Botox and Dermal Fillers

"Botox" is short for Botulinum Toxin, which is produced by a bacterium called Clostridium Botulinum. It has been used since 1920, but was marketed commercially in 1997. It has a wide variety of clinical uses for people who have problems with spastic muscle disorders, or an imbalance in eye muscles, to name a few. It can also be used in hyperhidrosis or excessive sweating of the palms or axillary areas. It was as a result of using Botox for other problems on the face that its efficacy in getting rid of wrinkles was noted.

Don't be put off by the word toxin! Botox interferes with transmission of the nerve impulse to muscles and hence stops the muscle working for a period of time. To be used effectively, it must be placed at a correct dosage into the correct muscle. There are a number of facial muscles, and it is the contraction of these that is responsible for facial wrinkling. As a plastic surgeon's my knowledge of the anatomy of these muscles will allow for safe placement of the toxin.

Botulinum toxin can be used to:

• Smooth crow's feet, forehead furrows, frown lines, lip lines and bunny lines
• Diminish neck bands
• Improve the appearance of skin dimpling of the chin
• Lift the corners of the mouth
• Soften a square jaw line
• Correct a gummy smile

There are 43 muscles in your face and it's vital that the person who performs botulinum toxin injections understands and pinpoints the correct spots to optimize your treatment.

A very thin needle is used to inject small amounts of botulinum toxin into specific muscles. By carefully choosing specific muscles, your healthcare provider weakens only the wrinkle-producing muscles, preserving your natural facial expressions. Botulinum toxin treatment injections usually take less than 15 minutes. The number of injections you need will depend on your facial features and the extent of your wrinkles. Crow's feet, for example, usually demand two to three injections. Furrows above your brow could take five or more.

Most people tolerate the injections very well. They are delivered through very fine gauge needles. However, local anaesthetic cream may be applied to the areas, one hour prior to treatment, for patients who are more sensitive however it is a waste of time unless other things are being done at the same.

Results start to appear in three to five days but may take up to a week. Finer wrinkles will disappear right away, and more established ones take more time. With regular usage, one sometimes loses the habit of frowning altogether! If the wrinkles are very deep, ancillary treatment with filler materials about two weeks post injection may be necessary to achieve 100% result. Botulinum toxin recovery. No anaesthesia is required. There is no down time or recovery time for botulinum toxin injections. You may resume normal activities immediately.

One note of caution: Don't rub or massage the treated areas after the wrinkle treatment because it can cause the botulinum toxin to migrate to another area of your face. If this happens, you could have temporary facial weakness or drooping.

This is an important question and patients need be informed about the side effects. If for some reason the toxin moves to a muscle which is not a target muscle, such as the muscle which opens the eye or the ocular muscles which move the eye, then side effects can occur. These are rare and involve drooping of the eyelid, or double vision. Remember that the effects of Botox last only for four to six months at best, and when a really small dose causes a side effect, it usually reverses itself back to normal in three to four weeks.