Botox and Fillers

Botulinum toxin is a purified substance that’s derived from bacteria. Commonly known type of botulinum toxin type A injections is Botox. Injections of botulinum toxin blocks muscular nerve signals, which then weaken the muscle so it can’t contract. The end result is diminished unwanted facial wrinkles. Thus Botox injections have their effect on “dynamic lines” only.

Botulinum toxin can be used to help smoothen:

Botulinum toxin can be combined with other cosmetic skin procedures – such as chemical peels, dermal fillers, laser resurfacing ormicrodermabrasion – to further improve your results. This combination of therapies can even help to prevent the formation of new lines and wrinkles.

How is it performed?

Injections of botulinum toxin may seem like a simple procedure to you, since it’s just a few shots. But it’s actually both an art and science that only an experienced healthcare professional should do. There are 43 muscles in your face and it’s vital that your doctor who performs botulinum toxin injections understands and pinpoints the correct spots to optimize your treatment.

A very thin needle is used to inject small amounts of botulinum toxin into specific muscles (Fig – Anatomy of facial muscles). By carefully choosing specific muscles, your doctor weakens only the wrinkle-producing muscles, preserving your natural facial expressions.

Botox injections can also be given into the masseter (located below and infront of your ear) to reduce the muscle bulk and make the lower face narrower.

Botulinum toxin treatment injections usually take less than 15 minutes.

The number of injections you need will depend on your facial features and the extent of your wrinkles. Generally, crow’s feet require 3-4 injections, forehead lines require 6-9 injections and frown lines require 1-2 injections per side. Similarly, masseters may require 5-8 injections per side (25 to 40 units).

Recovery

Botox injection takes 48 to 72 hours to show its effect. Don’t rub or massage the treated areas after the wrinkle treatment because it can cause the botulinum toxin to migrate to another area of your face. If this happens, you could have temporary facial weakness or other unwanted effect. You may resume normal activities immediately. You may be advised to apply gentle cold compresses locally to reduce bruising.

The effect of Botox usually lasts for 4 to 6 months after which the wrinkle lines gradually reappear.

Possible risks

Although generally safe, botulinum toxin side effects can include:

• Bruising and pain at the injection site
• Flu-like symptoms
• Headache
• Nausea
• Redness
• Temporary facial weakness or drooping
• Very rarely, the toxin can spread beyond the treatment area.

FILLERS

If you want to reduce facial wrinkles and lines (static lines – lines which are visible even at rest), hyaluronic acid (HA) is an excellent choice as a dermal filler because of its compatibility with the human body. In fact, this substance is found in almost every single living thing. In humans, it acts as a network around every cell and helps in transfer of essential nutrients from the bloodstream to cells.

Hyaluronic acid is a natural substance found in your body. It is extracted and reformulated and now has become one of the most popular kinds of injectable fillers. When this gel is injected, it acts like an inflated cushion to support facial structures and tissues that may have lost volume or elasticity due to normal aging. It also brings water to the surface of skin to keep it looking fresh and supple.

Fillers treatments will help to improve your appearance temporarily, but it’s not a permanent solution and it won’t stop the aging process. It serves as an excellent tool to rejuvenate the face temporarily till you are ready for surgical facelift.

Depending on how your body reacts to the injections, you might need additional injections. In some cases, you may require 2 or 3 sessions before you achieve your desired goal.

It’s key to understand that the injections last between 9 to 12 months, depending on your life style, body chemistry and the rate at which you are naturally aging. In some areas, such as the lips the rate of absorption is greater and the effect may wear off in 4 to 6 months.

If you decide not to re-treat, your appearance will return to its original condition. Wrinkles and scars will return, and plumped lips will lose volume.

How is it performed?

Fillers may be used for –

• Enhancing lip volume
• Reducing naso-labial lines, frown lines and forehead lines
• Filling up depressed scars eg chicken pox or post-acne scars
• Enhancing certain facial contours – to augment cheeks, chin etc

HA fillers are routinely performed as an office procedure. In most cases it can be performed using local anaesthesia creams or injections.

The procedure generally takes 10 to 15 minutes and you can see your results immediately. Your doctor will massage the treated area to prevent lumpiness and get a smooth result.

However, some of the visible filling effect diminishes after 3-5 days as the reactionary swelling reduces.

You will be advised not to massage the area for the first few days. Some local swelling and bruises may be alleviated by applying cold compresses.

Recovery

You may resume normal activities almost immediately. However, you must avoid massaging the treated areas for the initial few days.

Possible risks

Complications from dermal fillers are very rare. However, some possible side-effects include:

• Acne-like skin eruptions
• Asymmetry
• Bruising, swelling
• Lumps
• Palpability of the filler under the surface of the skin
• Skin rash with itching
• Skin redness
• Under- or over-correction of wrinkles

Please feel free to discuss these in detail with your doctor.