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

Botulinum toxin type A, produced by the bacterium C lostridium botulinum, is a powerful neurotoxin blocking the release of acetylcholine in the neuromuscular synapse. It weakens muscle tone until flaccid paralysis. Botox was safely and effectively used to treat patients with facial dystonia, hemifacial spasms (facial hemispasm) and facial ticks. The result of such therapy is cosmetic improvement. Often, patients who were given unilateral Botox injections for these disorders returned, asking for injections on the other side of the face to look younger.

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

In 1989 Botox was approved by the Office of Control and Quality of Food and Drugs (USA) as an effective and safe treatment for blepharospasm, strabismus and hemifacial spasm. Spastic phenomena were included in the indications for the application of Botox in 1998. The Conciliation Conference of the National Health Organizations (1990) introduced a number of "unwritten" statements, for example spastic dysphonia, oromandibular dystonia and torticollis. Many of these indications are now standard treatment. We have been using Botox for more than 12 years and recommend it for the elimination of hyperfunctional facial folds, including creases over the bridge of the nose, horizontal folds on the forehead, lateral oblique lines (crow's feet), strings of the subcutaneous muscle of the neck and wrinkles on the chin. Carruthers and Carruthers simultaneously reported similar results of Botox injections to correct hyperfunctional facial folds.

Botox treatment requires sterile saline, syringes and monopolar electromyographic (EMG) needles of small size.

The drug is stored in a standard freezer at a temperature of -15 ...- 20 ° C. Each bottle of Botox (Allergan, USA) contains 100 units of lyophilized botulinum toxin type A and is supplied on dry ice. Before the injection, it must be diluted with saline. We usually add 4 ml of saline to give 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).

Lines on the patient's face are photographed for documentary comparison before and after correction. The patient's face is taken at rest and at a voltage that demonstrates these lines. Their detailed analysis makes it possible to distinguish which functional lines originate from changes in the properties of the skin (for example, actinic or age-related changes), which are the result of structural deformations of the underlying tissues, and which are associated with scarring processes. When collecting history, special attention is paid to the presence of previous cosmetic procedures and facial treatments, injuries, inclinations to bleeding, on what medications the patient takes, the presence of hypersensitivity to medicines, the tendency to scarring or hypo / hyperpigmentation. Before and after treatment, we apply the scale of functional line evaluation at rest and at activity. Evaluation is performed by a doctor and patient at each visit together. The assessment scale has four grades: 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 given an injection of this drug, since its effect on the fetus has not yet been studied. We recommend caution to use Botox patient with neuromuscular diseases (for example, with Eaton-Lambert's syndrome, malignant myasthenia gravis), as well as with lesion of motor neurons. We do not recommend its use for patients receiving antibiotics of the aminoglycoside series, since aminoglycosides can influence neuromuscular transmission and potentiate the effect of the applied dose of botox.