An early sign of aging is wrinkle formation, which appears as fine, dynamic lines, gradually forming deeper, more static rhytids. Repetitive facial expression and movement contribute to the formation of deep wrinkles. Botulinum toxin neuromodulators (i.e. BOTOX® Cosmetic, Dysport®, etc.), derived from bacteria, temporarily blocks nerve signals to the muscle into which it is injected, paralyzing it. As the muscle no longer contracts, the lines may soften and even disappear, reestablishing a more youthful appearance.
The FDA has approved the use of Botox® Cosmetic for forehead lines, frown lines, and crow's feet. Other cosmetic uses are considered "off label.” Additional target areas include thick bands in the neck, thick jaw muscles (relating to bruxism and jaw pain), gummy smiles, and hyperhidrosis (excessive sweating) of the underarms.
Frontalis muscle activity in the forehead contributes to the formation of horizontal forehead lines. In addition, the periorbital region involves a complex interplay among the forehead, eyebrow, and eyelids. Brow/eyelid ptosis and dermatochalasis (excess eyelid skin) may further trigger the frontalis muscle to overcompensate with hyperactivity.
Frown lines, aka “the 11’s,” result from activity of the corrugator muscle. As these lines become more static, visible even when the face is relaxed, they can give off the appearance of aging, stress, and anger. Deep lines can be treated with both neuromodulator in conjunction with dermal filler.
Crow’s feet, aka “laugh lines,” are caused by frequent laughter and squinting, which contracts the orbicularis oculi muscle around the eye. In addition to smoothing out fine wrinkles, neuromodulator treatment of this area opens the eyes and can even achieve a minor lateral brow lift .
Bunny lines result from habitual scrunching of the nose with laughing and smiling. Neuromodulator treatment of the nasalis and procerus muscles prevents movement in these areas, softening these wrinkles.
Can men get Botox too? Of course! The key to achieving a natural look is to treat with incremental doses, preserving some facial movement and avoiding an overdone, paralyzed appearance. Men can also reap the benefits of looking younger, more rejuvenated, and remain competitive with their younger colleagues.
For excessive sweating (hyperhidrosis), not controlled by prescription antiperspirants, BOTOX® has been FDA-approved to treat underarms. The same mechanism that paralyzes muscles also blocks nerves that are responsible for activating sweat glands.
Neuromodulator treatment of the masseter muscle is ideal for patients with bruxism, who tend to grind their teeth, leading to dental problems, jaw pain, and headaches. Relaxation of the masseter muscle can also soften a strong square jaw into a more gentle oval shape.
Neuromodulators, such as BOTOX® and Dysport®, are injected with a tiny needle into multiple injection points. They block the action of muscle and nerves temporarily. Results may show within 2-3 days and may take up to 2 weeks to achieve its full effect. Generally, the effect can last 3-4 months, and repeated treatments are necessary to maintain its effects. For underarm sweating, effects can last 6-12 months. BOTOX® injections are quick procedures that take less than 30 minutes.
After neuromodulator injection treatment, stay upright for >4 hours. Do NOT massage or manipulate the injection sites for 1 day—AVOID facials, brow waxing, makeup application, etc. Do NOT perform any strenuous exercise or undergo extensive sun/heat exposure.
Risks & Complications.
Risks of Botulinum toxin type A include, but are not limited to: discomfort, bruising, swelling, redness, allergic reaction, headache, local muscle weakness, or eyelid ptosis (temporary eyelid droop). Women who are pregnant or nursing, persons with active infections, immune disorders, or any suspected or proven neurologic conditions, i.e. Eaton-Lambert Syndrome, Lou Gehrig’s disease, myasthenia gravis, or allergy to human albumin) should NOT receive this drug.