Botulinum toxin is a bacterium that blocks the release of acetylcholine, the substance responsible for transmitting electrical impulses that elicit muscle contraction. In medicine, botulinum toxin is injected directly into hyperactive muscles. It has been safely and effectively used to treat strabismus (cross-eye) and blepharospasm (lid spasm) since the early eighties.
Hyperactivity of the facial expression muscles often results in deep frown lines, forehead lines and/or crow's feet. Injecting botulinum toxin into the affected area temporary paralyses the underlining muscles responsible for wrinkling, giving the face a more relaxed and pleasant appearance. The wrinkles become smoother or disappear altogether. When a small amount of purified botulinum toxin (BOTOX) is injected into a muscle, it causes muscle weakness or paresis. This appears in 2-4 days and usually lasts 4 months but can be shorter or longer.
The botulinum neurotoxin can be used to soften the action of several muscles of facial expression. Regions that benefit from this treatment include the glabellar frown lines, the horizontal forehead lines, mild brow ptosis, crow's feet, infraorbital lines, zygomaticus and risorius folds and mouth frown, apple dumpling chin and mental crease. Both vertical and horizontal necklines and bands respond well to botulinum treatment.
The patient will not be able to use these muscles voluntarily. Simultaneously, the injection is effective, but that this will reverse itself after a period of months, at which time re-treatment is appropriate. The patient must maintain an upright posture and not manipulate the injection area throughout the 4-hour post-injection period.
The initial effects of treatment become visible within 48 hours to 72 hours. The maximum effect is reached in about 1 to 2 weeks. Your facial expression will become more relaxed but by no means mask-like. The overall result is very natural. The effect of treatment generally lasts for 4 to 6 months. Re-treatment is then required. Botulinum toxin injection is generally a safe and effective treatment method. Nevertheless, certain side effects can occur, but they are mostly reversible as the intended treatment effects. At this appointment, you will be informed about the potential side effects of botulinum toxin therapy, risks and complications, contraindications to therapy and potential drug interactions.
BOTOX treatment of frown lines can cause minor temporary droop of one eyelid in approximately 1% of injections. This usually last 2 - 3 week. Occasional numbness of the forehead lasting 2-3 weeks, bruising or transient headache has occurred. In perioral injections, the diffusion of the BOTOX may transiently weaken adjacent musculature. In a minimal number of individuals, the injection down not work as satisfactorily for as long as usual.
Drug interactions can occur when botulinum toxin is used concomitantly with other medications. Since these medications can alter the effects of botulinum toxin, you must ensure that your doctor is aware of any current medications you are taking, especially:
Cause-related treatment modalities available are to reduce the hyperactivity of the contracting muscles, correct the volume ptosis and rejuvenation of the photo-aged skin.
The available treatment modalities should be individualised to each patient based on the extent and severity of the etiologic factors affecting the skin and the supporting tissues.
If the patient wishes to only proceed with the application of dermal fillers alone, available treatment options for fillers (e.g., PLLA and HA based filler), the possible side effects and safety profile, pain management, amount of product required, cost, longevity and the need for maintenance, advantages and disadvantages of available options are discussed. On the basis of patient's realistic expectation an appropriate treatment option will be advised.
During the first appointment,your medical history will be taken, and after description of the patient's concerns and expectation, the possible options will be discussed.
The facial features, soft tissue cover/ support, volume, symmetry of facial contours, rhytids, lips and scars are assessed and evaluated at the consultation stage and prior to the treatment plan.
The possible treatment options along with, their possible side effects, safety profile, amount of product required, cost, longevity and the need for maintenance will be explained. The advantages and disadvantages of each product will be discussed and the most optimal option, appropriate for patient's treatment will be advised.
Some treatment options for the possible freckles and disperse pigmentations will be discussed.
Once you decide about the type of the treatment and agree to all terms and condition of your desired treatment, a valid informed consent is signed.
Hyaluronic acid (HA) is a member of the glycosaminoglycan family (GAGs) a constituent of dermis ground substance with high water-binding capabilities leading to an increased dermal volume and compressibility by creating a fluid matrix ontowhich collagen and elastic fibres can attach and proliferate.
The chemical structure of Hyaluronic acid is similar in all living species, hence require no allergic skin testing due to a minimal risk for causing immunogenicity.
Hyaluronic acid used for soft-tissue rejuvenation, are usually cross-linked to reduce proteolytic degradation rates, and migration.
Due to colourlessness, HA can be injected superficially without concern of discolorations. Less viscosity and more flow-ability, make HA superior to bovine collagen.
As these products are not permanent they require maintenance based on their particle size, application depth, tissue mobility and the patient's life style.
The clinical outcome from a recent randomized, multi-centre clinical trial comparing bovine collagen (Zyplast) and a non-animal stabilized HA (Restylane) suggest that less HA injection volume was required to achieve the same optimal cosmetic results, while HA provided a more durable aesthetic improvement.