Facial wrinkles – how to fight them effectively

Facial wrinkles are a river topic. Although they appear very early, even after the age of 20, we do not have to accept them at all. Modern aesthetic medicine meets the expectations of all women and has a solution for this. Where do they come from and how do we fight them effectively? You’ll find out in our series“Facial Wrinkles” – Part II. 

Fortunately, we have an effective weapon. The only effective treatment for facial wrinkles is the use of botulinum toxin (BTX-A) to temporarily and 100 percent reversibly paralyze the facial muscles. Returning to our creations of the imagination , BTX-A is nothing more than a pair of scissors that will temporarily cut the over-tightened and tangled tape in our beautiful curtains. Muscle paralysis, on the other hand, is “pulling the plug from the socket.” Very important is the fact that we can always re-sew the tape into the curtain fabric and the pulled plug back into the socket after time. Identical is the case with botulinum toxin – once applied does not mean that the effect will be forever. The nerve fibers will regenerate and the strength of the muscle will return. On the one hand, this is not very desirable for patients, because satisfied with their fresh and younger appearance, they would like to keep it forever, on the other hand, it is about guaranteeing the safety of the product. In the event of any complication – we know that in time it will fully resolve. Let’s remember that in aesthetic medicine nothing that is permanent is safe for the simplest reason above all – we never know how we will feel with a given change, whether we will like ourselves – having a guarantee of reversibility we can more boldly make decisions about certain procedures.

Botulinum toxin is most commonly referred to as Botox. This is because the first formulation of it to appear on the market, which moreover still exists today and is the most popular, bears the trade name ^BotoxÒ (^VistabelÒ – larger vial capacity). Other preparations containing BTX-A include m. in. ^AzzalureÒ, ^DysportÒ, ^BocoutureÒ, ^XeominÒ and others. It is one of the oldest and best studied preparations available to aesthetic medicine. Before cosmetic use was discovered, it was successfully used in medicine to treat m. in. Such conditions as:

• cerebral palsy,
• shrinking eyelids,
• Cervical dystonia and focal dystonia,
• hemifacial spasm,
• muscle spasticity,
• testimony,
• Muscular contractures of the limbs.

It was the treatment of strabismus that brought BTX-A into the world of beauty and the rapid development of this branch of medicine – aesthetic medicine. A certain ophthalmologist running his practice with his wife, a plastic surgeon, have noticed a rejuvenation of facial features in patients undergoing strabismus therapy with ^BotoxÒ . Surprised by such effects, they reported the fact to the manufacturer, and so research began on the cosmetic use of botulinum toxin preparations. This took place more than 60 years ago. This distant timeframe makes this preparation the safest, best-studied ace up an aesthetic physician’s sleeve.

Keep in mind, however, that for the procedure to be called safe, it must be performed by a doctor with experience and, above all, proper training. No other person is authorized to administer BTX-A, as it is a prescription-only drug. After injection, the toxin begins to take effect at about the fifth day, and the peak of its action is set at the fourteenth day. Therefore any follow-up visits and any minor adjustments are made no sooner than two weeks after the procedure. The procedure is not painful and lasts a maximum of half an hour (including the time when the doctor prepares the appropriate amount and dilution of the preparation). After preparing the patient (thorough medical history and informed consent of the patient, preparation of photographic documentation before the procedure, precise determination of injection points, disinfection of the treatment area) we proceed to the injection. After the procedure it is very important, and the doctor always informs about it, that:

• for 4 hours immediately after the injection try to keep the head in an upright position
• on the day of the procedure, we categorically refrain from flying by plane after the injection
• do not consume alcohol on a given day (even in “symbolic” doses)
• avoid physically demanding situations on a given day J

What are the indications for BTX-A?

The most common and primary sites where we use botulinum toxin include:

• wrinkles of the interbrow area – glabella (“lion’s wrinkle”)
• transverse forehead wrinkles
• wrinkles around the outer corner of the eye (“crow’s feet”)

Other less popular places we can include:

• nasolabial wrinkles
• Wrinkles above the upper lip (“smoker’s wrinkles”, “barcode”)
• Neck and cervical rim wrinkles
• facial asymmetries
• overexposed gums when smiling (“gummy smile”)
• excessive sweating

Since we have indications, there are contraindications as well…
Absolute contraindications to the procedure include:

• pregnancy
• breastfeeding
• Disorders of neuromuscular connections (myasthenia gravis, myopathies)
• Aminoglycoside therapy and the use of “muscle relaxant” drugs

Among the most common side effects of the procedure, we can include bruising of the area of administration. It is a relatively harmless complication that resolves spontaneously over time. The only discomfort is an aesthetic defect, as these are usually visible areas. Side effects, which account for a negligible percentage of failures, include drooping eyelids, drooping or crooked eyebrows, improper eyebrow position, and double vision. However, the risk of these complications decreases significantly if you go to a trusted doctor who works with original preparations for the procedure. The reversibility of the procedure also provides a measure of safety, since if any complication occurs, we are well aware that it is a matter of time.

The dose of the product used should be as low as possible, and the intervals between injections should be maximized (the limiting minimum is 3 months from the previous treatment). It is worth remembering this, because falling into the web of “addiction” to the procedure in this case causes the opposite effect over time. Unfortunately, the product will eventually act like a vaccine and cosmetic doses will cease to have the beneficial effect of improving our appearance. This leads to patient frustration and attempts to force doctors to use a higher dose every now and then. It is enough to rationally use the goods that aesthetic medicine brings us, and we will certainly enjoy a beautiful and youthful appearance for years! It is also very important to remember that “botox” is not always the only one in the treatment plan for even facial wrinkles. When dealing with stage III or IV according to the Glogau scale, only combination therapy – a combination of several different treatments in succession – will prove effective.