Botulinum toxin and various injectable fillers are used either alone or with facelift or blepharoplasty surgery as part of a total facial rejuvenation.

BOTOX©

Or Botulinum toxin Type A, temporarily weakens various specific facial muscles responsible for creating a wrinkle or group of wrinkles. The best examples are the “you look cross and/or angry” frown lines around the top of the nose and the “crow’s feet” or smile lines around the eyes. By weakening these muscles Botox causes the wrinkle(s) to flatten, fade and becomes less noticeable. Botox acts only where injected and very selectively on the treated muscle(s). It does NOT spread anywhere else in the body. It does not freeze the face or the expression. Areas which have been shown to be effectively treated are listed below:

• Frown lines
• Forehead lines
• Crow’s feet
• Upper lip
• Chin
• Neck bands

Treatment involves a simple and relatively painless injection (said to feel like an ant bite sting). This is performed in the consulting room and requires no anaesthesia. Small bumps and a slight redness due to the injection last for about half an hour. Muscle weakness starts only 1-2 days after the injection and takes about a week to reach full effect. Muscle function will begin to return after about 3-6 months, but this is often slightly weaker than before. The injections can be repeated regularly for a sustained effect.

Botox is safe provided it is given by an experienced practitioner who has a reputable practice and pharmacy to provide the drug. In the United Kingdom a GMC registered doctor must prescribe Botox before it is given to a patient. Despite widespread use, overdose toxicity has not been reported. Occasionally the local effect in the face can be excessive and temporary problems such as eyelid droop or excess tear formation can occur. Some bruising (especially if you are on aspirin or other blood-thinning drugs) and occasional headached may be experienced for a few days after injection. Pregnant or lactating mothers should not receive Botox, and anyone with neurological conditions, such as myasthenia gravis, should also be cautious.

First used in 1973 for the treatment of squints, Botox has recently been licensed by the FDA for the cosmetic treatment of wrinkles. Botox works by inhibiting the release of acetylcholine, a neurotransmitter, at the junction of the nerve with the muscle. For more information, go to www.botox.com. A good medical reference is “Consensus Recommendations on the Use of Botulinum Toxin Type A in Facial Aesthetics. Plastic and Reconstructive Surgery. Vol 114, No 6 Supplement. Nov 2004.”

INJECTABLE FILLERS

Are increasingly popular and have become known as “office” procedures. They are used to flatten wrinkles or rejuvenate and enhance lip shape. All of these products have non-permanent effects and are slowly re-absorbed by the body; the effect typically lasts 9-12 months.

Injectable hyaluronic acid Skin wrinkles can be filled with off-the-shelf injectables. Although collagen injections used to be popular, allergic problems and the fact that injectable collagen was derived from cattle, have led to their decline. Instead, I use non-animal derived hyaluronic acid, a naturally occurring substance that forms much of the so-called ground substance which lies between collagen fibres in our skin. This is available as Restylane, Perlane and similar products and is useful for filling lines around the face. New-Fill© (polylactic acid) is another product that I use and I have considerable experience of using it to treat HIV patients who sometimes get facial lipoatrophy as a result of their medication.

Fat Injection (Coleman Liposculpture) Deeper filling may be accomplished with off-the-shelf injectables or with fat. Areas treated in this way include lips, frown and forehead lines and cheeks. Liposuction is used to safely harvest a small quantity of fat, which is then treated and re-injected where needed. As the fat is derived from your own body, there are no problems with allergic reactions or other safety issues. Fat survival at its new site is a little unpredictable and, like all injectable fillers, the procedure may need to be repeated. I currently use the Coleman technique, which is associated with more predicable results.

Dermal grafts Other filling techniques may include using your own dermis (the deeper layer of the skin), which is harvested from old scars, buttock or groin creases, or at the time of facelift surgery, when some of your skin is removed. The dermis can then be threaded into the areas that require filling. Dermal grafts tend to last better than fat injection.

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