INTRODUCTION
BOTOX® (Botulinum A) has been used safely by physicians
for 20 years to treat patients with certain medical conditions
such as eye spasms, central nervous system disorders and
excessive muscle contractions. The more recent use of BOTOX®
to reduce wrinkles was discovered almost by accident. Vancouver
dermatologist, Dr. Alastair Caruthers, began using BOTOX®
to treat signs of aging in 1986 after his wife Jean, an
ophthalmologist, observed that her patients who were treated
for eye spasm lost their crow's feet. According to Dr. Caruthers,
one patient actually commented that she looked "much
happier" and "less angry" because the BOTOX®
also improved the wrinkles between her eyebrows.
Since
that time, Dr. Gurney F. Pearsall, Jr. began using BOTOX®
injections to reduce horizontal creases in the forehead,
frown lines and other areas of the face. The overall effect
of BOTOX® is a relaxed, smooth appearance. If administered
properly, the final result is natural and pleasing to the
majority of patients.
Dr.
Pearsall has observed that BOTOX® is most effective
in the upper third of the face (eyes and forehead) but other
areas of the face and neck can be treated as well.
BOTOX®,
short for Botulinum Toxin A, works by binding to nerve endings
and preventing the release of chemical transmitters that
activate muscles. Botulinum toxin therapy is used to paralyze
small muscles of the face which cause frown lines, crow's
feet and other wrinkles. It
decreases the ability to frown or squint, thereby preventing
the appearance of lines and wrinkles caused by repeated
facial expressions. BOTOX® affects the ability of
the muscle to move, but does not impair sensory perception.
How
is BOTOX Administered?
An
extremely diluted amount of Botulinum Toxin A is administered
by Dr. Pearsall in the area where a person desires an elimination
of wrinkles. Dr. Pearsall uses a fine-gauge needle to inject
BOTOX® into the skin and muscle. To treat crow's feet,
three injections are given on the side of the face close
to the outer region of the eyes, known as the "orbital
rim." Patients should know that injection of BOTOX®
in the orbital rim, reduces, but does not abolish wrinkles
in this area. The result, however, is very satisfying to
many people who are self conscious about the appearance
of their crow's feet, especially when they smile.
To
treat forehead lines, 6 injections are administered over
the forehead area. The goal is to weaken, rather than paralyze
the forehead muscle, according to Dr. Pearsall. In certain
cases, BOTOX® can be used to improve the appearance
of "laugh lines," the folds in the area between
the nose and lips (naso-labial folds). There is a risk,
however, of lip drooping or other unfavorable cosmetic results
in the mouth area when treating the naso-labial folds. The
outer portion of the fold is better treated by other means,
such as facelift surgery. Unwanted horizontal lines on the
neck, nasal flares and chin creases have also been treated
successfully with BOTOX®. These areas are treated less
frequently.
An
alternate method of delivery BOTOX® involves the use
of a needle, which is connected to an EMG (electromyography)
recorder which guides Dr. Pearsall in locating muscles.
An audio signal can be heard when the probe comes in contact
with the most active part of the muscle. While this technique
may allow for more accurate placement of BOTOX®, it
can be more painful. Experienced physicians like Dr. Pearsall
do not require the use of EMG.
People
who wish to reduce the appearance of wrinkles around the
eyes and on the forehead, but don't want cosmetic surgery
are good candidates for this procedure. For this group,
BOTOX® is an effective but temporary treatment. The
effect of BOTOX® usually lasts four to five months.
However, more frequent treatments seem to produce a "build
up" of BOTOX®. Studies show that individuals who
have had at least five treatments had results that lasted
longer.
BOTOX®
is not recommended for:
Pregnant women even though there have been no reports
of birth defects with its use and women who are breast feeding.
This is because only limited data in this area is available.
Persons with neuromuscular disease, such as muscular
dystrophy or generalized movement disorders, may not be
candidates for BOTOX® and should consult their neurologists
before being treated. Persons with known allergies
to the components of BOTOX®, such as saline solution
and human albumin. Persons such as actors or on-air
broadcasters, for example, who use their face for expressiveness
should consider whether BOTOX® is right for them because
BOTOX® has a paralyzing effect on the muscles.
Treatment
Patients who are considering BOTOX® should not take
aspirin or any other non-steroidal anti-inflammatories (NSAID)
such as Motrin or Advil for two weeks before treatment.
Aspirin can increase the risk for bleeding and bruising
at the injection site. Also be certain to advise Dr. Pearsall
of any medications you are taking and any known allergies.
BOTOX®
Injections: Side Effects and Risks
Soreness
or bruising at the injection site can occur. Applying ice
packs over the treated site before and after the injections
can reduce this problem.
Another
side effect when BOTOX® is used around the forehead
is eyelid droop, known as ptosis. This temporary condition
occurs in about 5% of patients. It usually appears 7 to
14 days after the injection and can last 4 to 6 weeks. A
more speedy method of treating ptosis is the application
of prescription eye drops (iopidine). In many cases, these
drops will help resolve the droop within a few days. Dr.
Pearsall is well aware of this potential side effect and
takes all of the necessary precautions to reduce the risk
of ptosis. It is also important for a patient to remain
vertical for 4-6 hours after the injection. This allows
the BOTOX® to be taken up in the treated area and reduces
the chance of displacement to other muscles. It is also
helpful to contract the treated muscles repeatedly (smile
or squint depending on the area treated). Do not touch the
injected sites for two to three hours.
A welcome
side effect for some patients is the disappearance of "tension
headaches." Researchers are now experimenting with
BOTOX® to determine whether it can help in eliminating
migraine headaches for persons who are affected by them.
BOTOX®
can reduce or eliminate wrinkles without surgery. It is
a unique treatment because unlike other non-surgical treatments
such as chemical/laser peels and collagen injection, BOTOX®
corrects underlying muscle instead of the skin surface or
subsurface.
BOTOX®
appears to be a safe cosmetic procedure when administered
by a well-trained physician to an appropriate candidate.
In terms of safety, muscle biopsies taken from patients
after repeated injections of BOTOX® have not shown any
evidence of muscle weakness or degeneration.
Furthermore,
the Food and Drug Administration state that there have been
no reports of systemic toxicity from injections. BOTOX®
is recognized by the American Academy of Neurology, the
American Academy of Ophthalmology and the National Institutes
of Health as safe and effective.
According
to Dr. Pearsall, BOTOX® may be the "ideal cosmetic
procedure" because it produces "dramatic results,
has few side effects and is reversible." For persons
who are not candidates for cosmetic surgery or cannot afford
it, BOTOX® may provide the solution for their quest for
a more youthful appearance without the risks of other procedures.
