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Expression lines, or "dynamic wrinkles,"
are caused by contraction of delicate facial muscles. The more emotion
you show, the deeper these lines tend to be. Typical dynamic wrinkles
include "frown lines" between the eyebrows, "crow's
feet" (smile lines) around the eyes, and forehead lines. These
lines can make us appear angry, worried, or tired. Fortunately,
these expression lines respond beautifully to treatment with Botox.
How do "dynamic"
wrinkles differ from other types of wrinkles?
Many facial wrinkles are not related to underlying muscle motion.
Rather, these "static" wrinkles result from sun exposure
and the natural maturing process. Static wrinkles are effectively
addressed by techniques that resurface the wrinkle (laser resurfacing,
dermabrasion) or elevate it with respect to surrounding skin (collagen
injections). These techniques have proven less effective with dynamic
wrinkles because they do not address the underlying muscle function.
What is Botox?
Botox is the trade name for botulinum toxin. It selectively weakens
tiny facial muscles by blocking the impulses that cause them to
contract. This quieting of selected muscles allows overlying skin
to remain smooth and unwrinkled, while untreated facial muscles
contract in a normal fashion.
Botox has been used since the early 1980's to treat
spasms of the neck muscles and eyelids. In the early 1990's, an
ophthalmologist and her dermatologist husband first noticed its
beneficial effects on expression lines. Their pioneering research
led to the use of Botox in cosmetic surgery.
Is it safe?
Please don't let the word "toxin" scare you. Botox is
one of the safest products in medicine. There has never been a report
of a serious side effect resulting from the use of Botox in cosmetic
surgery. Furthermore, Botox will not cause botulism – a form
of paralysis caused by natural exposure to large amounts of botulinum
toxin.
Where is Botox placed?
Botox is precisely placed only into the muscles responsible for
the unwanted wrinkles. For example, the frown line between the eyebrows
results from contraction of the corrugator and procerus muscles.
These small muscles can be felt during a purposeful frown as a thickening
just below the inside aspect of your eyebrows. By carefully targeting
only the offending muscles, the function of other facial muscles
is preserved.
Does treatment hurt?
A tiny micro-needle is used to place the medicine. Because the needle
is so fine and only a small amount of fluid is used, the pain associated
with the injections is minimal. Many patients compare the sensation
to a bug bite. No sedation or anesthetic is required, although a
topical anesthetic is available if desired. You can resume your
normal activities immediately, including driving.
What do I need to do
after treatment?
To ensure good uptake of Botox by targeted muscles, and to avoid
spread of Botox to non-targeted muscles, we will ask you to do the
following for 4 hours after treatment:
- Contract and exercise the treated muscles as much
as possible.
- Avoid rubbing or pushing on the injection areas.
- Stay upright.
How long do the benefits
last?
Results are seen in 3-7 days, and generally last 3-6 months. The
improvement is easy to maintain with touch-up sessions. With repeated
treatments, most patients find that the desired results last even
longer. You can stop Botox treatments at any time with the confidence
that you will eventually return to your pre-treatment appearance.
What are the possible
side effects?
Temporary bruising is uncommon and can be covered with makeup. In
very rare cases, Botox can cause temporary drooping of an eyelid
or eyebrow, double vision, or decreased tear secretion. Because
the effects of Botox are completely reversible, any side effects
are temporary, lasting no more than a few weeks.
What other conditions
can be treated with Botox?
Botox can effectively decrease excessive sweating of the palms or
armpits for several months. It works by blocking the signals that
"tell" glands to produce sweat. Two to three sessions
are required annually to maintain results. Treatment of the palms
requires nerve blocks by an anesthesiologist, making this a rather
expensive procedure.
Is the treatment for
everyone?
There are very few restrictions regarding Botox treatments. However,
patients who are pregnant, nursing, or have a neurologic disease
(for example, myasthenia gravis) should not be treated. Also, aminoglycoside
antibiotics and other drugs that interfere with neuromuscular transmission
should be avoided during Botox therapy.
What are the limitations
of Botox?
It is not permanent and will require touch-up injections 2-3 times
per year to maintain results. Also, Botox will not improve wrinkles
due to sun damage or aging since they are unrelated to facial muscle
contractions. There are rare reported cases of patients who possess
a natural resistance to Botox and therefore do not respond to treatment.
An alternative product called Myobloc is now available for these
patients. Treatment of wrinkles is considered cosmetic and is not
covered by insurance. Payment is expected at the time of scheduling.
Thank you for choosing Dermatology Associates
of Kentucky for your skin care needs. Established in 1951, we are
one of the oldest, largest, and most comprehensive dermatologic
practices in the United States. We look forward to caring for you.
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