Botulinum Toxin or Botox

Used since the 1970s by our neurologist colleagues for issues such as cervical dystonia or muscle spasticity, as well as by ophthalmologists for blepharospasm or strabismus, the use of botulinum toxin in wrinkle treatment was approved in 1989 in the United States and in 2004 in Europe.

Repeated contractions of facial expression muscles contribute to the formation of wrinkles. These wrinkles are always perpendicular to the action of these muscles.

Botulinum toxin is an active substance (a natural protein obtained from a bacterium: an anaerobic gram-positive bacillus of the Clostridium genus) that locally reduces the contractile capacity of the muscle by blocking the release of the neurotransmitter at the neuromuscular junction (a light chain of toxin blocks the release of the neurotransmitter by cleaving SNAP-25).

The absence of muscle contraction results in a reduction or even disappearance of expression wrinkles and, ultimately, a smoothing and rejuvenation of the facial skin three to four days after injection.

Muscle re-innervation occurs through the regrowth of nerve endings after three to four months. This is why the injection must be repeated every three to four months during the first year and every six to seven months thereafter.

The best indications are expression wrinkles in the upper third of the face that give a tired, sad, or severe appearance to your face

• Forehead wrinkles
• Frown lines (glabellar lines)
• Crow's feet wrinkles
• Bunny lines (oblique nose wrinkles)

Other Lesser-Known Indications

• Treatment of gummy smile (unsightly gum visibility)
  • There are three types of smiles. Depending on yours, Dr. Zirak will choose the best injection sites to maintain your natural smile but without gum visibility.
  
  • The duration of action is one to three months depending on your muscle tone and the mobility of your upper lips.
  
  
• Treatment of hyperhidrosis (excessive sweating in the axillary region, palms, or soles)
  In the past, to solve this problem, we resorted to heavy surgery (surgical sympathectomy) not without complications (wound dehiscence, infection, seroma). Moreover, rebound sweating (excessive localized sweating in another part of the body) was not uncommon.
  
  • After applying starch and Isobetadine, Dr. Zirak will inject the affected areas under local anesthesia.
  
  • For six to nine months, the treated area will no longer sweat.
   
• Treatment of migraines
  Botulinum toxin injection helps reduce the number of migraine attacks in people suffering from chronic migraines (headaches more than 15 days a month with a migraine on at least eight of those days).
  
  
• Treatment of Verneuil's disease (hidradenitis suppurativa)
  This is a chronic, suppurative, and fistulizing condition of the pilosebaceous follicles in skin regions with apocrine glands: axillary hollows, inguinal folds, perineal region, inframammary folds, nape, and retroauricular region. It is thought to be an infundibulo-folliculitis followed by occlusion of the apocrine glands. It affects about 1% of the population, most often between puberty and the age of 40. Contributing factors include smoking, obesity... Treatment can be medical (antibiotics, antiseptic application), botulinum toxin, or surgical (resection, skin graft, musculocutaneous flap).
  
  
• Treatment of platysmal bands
  The two platysma muscles of the neck tend to contract, revealing their free edges. In early stages, Botox™ injection can smooth these bands to rejuvenate the neck region.
  
  
• Uneven chin appearance
  
  
• Wrinkles on the lower eyelids
  This injection will only be performed for specific indications. You should discuss this with Dr. Zirak.
  
  
• Prevention of aging in the lower third of the face
  Preventive treatment counteracting the action of all muscles that tend to sag the face.

Contraindications

• Pregnancy, breastfeeding
• Hypersensitivity reaction to human albumin
• History of neuromuscular disorders (myasthenia, Amyotrophic Lateral Sclerosis, etc.)
• Taking medications that potentiate the action of the toxin (Quinine, etc.)

Complications

• Pain, rash, local bruising
• Paralysis of adjacent muscle (eyelid ptosis, dysphagia)
• Hypersensitivity reaction