Botox quickly became a household name over 10 years ago and we all know the well-glamorized shiny immobile foreheads and the lack of expression it caused in its early days of use. However, physicians have come to respect it and use it in a way to allow their patients to have a more natural and youthful look while still preserving some function to the facial muscles.
Botox belongs to the family of Botulinim neuromodulators which also includes Dysport. These neuromodulators act to temporarily paralyze the action of the muscle at a cellular level. Botox is the most commonly known type of neuromodulator while Dysport is becoming more and more popular among patients and physicians. Both types are safe and effective For the sake of this blog, we will refer to the group of Botulinim neuromodulators as Bot-NMs.
According to American Society of Plastic Surgeons, Bot-NMs are the single most common aesthetic procedure performed in men and women in the US. A large percentage of the users are young women between the ages of 25 and 35, comprising nearly 30-40% of patients. However, a recently increasing amount of men are receiving Bot-NMs as well. Both men and women today are more health conscious – and want to look as good as they can.
Bot-NM is most commonly administered to the following sites:
1) Forehead wrinkles. Horizontal wrinkles (or creases) along the forehead that are seen at rest and with movement can often be reduced with Bot-NMs.
2) Glabellar folds or wrinkles. These are wrinkles noted best when frowning and they occur right where the nose and forehead meet in between the eyebrows. Treating this area can allow for a more “relaxed” look.
3) Crow’s feet. These are the wrinkles that form around the corner of the eyelids and are most prominent when one smiles.
Physicians that are experts in using Botox can also use it for other parts the face to achieve slight elevations in the brow positions (referred to as a Botox Brow Lift) and treating eyelid asymmetries. It can also be used to treat “bunny lines” around the side of the nose most noticed when smiling, lip wrinkles (referred to as smoker’s lines) and the help change the appearance of the corners of the lips as well.
How many units are typically injected?
This all depends on the physician and their personal experience with the product. Each botox vial is 100 units of botulinim toxin, and this can be diluted in however fashion. Although the diluation is different, the total number of units to each area is still the same. In my practice, treating a typical glabellar or crow’s foot area ranges 20-40 units. For Dysport the potency is a little less than Botox so usually two times the units are required.
What to expect from Bot-NM?
Physician communication is vital since excessive Bot-NM can result in the overdone look which was fairly common in its early use over 10 years ago. The desired look is often a natural look resulting in reduced wrinkles at rest and during facial expression; although, maintaining some visible signs of facial expressions are important to a natural look. Expressing your desires to the physician are key.
Ask your physician about the Bot-NM process and whether they provide topical anesthesia (usually applied 40 to 60 minutes before procedure) or other ways to reduce the pain that is involved with the injection. With my experience, ice compresses to the regions of application 5 minutes before the procedure is sufficient and provides an excellent source of pain control and reduces the incidence of bruising that can often occur. The procedure usually takes a few minutes.
Headaches can occur especially if it’s the first series of injections that you receive and when the injection is often placed too deep.
How safe is Bot-NM?
Bot-NM is used to treat a variety of different medical conditions such as blepharospasm (uncontrolled blinking of the eyes), and migraines, excessive underarm and palm sweating.
Bot-NM procedures are non-invasive, which means there is no surgery involved.. Facial expressions will remain the same for the most part. There is little to no recovery time after a procedure. It is safe to have multiple Bot-NM procedures performed, plus Bot-NM procedures cost much less than other, invasive cosmetic surgery choices.
Over a period of time, the effects of Bot-NM gradually wear off, and the muscles return to their normal state. Because it wears off, it is safe to return for more Bot-NM injections every three or four months in order to keep smoother, younger looking skin.
Is it okay to be administered to young patients?
Bot-NM is safe to be administered to young patients that are healthy but show some early signs of wrinkles. Some plastic surgeons do not feel it is appropriate to inject Bot-NM prophylactically to prevent wrinkle formation. However, this is often done especially to young 20 year-old women. Patients should be counseled about the role of Bot-NM and wrinkle formation and whether it is an appropriate procedure for them.
Figure 1. Basal cell carcinoma of the lower lid. Notice the loss of lashes and the raised, pearly appearance of the lesion.