Botulinum toxin is a purified protein derived from the bacterium Clostridium botulinum and has been researched for more than 100 years. Botox® neurotoxin has been approved in more than 75 countries for 20 different indications to provide effective treatment to patients suffering from a range of neurological disorders.
Botox® injections are the most common and successful minimally invasive cosmetic procedure worldwide. Botox® has been used for cosmetic and medical applications and have been considered a safe and efficacious treatment for many conditions. In cosmetics, Botox® is mainly used to treat facial wrinkles. Botox® is also an effective treatment for migraines and excessive sweating.
Botox® is prescription drug and can only be administered by a medical professional. A Botox® specialist knows which areas should be injected to treat a certain problem. Patients are often confused about which areas of their face they need treated. Most of them think Botox® can smooth out all wrinkles. There are a few areas where wrinkles commonly appear in middle or old age.
In order for physicians to inject Botox®, they must undergo accredited training.
The International Association for Physicians in Aesthetic Medicine (IAPAM) offers Botox training to well-trained and skilled physicians to learn the proper Botox® injection techniques in order to meet the growing demand of aesthetic procedures.
Where Should Botox® be Injected?
Forehead, Temples and Eyes
Starting from the top of the face, there are three major types of wrinkles that appear in this area:
- Surprise lines that appear on the forehead as horizontal creases, and become more prominent when the eyebrows are raised.
- Frown lines, the vertical wrinkles between the eyebrows and they are more pronounced when a person frowns. They are also referred to as “the number 11 lines”.
- Crow’s feet which are small fan-shaped lines which begin at the outside corner of the eye and extend upwards toward the forehead. They are called crow’s feet because they are similar in appearance to the bird’s feet. These lines are visible when a person is squinting.
Surprise lines, crow’s feet and frown lines are the areas that clients mostly ask to be treated and they also produce the most successful results as well.
When treating frown lines, one common side-effect is the frozen forehead. This entails the face not moving at all and the patient appearing emotionless and unnatural. The corrugator muscle that is associated with frown lines is completely relaxed in the beginning to reduce the wrinkles. However, once they are gone the Botox® dose should be altered to allow some movement of the face. The goal of the Botox® administrator should be zero wrinkles, not zero movement for the Botox® patient.
A larger dose of the Botox® injection to the forehead can result in a heavy feeling on the eyebrows. The frontalis muscles in the temples, which are employed while raising eyebrows are over-Botoxed resulting in this side-effect. The forehead is too relaxed and therefore the weight of the eyebrows feels like a mountain. The administrator has to accurately judge how much Botox® is needed to correct the frown lines or worry lines.
One other side-effect of Botox® in this area is the eyelid drooping, making the eyebrow drop and the lid feel heavy. This is the most unappealing complication and if this happens immediate action should be taken. A possible option is to give prescription drops to the patient to reduce the dropping until the effect completely wears off.
Injecting the eye and brow area to remove crow’s feet can result in one or both eyebrows being raised too high. Part of the eyebrow is elevated to an angle bigger than what it normally should be giving the person a perpetual surprised look. This also promotes the formation of wrinkles over the brow. To prevent such a thing from happening, Botox® is strategically injected into a specific Botox® location.
Mouth and its Surroundings
The mouth and its surroundings are another prime Botox® location and the common problems faced by patients in this area are:
- Smile lines that start at the outside edge of the nose and go down to the mouth. They form significant creases in the face when a person is smiling. The medical term for these lines is nasolabial folds.
- Marionette lines which are creases that appear around the mouth and extend towards the chin. The lines resemble the jaws of marionette dolls which allow their mouths to open and close.
- Smoker’s lines that are defined vertical creases around the lips. These wrinkles are commonly found on smokers’ faces as the action of puckering up the mouth to inhale a cigarette makes the lines more significant.
Smile lines and marionette lines that form deep creases even when the face is at rest cannot be diminished by Botox® injections. Injecting the muscles responsible for these lines can lead to serious complications and not make any difference on the wrinkles either.
Smoker’s lines can also be reduced by Botox® but if the individual is a chain smoker then there will be little or no effect because the constant act of puckering the lips is what creates the lines in the first place.
It is important to note that Botox® smooths wrinkles by relaxing the muscles. It does not tighten the skin and only affects the facial muscles. Wrinkles form when the muscles are constantly in use and pull at the skin. The injection minimizes the motions of the muscles in the Botox® location.
When the muscles are less active, the skin does not come under motion stress therefore reducing the number of lines and wrinkles on the skin. Botox® has a better effect on elastic and well-hydrated skin. The younger the person is, the faster the results will be. Botox® does not tighten sagging or drooping skin. Neither can it stretch out wrinkles. It only relaxes the muscles responsible for those wrinkles and lines.
Because Botox® relaxes the muscles, those facial muscles that are in frequent use benefit from the injections the most. However, care must be taken so that muscles are not involved in creating facial expressions and other important functions or unpleasant side-effects such as drooping, frozen expressions and asymmetric features may occur.
Botox is a trademark of Allergan Inc.
For more information, visit the the IAPAM’s Aesthetic Medicine Symposium with Botox Training website