Use of Botox (botulinum toxin type A) for facial wrinkles

Botulinum toxin type A, produced by the bacterium C lostridium botulinum, is a potent neurotoxin that blocks the release of acetylcholine at the neuromuscular junction. It weakens muscle tone to the point of flaccid paralysis. Botox has been used safely and effectively to treat patients with facial dystonia, hemifacial spasms, and facial tics. The result of this therapy is cosmetic improvement. Often, patients who have had unilateral Botox injections for these disorders return asking for injections on the other side of the face to look younger.

Botox injections improve appearance by reducing or eliminating hyperfunctional facial folds, which are caused by wrinkling of the skin due to contraction of the underlying muscles. The disappearance of these folds with a smoothing of the skin surface is observed in conditions that weaken the facial muscles: damage to the motor nerves of the face, peripheral facial paralysis, or stroke. Botulinum toxin does not affect facial folds that are not caused by muscle hyperfunction: radiation damage, loss of elastic fibers, or skin atrophy. These conditions are best corrected by chemical peels, laser resurfacing, or the introduction of injectable fillers.

In 1989, Botox received FDA approval as an effective and safe treatment for blepharospasm, strabismus, and hemifacial spasm. Spasmodic phenomena were added to the indications for Botox in 1998. A consensus conference of national health organizations (1990) created a number of "unwritten" indications, such as spasmodic dysphonia, oromandibular dystonia, and torticollis. Many of these indications have now become standards of care. We have been using Botox for over 12 years and recommend it for the treatment of hyperfunctional facial folds, including nasal folds, forehead lines, lateral oblique lines ("crow's feet"), platysma bands, and mental folds. Carruthers and Carruthers concurrently reported similar results with Botox injections for the correction of hyperfunctional facial folds.

Botox treatment requires sterile saline solution, syringes, and small monopolar electromyography (EMG) needles.

The drug is stored in a standard freezer at a temperature of -15... -20 ° C. Each bottle of Botox (Allergan, USA) contains 100 U of lyophilized botulinum toxin type A and is supplied on dry ice. Before injection, it must be diluted with saline. We usually add 4 ml of saline to obtain a concentration of 25 U/ml (2.5 U in 0.1 ml); 2.5 ml to obtain a concentration of 40 U/ml (4 U in 0.1 ml) or 2 ml to obtain a concentration of 50 U/ml (5 U in 0.1 ml).

The patient's facial lines are photographed for documentary comparison before and after the correction. Photos are taken of the patient's face at rest and under stress, demonstrating these lines. Their detailed analysis allows us to distinguish which lines are functional, which ones have arisen due to changes in skin properties (e.g. actinic or age-related changes), which ones are the result of structural deformations of the underlying tissues, and which ones are associated with scarring processes. When collecting anamnesis, special attention is paid to the presence of previous cosmetic interventions and facial treatments, injuries, tendency to bleeding, what medications the patient is taking, the presence of hypersensitivity to medications, tendency to scar formation or hypo/hyperpigmentation. Before and after treatment, we use a scale for assessing functional lines at rest and during activity. The assessment is made by the doctor and the patient together at each visit. The assessment scale has four gradations: 0 - no lines; 1 - light lines; 2 - moderate lines; 3 - pronounced lines.

Despite the small amount of data on the use of Botox in pregnant and lactating women, they should not be injected with this drug, since its effect on the fetus has not yet been studied. We recommend caution in using Botox in patients with neuromuscular diseases (for example, Eaton-Lambert syndrome, malignant myasthenia), as well as in cases of motor neuron damage. We do not recommend its use in patients receiving aminoglycoside antibiotics, since aminoglycosides can affect neuromuscular transmission and potentiate the effect of the applied dose of Botox.