Mimic wrinkles arise by repeated and long term involvement of different mimic muscles of the face and neck, which are important aesthetic issue.
Discovery of botulotoxine
In history of medicine, solution was long sought, but still a convenient chemical was not available. Ideal substance would, with minimal side effects, cause blockage of function of specific muscles without other muscle groups influenced. Experiments with substances, which cause so called “chemodenervation” – which is targeted blockage of nervous control of specific muscles are dated to the begininng of 20th century. In 20’s, first experiments were conducted with botulotoxine application for weakening of muscle function. Until this era, botulotoxine was only known for its negative effects as a poison created by unsufficient meat and vegetable can conservation (so-called “sausage venom”).
During observation of so-called botulism – poisoning after contaminated food – was found out that botulotoxine cause muscle paralysis by blockage of nervous impulse. In a year 1946, botulotixine – exotoxine, a product of bacteria Clostridium botulinum – was isolated in crystalic form and used in therapy by child ophtalmologist Dr. Alan Scott in cooperation with Dr. Edward J. Schantz. From 80’s of twentieth century was botulotoxine used in neurology for treatment of diseases concerning increased muscle tension or mscle contraction (esential blepharospasm, strabism, focal cervical dysphonia, hemispasms). Although strabism was one of first neurological indications, it is not in use anymore in this diagnosis. In other diagnoses, it was proven beneficial and it is still in use.
During treatment of abnormally contracted was observed, that due to muscle blockage, skin over the treated area is tightened and smoothed. Nerve conduction is renewed gradually as nerve endings sprout around the spot which was blocked.
Effect of botulotoxine on mimic wrinkles was described in 1992 by Alstair Carruthers. From that time this esthetic indication is expanding and it is used also in other domains, such as treatment of focal hyperhidrosis (excessive sweating).
Botulotoxine and wrinkles
Administration of botulotoxine is possible only in hands of professionally trained medical doctor. Procedure is an outpatient medical intervention with minimal stress involved, it can be completed “over the lunchbreak”, so to speak. Client is informed thoroughly by medical doctor about mechanism of action, administered preparation and side effects and about post-treatment regimen and self-care. In order to undergo treatment, client must also sign informed consent about the procedure. Medical specialist will interview client about his medical condition and inform him about treatment options and discuss the desired final outcome. Client is informed about temporary nature of treatment – from 4 to 6 months after first administration, 6 to 12 months after follow-up treatments. It is recommended to undergo follow-up treatments (not before 2 months period from first administration) and combination with other methods (laser resurfacing, chemical peeling, implantation materials, plastic surgery) is possible.
Contraindications
Some of the clients cannot be treated because of medical conditions that rule out safe treatment. These are: pregnancy and breastfeeding, neuromuscular diseases (myasthenia gravis), allergic reactions to added substances, usage of anti-inflammatory drugs (e.g. NSAID’s), inflammation or acute infection in site of administration, in clients with higher risks of bruises and in clients with unrealistic expectations, where post-treatment compliance is in dispute.
Administration of botulotoxine
Procedure of treatment facial mimic wrinkles and neck wrinkles is conducted while sitting, with spine erected. Client props his head against a solid mat and medical professional administers solvent of botulotoxine directly into the muscle. Amount of botulotoxine (in international units) differs according to localization, muscle tension and type of administered substance. Application is not without certain pain and discomfort, but not much. It depends on individual client’s sensitivity. First it is the feeling of needle inserted, after that comes ceratin pressure and twitching (from the substance administered). Articles, that say that the pain is unbearable, are not true. After finishing the procedure client leaves the clinic without accompaniment and usually, after few minutes, all discomfort is gone. Very thin needle is used during administration and very small amounts of substance are injected. In aesthtetic indication, quantity injected is 1000x lower than in neurological indications.
Care after procedure
These instructions must be followed by client:
• 4 hours after procedure client cannot lie down (should be straight up in vertical position)
• client cannot massage the treated area and not touch it
• 6 hours after procedure client cannot go to areas with great pressure change
• client has to work out treated mimic muscles 2 hours after procedure (for good substance distribution)
• when observing complications, client has to inform attending doctor immediately
• when used for eye lid treatment client can use artificial tears for one week
• procedure takes effect during 2 – 21 days after treatment. After that client cannot move affected muscle and wrinkles are smoothed and skin is tightened, but the effect is temporary.
What solves botulotoxine?
Currently, these localizations are the most popular:
• mimical wrinkles
• glabella between eyes – muscles affecting central perpendicular wrinkle between eyebrows and wrinkles on upper part of the nose – they have effect on frowned, concentrated facial expression. With its loosening face get cheerful, youthful appearance.
• Forehead – wrinkles of awe, horizontal line over entire forehead. By blockage of this muscle the forehead is completely smooth.
• Temporal area – crow’s feet wrinkles, laugh lines. After administration in this area laugh is not rolling fine temporal skin, although laugh apperance is natural.
• Other locations – lower lid, corners of mouth, nasolabial wrinkles, perpendicular wrinkles on upper lips, chin and neck, these location are all possible, they are so-called new moder localisations. Here is neural supply very complicated and therefore maximal caution and precision during administration is required.
Conclusion
Botulotoxine has in the are of esthetic medicine wide range of use and it is sole ideal outpatient procedure for treating mimic wrincles and excessive sweating. Although relatively financially costly, it’s effectiveness is a good trade-off.