WRINKLE REDUCTION BY INJECTION
In any face-to-face encounter, words alone don't tell the whole story. More often, our facial expressions send a stronger message. If you've found that frown lines, forehead creases or other facial-expression lines are preventing you from looking as good as you feel, cosmetic denervation with botulinum toxin (BTX) injections may be a good option for you. (BTX is also known by product names such as Botox®* and Myobloc**.)
Botulinum toxin is a purified therapeutic agent that removes lines and creases in the upper part of the face by inactivating specific muscles that pull on the skin. It works to eliminate the face's dynamic wrinkles - those wrinkles that are caused not by aging or sun exposure, but by years of facial movement, such as laughing, smiling or frowning. Treatment with BTX in the affected areas, causes the underlying muscles to relax, giving the skin a smoother, more refreshed appearance.
You'll find basic information about BTX treatment in this brochure. However, the best way to get complete answers to specific questions that relate to your individual needs is to have a personal consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Is BTX treatment right for me?
BTX is most commonly used to treat adults 30 and older. However, patients of any age can benefit from treatment.
You may be a good candidate for cosmetic BTX injections if you have any of the following conditions:
Other uses for BTX
frown lines (vertical wrinkles between the eyebrows)
- forehead creases (horizontal forehead lines)
- "crow's feet" near the eyes
- platysmal bands, which appear in the neck as thick bands or "cords"
In addition to its cosmetic use, BTX has a long record of safe and effective use in treating other conditions, such as:
- eyelid spasm or eye muscle spasm that can cause crossed eyes
- facial muscle imbalance
- spasms of the neck muscles
- spastic muscles in patients with cerebral palsy
- Newer research has found the BTX may also provide some relief for:
- - migraine headaches
- - excessive sweating of the palms or underarms
BTX has a 20-year record of safe and effective use. However, you should be aware that cosmetic denervation is an "off label" use for BTX. This means that the Food and Drug Administration has not yet reviewed and approved BTX for its expanded use in the correction of wrinkles, even though it is widely and safely used for this purpose.
What should I expect from the consultation?
A personal consultation is the first step for every patient considering BTX treatment. During the meeting, your surgeon will assess your physical and emotional health and discuss your specific treatment goals.
You should arrive at the consultation prepared to give complete information about:
During your physical evaluation, your plastic surgeon will assess your bone structure, the texture and elasticity of your skin and the muscle activity of your upper face.
- past and present medical conditions (If you're a woman, your surgeon must know if you are pregnant or are nursing a child.)
- medical treatments or recent psychological counseling you may have received
- medications that you take, including nutritional supplements and herbal remedies
- any allergies you may have
Your plastic surgeon may explain additional procedures that can be performed in combination with BTX injections to better meet your appearance goals. Some of the procedures that might be considered include:
How is a BTX treatment performed?
- a facelift, which removes excess skin and tightens muscles in the mid and lower face
- eyelid surgery, which can correct excessive skin overhang in the upper eyelids and minimize puffy bags beneath the eyes.
BTX injections are quick and associated with very little pain. Often, patients remark that the ultra-thin needle that is used makes the injections far less uncomfortable than expected. The simple office procedure typically takes 10 minutes or less and the actual injections take only seconds. No anesthesia is required. However, if you are especially sensitive, your surgeon may elect to use a topical numbing cream.
The number of BTX injections you'll need depends on the areas that are affected. For the neck or forehead, you can probably expect about 8 - 12 injections; for frown lines between the eyebrows, 5-7 injections; and for lines around the eyes, 2-3 injections for each eye. Your surgeon will target the hyper-kinetic muscles, that is, the over-active muscles that are responsible for movement and expression.
Are there other treatment options?
For deep horizontal creases across the forehead or furrows between the eyebrows that are caused by aging, your surgeon may recommend an endoscopic forehead lift.
If the wrinkles on your face are mainly caused by sun damage or aging and are not concentrated to the upper third of your face, your surgeon may recommend a skin-resurfacing technique, such as chemical peel, dermabrasion or laser resurfacing, to shrink the wrinkles and create a smoother appearance.
How will I look and feel right after the injections?
Though it is unusual, you may experience some mild discomfort, bruising and/or swelling at the injection site. (If any of these side effects becomes bothersome, your surgeon may give you medication or suggest that you apply ice to the affected area.)
You may return to work or your normal daily activity immediately after the treatment. However, for the first 3 to 5 hours after the injections, you'll be advised to avoid bending or straining. Exercise or facial massage may spread the medication to an area where it is not needed. The goal is for the toxin to be taken into the muscle at the place where it was injected. After a few hours have passed, you may resume any activity or exercise.
What should I know about my results?
The effect of BTX may take several hours or even several days to develop. The duration of the results may vary. However, in general, you can expect your results to last for three to five months.
If you find that your treatment did not produce the look that you had hoped for, your surgeon may recommend a repeat treatment.
Patients are typically quite pleased with the results of this quick outpatient procedure. Most are surprised at how simple it is to maintain the results with regular treatments.
How long will I continue to see my plastic surgeon?
To maintain your softer, more relaxed appearance, you will need to see your plastic surgeon every 3-6 months for repeat treatments. You may find that as the muscles gradually weaken from lack of use, your repeat treatments will become less frequent.
However, it's important to be aware that if you discontinue your treatments altogether, the botulinum toxin will leave your body entirely and your appearance will return to its earlier state.
At your return visits, your surgeon will assess your results, modify your treatments if needed and address any questions or concerns you may have.
CHOOSING A QUALIFIED SURGEON
No matter what type of plastic surgery you're considering, one of the most important factors in its success is the surgeon you choose. Although it may seem hard to believe, some of the physicians who are performing cosmetic surgery today have had no formal surgical training at all.
It's advisable to consider the following points before scheduling a consultation:
Find out if your doctor is certified by the American Board of Plastic Surgery (ABPS). Surgeons with this certification have completed a minimum of five years of surgical training following medical school, including a plastic surgery residency program. During this intensive program, surgeons learn to perform surgical procedures for the entire body and face. At the same time, they develop their technical skill and aesthetic judgement. After training, a surgeon must pass comprehensive oral and written exams before being granted certification. The two organizations that have prepared this brochure, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, require their members to be certified by the American Board of Plastic Surgery.
Ask about the surgeon's hospital privileges
Even if you are planning to have your surgery in your doctor's office or at a surgery center, it is important to find out if your surgeon has operating privileges in an accredited hospital for the same procedure that you would like to have performed. Before granting privileges, hospital review committees evaluate a surgeon's training and competency for specific procedures.
*BOTOX® is a registered trademark of Allergan, Inc.
**MYOBLOC is trademark of Elan Pharmaceuticals, Inc.