Botulinum

Botulinum is the most popular medication in aesthetic medicine. It was initially approved for the treatment of strabismus, muscle spasms and hyperhidrosis (excessive sweating) of the underarms, hands and feet. Since 2002 it has been authorised for cosmetic purposes.

Botulinum reduces muscle contraction. Therefore, it is mainly used in aesthetic medicine to eliminate expression lines in the upper facial region, brought on by excessive muscle activity. These wrinkles, caused by continuous muscle contraction (smiling, frowning or lifting the brows), become deeper with the passage of time leading to grooves: the first visible signs of ageing skin.

Botulinum reduces muscle movements with  minor stress to the skin and considerable distension of expression lines, leading to a more youthful and relaxed appearance. Botulinum also works to prevent further development of wrinkles.

 

Indications

The main indications for which botulinum is prescribed are:

  • horizontal wrinkles on the forehead;
  • wrinkles between brows (frown lines);
  • wrinkles around eyes (crow’s feet);
  • hyperhidrosis  (eccessive sweating of hands, underarms and feet).

 

Before treatment

Accurate clinical assessment is necessary before the treatment through:

  • accurate medical history regarding diseases or allergies, possible contraindications to treatment, in particular:
  • pregnancy and breastfeeding
  • neuromuscular diseases
  • severe tissue ageing
  • previous facial palsy
  • coagulation disorders (anti-coagulant medications);
  • professional assessment of the aesthetic imperfection (wrinkles and grooves) to determine if the prescription of botulinum is appropriate for the indication, i.e. it will achieve positive results;
  • honest discussion to determine patients’ expectations, both in aesthetic and psychological terms.

 

How the treatment is performed

The treatment is performed on an out-patient basis and involves a series of quick, shallow injections of tiny amounts of drug into the treatment area. Each session lasts roughly 15-20 minutes. A numbing cream is applied locally before the procedure.

 

After treatment

Immediately after the procedure the patient may experience a mild burning sensation and observe some redness at the site of the injection, which usually subsides within minutes.

After proper disinfection it is possible to apply hydrating creams and make-up.

For six hours after the procedure it is advisable to keep the head elevated, not to smoke, not to consume alcohol, and not to massage the injected areas, so as not to dislocate the medication.

Aside from the aformentioned precautions, all normal activities can be resumed immediately.

If the treatment is performed by an expert and qualified plastic surgeon, complications are very rare and minor but may include:

  • small bruises, which heal in a matter of days, and which can be safely concealed with make-up. Use of ice-packs can prevent and limit their onset;
  • mild tenderness at the site of the injection and headache in the days following treatment;
  • asymmetrical brows, which can be corrected with a touch-up of botulinum.

The injected areas must not be exposed to the sun for at least seven days after the procedure, especially if bruises appear.

 

Duration of results

The medication starts to take effect two to four days after treatment and the final results are visible after 15 days. This is a  feature appreciated by many patients as the cosmetic improvement is gradual, natural and without a sudden change.

The results last for around four to six months. Repeating the treatment at four to six month intervals, works to stabilise the reduced muscle contraction and prolong the effects.

Injections should not be more frequent than every three months, so as to avoid the production of antibodies which may inactivate the drugs.

Combination with fillers

In cases of deep and marked expression lines that have been present for some time, it is advisable to inject a filler, after the application of botulinum to the area, to smooth out persisting grooves. In this particular case the filler lasts longer, as reduced mobility limits its resorption.