide a consistent improvement and in most cases a regression of symptoms could be observed.