BOTOX®
BOTOX® was first developed by an ophthalmologist nearly three decades ago and has been safely used for medical purposes for many years by ophthalmologists treating crossed eyes as well as uncontrolled spasms of the eyelids and face. While treating these medical conditions, Dr. Auker and others noted the added beneficial cosmetic effects resulting from relaxation of the muscles around the eyes and face.
BOTOX® is an increasingly popular application of this remarkable medication. In experienced hands, BOTOX® is a safe, predictable technique to soften and eliminate wrinkles and creases of areas of the face without blunting important facial movements or the positive range of human expression.
Botulinum toxin is produced by the bacteria Clostridia Botulinum. BOTOX® is a highly purified medicine containing miniscule amounts of this protein produced by these bacteria under precisely controlled laboratory conditions. BOTOX® is not alive but is a protein that weakens and inactivates muscles for several months.
First Clinical Uses of BOTOX®
In 1973, BOTOX® was first used as a treatment for patients with crossed eyes. By weakening the overactive eye muscles, this medicine provided an alternative to surgery. After this breakthrough, BOTOX® quickly gained acceptance for other ophthalmologic disorders including nystagmus and blephospasm (involuntary spasm of the eyelids). Hemifacial spasm is generalized and debilitating muscle spasms of one side of the face and is also amenable to BOTOX® therapy. The only other option for hemifacial spasm patients is neurosurgery of the brainstem. Ophthalmologists are understandably enthusiastic about this safe and miraculous treatment for these diseases. The clinical experience with BOTOX® is extensive and research has repeatedly confirmed a high success rate with minimal side effects using minuscule amounts of this remarkable medicine.
Safety
While BOTOX® is a potent toxin in high concentration; it is used in very small quantities with high margins of safety. After a muscle is injected, its first effects are not seen for at least 24 hours and the full effect often develops over two weeks. The effects of BOTOX® blockade on the localized muscle fiber contraction are not, alas, permanent. BOTOX® protein binds only to local muscle fibers and has no effect on the central nervous system or on the body if injected accidentally into a nerve or blood vessel. Typically, one half vial or less of BOTOX® per session is used in cosmetic applications. To have toxic effects on a patient, over 20 vials of BOTOX® would have to be injected at one time.
Background of the Cosmetic Use of BOTOX®
A Vancouver ophthalmologist and her dermatologist husband are credited with pioneering BOTOX® injections in 1988. Since that time, many ophthalmologists, cosmetic surgeons and dermatologists have treated patients for aesthetic purposes to reduce and eliminate wrinkles due to overactive muscles of the face and the effects of aging. Most patients have ranged in age from approximately 30 to 60 years old.
These experiences led to further research that has confirmed the effectiveness and safety of the Cosmetic BOTOX®. In 1996 at the annual meeting of The American Academy of Dermatology in Washington, Dr. Nicholas Lowe presented a study demonstrating that BOTOX® was useful for unwanted facial expression lines. Significant improvement was noted on both forehead frown lines and crow's-feet. No significant side effects were noted beyond the expected injection discomfort. For 30 patients only one experienced a mild drooping of the upper eyelid that cleared spontaneously. The length of effective improvement for the forehead -frown lines was approximately eighteen weeks. The degree of improvement of the crow's-feet was generally less than the forehead frown lines. BOTOX® is not 100% effective in all patients.
BotoxCosmetic® for Frown Lines
This application of BOTOX® is the most dramatic and perhaps the most rewarding use. The deep vertical creases and lines midline between the brows resulting from expressions of anger, frustration, consternation and concentration can be lessened or even eliminated. Many patients have noted the positive benefits of this specific therapy as being greater than they expected. Clinical psychology research has demonstrated that others respond differently to us, and at times negatively, based on their perception of our facial expressions and mood. Many of us find that there are no positive benefits of retaining these outward expressions that furrow the central brow. Dr. Auker has had numerous patients report that their general mood has been positively affected by this specific treatment of the central brow. While this is by no means an intended result of treatment and cannot be expected, Dr. Auker is fascinated by the possibility that BOTOX® treatment can in some way help lessen a situational cycle of negativism in mood and expression.
BOTOX® for Crow's-Feet
Wrinkles, radiating from the corner of the eyes caused by squinting, smiling, or laughing are especially distressing to some individuals. Previously, no reasonable medical or surgical solution improved this problem due to the strong underlying muscles. Even with the deepest chemical peels or laser resurfacing techniques, rapid recurrence of these lines is inevitable. BOTOX® injections can dramatically reduce these wrinkles and can be used in conjunction with resurfacing procedures.
BOTOX® for Forehead Furrows
The furrows in our foreheads develop over time due to the effort we exert to elevate the upper brows and lids and the natural aging changes of the skin and underlying tissue. Most patients wish to retain their ability to elevate their eyebrows for expression. We wish to avoid dropping the upper lid with our BOTOX® treatments. As such, we typically limit our treatment to the mid and upper forehead in an attempt to achieve these two goals. A forehead lift procedure is sometimes required for those patients seeking a very smooth forehead not adequately achieved with BOTOX®.
BOTOX® for Lips and Lower Face
Care must be taken to avoid unwanted side effects when considering these applications. A combination of collagen and BOTOX® can help soften deep wrinkles of the lower face.
BOTOX® is a registered trademark of Allergan, Inc.