Botox Injection
Surgery Length: 15 minutes
Anesthesia: Ice Pack to face prior to procedure/Numbing cream applied to face
Where: Outpatient Office
Recovery: Swelling, bruising, pain related to injection, weakness of adjacent muscles related to diffusion of botox
Back to work: 24 hours or less with use of cosmetics to cover up any bruising
Full activities: No restrictions of activities
Risks: No long term complications or hazards have been identified; however, nursing or expectant mothers should not use this product
Injections of Botulinum Toxin which temporarily paralyzes the muscles are used for overly active muscles at the bridge of the nose and forehead and in the crows feet area of the eyes. These injections albeit lasting only up to 6 months effectively soften the appearance of the face and eyes and is recommended as a temporary procedure to bypass more effective procedures such as a forehead lift and eyelid surgery which would on a permanent basis eradicate many of these deformities.
Facial lines and wrinkles have a multifactorial etiology including sun exposure, loss of dermal elastic fibers, skin thinning, and excessive muscle activity. Hyper functional facial lines are caused by the skin pleating when the underlying muscles contract, which is best illustrated when there is a loss of these hyperfunctional lines and creases with the resultant smooth skin surface in patients who have suffered strokes, facial nerve injuries, or Bell’s palsy.
Hyperfunctional facial lines bother patients because they may be misinterpreted as anger, anxiety, fear, fatigue, melancholia, and aging.
Botulinum toxin A (BOTOX) is a most potent neurotoxin. It exerts its effect at the neuromuscular junction, inhibiting the release of acetylcholine, producing a weakness or flaccid paralysis of muscle. Botulinum toxin A (BOTOX) has been approved by the Food and Drug Administration (FDA) as a safe and effective therapy for blepharospasm, strabismus, and hemifacial spasm since December 1989. The National Institutes of Health (NIH) consensus conference of 1990 also included it as safe and effective therapy for the treatment of adductor spasmodic dysphonia, oromandibular dystonia, and torticollis.
Botulinum toxin A (BOTOX) injections have been found to be a useful adjunct for minimizing or eliminating hyperfunctional facial lines, particularly those of the glabellar region, forehead, and lateral orbit (crow’s feet). Platysmal bands, and hyperactive mentalis muscles with lip pursing have also been treated. Deep nasolabial lines may be reduced with Botulinum toxin A (BOTOX) injections, but the injections may diminish the elevation of the upper lip on smiling, an effect most patients do not want. The Botulinum toxin A (BOTOX) does not address the skin lines or wrinkles associated with actinic changes or age related loss of dermal elasticity or laxity of skin. Botulinum toxin A (BOTOX) has also found application in diminishing over productive sweating when injected in the palms and soles of the feet as well as armpits.
The alternatives to Botulinum toxin A (BOTOX) injections have included surgical excision, laser skin resurfacing, or augmentation with fat, collagen, or a variety of alloplastic materials. Forehead-lifts with muscle excision or face-lift procedures also have been used to stretch and smooth the lines. Most of these methods do not address the cause of the fold, which is the hyperactivity of the underlying muscle. In some cases, these surgical procedures can be used in conjunction with Botulinum toxin A (BOTOX) to enhance the cosmetic outcome.
The patients are first evaluated with a thorough review of their medical history, medications, and prior plastic surgery. A detailed discussion of the patient’s facial lines and the Botulinum toxin A (BOTOX) technique and effect then takes place. Standardized photographs are taken of the patient’s face at rest and with activity. A rating of the patient’s facial lines also is made by the patient and by the physician at rest and with the activity that causes the wrinkling.
Although there is a paucity of data, patients who are pregnant or lactating should not be injected. In one report of nine patients treated during pregnancy (dose unspecified), one patient gave birth prematurely, although it was thought not related to the drug.
After the injections are completed, the patient is asked to come back to the office to reevaluate the effect of the Botulinum toxin A (BOTOX). New photographs are taken. When the muscles are adequately weakened and a pleasing facial skin contour has been achieved, the patient is instructed to come back when the facial lines again become prominent. In general this is about 4 to 6 months. In some patients, who have been treated a number of times, the Botulinum toxin A (BOTOX) effect seems to last for longer and longer periods, perhaps related to behavior modification. The patients may have been conditioned to avoid certain undesirable facial movements, thereby avoiding the excessive pleating of the facial skin.
The complications of Botulinum toxin A (BOTOX) injections may be mild bruising or local pain related to the injection. There also may be weakness of adjacent muscles related to diffusion of Botulinum toxin A (BOTOX). There have been no long-term complications or hazards of Botulinum toxin A (BOTOX) use. Studies have shown that muscle biopsies taken from patients after repetitive Botulinum toxin A (BOTOX) injections have not shown any evidence of permanent atrophy or degeneration.
Overall, Botulinum toxin A (BOTOX) injections for hyperfunctional facial lines have been found to be extremely safe and useful alone or in combination with other modalities. Patient satisfaction with the injections is very high.
Please feel free to ask Dr. Kennedy or any member of his staff questions on any of these points raised.
