BOTULINUM TOXIN (BOTOX)

Botulinum toxin is a substance which blocks certain chemical signals from nerves. Instead of contracting, the muscle stays relaxed thus preventing wrinkles from forming. The doses used in esthetic medicine block the contraction of the muscle at rest, not in movement, to give a natural appearance.

This neurotoxin is produced by an anaerobic bacterium, Clostridium Botulinum which is a natural toxin. Only 2 of the 7 Botulinum toxin serotypes are used in medicine, type A and more recently type B.

As time goes by, muscles tend to become strained and tighten up in contracted position, even at rest. The goal of Botulinum toxin is to reduce the resting tone of these muscles.

Botox allows to smooth out wrinkles created by overactive muscles.

Botulinum toxins type A that are the most used in France are Botox, Azzalure, Vistabel, Dysport, Boccouture, Xeomin, …

• Botox injections have to be performed by a qualified, board-certified plastic surgeon. During the consultation you will be asked about your medical history to detect contraindications (pregnancy, allergies, herpes, neuromuscular disease, recent injections …), you’ll discuss your expectations and the outcomes, and the doctor will evaluate the areas to be treated.
• Before and After comparison photographs will be taken;
• Discontinue aspirin and anti-inflammatory medication the week before the injections.
• No fasting is necessary before the injections.
• Come without make-up (it will be removed before but may be applied after the injections) when possible.
• As the injections are not painful and there is no requirement of local anesthesia in most cases. If required, a local anesthetic may be injected or an anesthetic cream, Emla, may be applied 30 minutes prior to the injections of Botox.

• The injections are administered at the doctor’s practice, except if they are combined with a surgery.
• Dr Vincent Nguyen has developed his own method of injection to obtain the best possible results.
• The amount of Botox needed is determined by the number of areas to be treated.
• Make-up is removed and the areas to be treated are thoroughly disinfected.
• Local anesthetic is applied if required.
• Botox is injected with very thin needles to make the injections painless.
• The treatment lasts 10 minutes to one hour depending on the number of areas to be treated and of other combined treatments such as Hyaluronic Acid injections.

• You won’t feel any pain.
• No need to take time off from work.
• Make-up may be applied immediately after the session.
• Small transient redness, edema, or slight bruising may appear after the injections.
• Avoid lying down or practicing a physical activity 2 hours following treatment.
• Avoid wearing a helmet or a hat for 24 hours.
• Discontinue aspirin-containing and anti-inflammatory medication for 2 weeks after the injections to avoid bruising or bleeding.

Since the effects of Botox are temporary, you get to repeat injections to maintain its results that begin to stabilize from the third session.

The recommended treatment is every 3 to 6 months but the period of time between two sessions can’t be less than 3 months, not to create resistance to Botulinum toxin. There is no defined limit to the number of injections you may have but the body’s immune system may develop antibodies to Botulinum toxin that make the injections ineffective.

Fine lines and wrinkles appear reduced at rest but muscles still contract.

Thus the results will be obvious at rest, even if the wrinkles will be diminished also when the muscle is in action.

In order to treat drooping eyebrows or the corner of the mouth, injections will create a balance between the muscles that lift and those that lower. The treated areas lift in a few days and the face looks more youthfully harmonious.

Botox is injected with very thin needles in the muscle, under the skin. It is a painless procedure.

On the first procedure, you will be given a low dose to see how well the treatment works on you. If the response is positive, the dosage may be increased. It is better to have a less optimal result at the beginning with a dosage that can be adjusted than a “frozen” face.

To have a natural result it is better to treat different areas during the same session: frown lines and forehead, crow’s feet wrinkles, nose wrinkles, …

Since 1975, Botulinum toxin has been used in medicine to treat strabismus in children as well as facial tics and uncontrolled eye blinking (blepharospasm). In France, legal use of Botulinum toxin in medicine got the drug marketing approval by French authorities in 1990 for a few pathologies (ophthalmology, functional reeducation, neurology, ENT, …).

In esthetic medicine, Dr Carruthers was the first to notice that his patients, treated for ophthalmic pathologies with Botulinum toxin, had less wrinkles around the eyes than others. In 1990 a patient asked him to treat her other eye to restore the harmony of her face. It was the first time Botulinum toxin was used in an esthetic treatment.

Botulinum toxin, known as Botox, got the Food and Drug Administration approval in 2002 for its use in esthetic medicine in the USA.

The French authorities in charge of drugs delivered their authorization (AMM) in 2003 concerning the use of Botulinum toxin in esthetic medicine for VISTABEL, AZZALURE and BOCOUTURE.

It is common to combine Botox and Hyaluronic Acid in esthetic medicine for optimal results. The two products potentiate. Deep wrinkles are easier to plump up as they are relaxed by Botox.

It is also frequent to maintain the results of a face esthetic surgery (cervico-facial lift, minilift, face lipomodelling, blepharoplasty) with Botox injections.

In some rare cases Botox is combined with surgery in face esthetic surgery ( cervico-facial lift, neck lift, face lipomodelling, …).

There are many other indications which prove that Botox is very efficient:

• In Neurology: cervical dystonia, writer’s cramp, myclonia (sudden jerky movements), child spasticity (muscular hypertonia), chronic migraine,…
• In Ophtalmology: oculomotor disorders, blepharospasm (eye blinking), hemifacial spasm, …
• In ENT: pharyngeal dystonia, bruxism, …
• In Gastroentorology: achalasia, anismus (defecation disorder), anal fissure, …
• Others: to alleviate watery eyes (hyperlacrimination), sialorrhea (hypersalivation), hyperhidrosis, …

When the skin is too loose and the wrinkles too deep, Botox must be combined with Hyaluronic Acid to plump up the wrinkles. But only surgery can remove excess sagging skin (facelift and face lipofilling).

No other esthetic medicine substance is able to create a Botox-like effect. In esthetic surgery a muscle can be severed to definitively inactivate it, but this is much more invasive.

Yes, it is more and more common to use Botox to prevent aging as it is very efficient. Mini doses of Botox injections can begin before the first wrinkles appear but the treatment prevents wrinkles as long as it is kept up.

There is no age limit. As far as pathologies are concerned, Botulinum toxin is used for kids as well as for seniors without any risk. It is the same as far as esthetic medicine is concerned.