Botulinum toxin (Botox) was originally used to treat eye spasms and central nervous system disorders. Since the late 1980s it has been used for cosmetic purposes, as well as medical therapies. Botulinum toxin A, a purified protein made from botulism bacteria, binds to the nerve endings, preventing the release of the chemical transmitters that activate muscles. When injected into specific areas of the face, it paralyzes the small muscles that cause frown lines, crow’s feet, and other wrinkles. Botulinum toxin treatment decreases muscle activity, thereby preventing the appearance of “dynamic” wrinkles that are caused by repeated facial expressions.
The toxin acts on the junctions between nerves and muscles, preventing the release of a chemical messenger called acetylcholine from the nerve endings. Tiny amounts are injected into a specific facial muscle so that only the targeted impulse of that muscle will be blocked, causing a local relaxation. It acts as a muscle block to immobilize the underlying cause of the unwanted lines caused by muscle contractions and to prevent wrinkle formation. Since the muscles can no longer make the offending facial expression, lines gradually smooth out from disuse and new creases are prevented from forming. Other muscles that are not treated are not affected, so a natural look and expressions are maintained.
Botulinum toxins may not be as effective on lines that are not entirely caused by the action of a muscle, i.e. the nasolabial folds that are formed by a combination of muscle action and the weight of sagging skin. Treatment of some areas is less effective because the muscles are needed for expression and important functions like eating, kissing, and opening the eyes.
There is a common misconception that botulinum toxin is a wrinkle filler. Rather, it is a muscle relaxer that gets injected in very tiny amounts into specific muscles to treat and improve lines, wrinkles, and furrows associated with facial expression. Since the advent of botulinum toxin in facial rejuvenation, dermal fillers are used less frequently for the forehead and around the eyes. If the creases between the brows are very deep, a filler may be used to smooth it, but botulinum toxin is usually the first course of treatment. The botulinum toxin in this instance is preventative, and the filler substance is a corrective measure. The brow area is the most common area to treat with botulinum toxin.
Since botulinum toxins have become so popular, fillers are used less frequently for the forehead. If the creases between your brows are very deep, fillers can come to the rescue, but a toxin is usually the first course of treatment. In general, static wrinkles are best treated by fillers, and dynamic wrinkles are handled by toxins.
Botulinum toxin uses
• Vertical lines between the brows
• Lines at the bridge of the nose
• Crow’s-feet or squint lines
• Horizontal forehead lines
• Muscle bands on the neck
• Under eyelid creases
• Uneven eyebrows
• Popply or cobblestone chin
• Chin creases
• Drooping corners of the mouth
• Upper lip lines
• Muscle roll under the eyes
• Décolleté lines
• Migraine headaches
• Underarms, palms, and soles for excessive sweating
Typically the frowning area lasts the longest, whereas areas around the mouth last the least long. The procedure is usually performed in your doctor’s office and takes between 15-30 minutes. First, the skin may be treated with a topical anesthetic, if requested. A thin, fine-gauge needle is then used to inject the Botulinum toxin into the skin and muscle of a specific part of the face. Crow’s feet are treated with three or more injections on the side of the face close to the outer eye area or orbital rim. Forehead creases are typically treated with a series of small injections, thereby weakening rather than paralyzing the forehead muscles. Botulinum toxin can be used to improve the appearance of nasolabial folds between the nose and lips and the fine lines above the lips. Vertical muscle bands in the neck can also be effectively treated with Botulinum toxin.
Botox Cosmetic® (Allergan) was also approved by the US FDA for the treatment of excessive sweating in the underarms, palms of the hands, and soles of the feet. Botulinum toxin is used to block the release of acetytylcholine, the body chemical that regulates sweating.
Currently Botox Cosmetic® (Allergan) and Dysport® (Medicis) are FDA approved for cosmetic use in the United States. Xeomin® (Merz) is now approved by the FDA for treating neurological conditions.
Botulinum toxin basics
Wendy Lewis is a nationally recognized aesthetics consultant and the author of the Vibrant Nation Health and Beauty Guide, Cosmetic Procedures and Plastic Surgery After 50: Expert Advice for Choosing the Best Option for You.