Botulinum toxin in very small doses is a therapeutic neuromodulator. Botulinum toxin works by blocking neuromuscular synapses. In this way it is able to weaken muscle activity. This results in controlled partial paralysis of certain muscles. It has been found that this treatment in the upper face lead to reduced wrinkles caused by muscle contraction. Botulinum Toxin treatment is the way most people treat facial rhytids or wrinkles, specially in the forehead and periocular region. Dr. Thomassen provides this treatment in his office in Fort Lauderdale.
There are multiple varieties of botulinum toxin based on their chemical composition. The variety used for cosmetic purposes is botulinum toxin a. The different brands of botulinum toxin a differ in their potency.
How botulinum works to reduce facial wrinkles
The procedure involves an injection of dilute botulinum toxin into facial muscles. The toxin acts on the motor end plate of the motor nerves that innervate the respective muscles. The toxin prevents vesicles filled with acetylcholine from opening into the synapse. This causes a weakening or paralysis of these muscles. There is a loss of wrinkles in the overlying skin caused by chronic muscle tension. Wrinkles that form from underlying muscle tension are ideal for treatment. These include the forehead lines, lines between the eyebrows, and lines on the lateral corner of the eyes. Additionally, when placed in selective areas, it can result in eyebrow elevation. Newer techniques include placement of small amounts around the mouth to raise or lower the lips or eliminate wrinkles.
Indications and Contraindications
Good candidates are patients who have forehead, glabella (region between the eyebrows), and temple lines. They wish to improve these lines and wrinkles.
Patients should not be on blood thinners that can result in bruising. They also should not suffer any conditions that result in neuromuscular weakness like Myasthenia gravis. Finally, they should not be pregnant or breastfeeding or have an allergy to the ingredients
Botulinum Toxin Treatment
The first step in planning a treatment involves a physical exam. Asking the patient to raise their eyebrows, frown, smile and wrinkle their nose. These maneuvers exhibit the most common lines and wrinkles that botulinum toxin can treat.
The medication comes in a small vial with either 50 or 100 units of the toxin inside. It is diluted with normal saline to make a concentration of 2 to 2.5 units per 0.1 cc. One 1 cc syringe can be used to administer 25 units which is an appropriate starting dose for someone’s first treatment
The treatment starts with a cleansing of the involved skin with an alcohol wipe. Sometimes a topical anesthetic cream is used in patients that are sensitive. Using a very small needle the solution is injected into the forehead, glabella and crow’s feet muscles. Small amounts are injected throughout, consisting of multiple small injections.
Care is taken to not inject excessive amounts in certain areas as this can result in eyebrow ptosis or descent. There have been cases of temporary paralysis of the eyelid where patients can’t completely open their eye.
Following the injection, a cold pack is placed throughout the affected area for a few minutes to limit bruising afterwards. By carefully avoiding any superficial veins, this complication can be eliminated.
Results
The results are not immediately visible. Over the next 2-5 days, you will notice the effects. Lines and wrinkles across your forehead, glabella and crow’s feet will slowly fade and sometimes completely be eliminated.
In rare cases, some asymmetry may occur if a muscle is more active on one side than another. Sometimes an additional treatment is needed a week after the original injection to address any asymmetries that arise.
The results should last for 3-4 months. At that time a new treatment can be scheduled to keep the effect going.
Visit us to learn more about getting botulinum toxin treatment in Fort Lauderdale. Learn more about botulinum toxin treatment in the American Society of Plastic Surgery website.
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