Botulinum Toxin or Botox

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

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

Botulinum toxin is an active substance (natural protein obtained from a bacterium: a gram-positive anaerobic bacillus of the genus Clostridium) that locally reduces the contractile capacity of the muscle via an action 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 leads to a reduction or even disappearance of expressive wrinkles and, ultimately, to smoothing and rejuvenation of the skin of the face three to four days after injection.

The re-innervation of the muscle occurs by the regrowth of nerve endings after three to four months. This is why the injection must be repeated every three to four months, in the first year and every six to seven months thereafter.

The best indications are the expressive wrinkles of the upper third of the face giving a tired, sad or severe look to your face

• Forehead wrinkles
• Glabellar wrinkles (frown lines)
• Wrinkles at the corners of the eyes (crow's feet)
• Oblique nasal wrinkles (bunny lines)

Other less well-known indications

• Treatment of a gummy smile or gingival smile (inesthetic visibility of the gums)
  • There are three types of smile. Depending on yours, Dr. Zirak will choose the best injection sites to maintain your smile natural but without the visibility of your gums.

  • The duration of action is one to three months depending on the tone of your muscles and the mobility of your upper lips.

• Treatment of platysmal bands
  The two subcutaneous muscles of the neck tend to contract, making their free edges visible. In early stages, injection of Botox™ can erase these jowls to provide a rejuvenation of the neck region.
• Uneven appearance of the chin
  
  
• Wrinkles of the lower eyelids

  This injection will be performed only for well-defined indications. You should discuss it with Dr. Zirak.

• Prevention of aging of the lower third of the face

  Preventive treatment countering the action of all the muscles that tend to sag the face.

• Prevention of the downturn of the lip corners (mouth corners)

  This injection targets the Depressor Anguli Oris muscle which lowers the corner of the mouth. Its treatment with botulinum toxin helps prevent "marionette lines" and thus a sad look.

• Treatment of hyperhidrosis (excessive sweating of the forehead, axillary region, of the palms or the soles)
  In the past to address this issue, we used to resort to heavy surgery (surgical sympathectomy) not devoid of complications (wound dehiscence, infection, syndrome). Moreover rebound sweating (excessive sweating localized to another part of the body) was not rare.
  
  • After applying starch and Isobetadine, Dr. Zirak will inject the implicated areas under local anesthesia.
  
  • For six to nine months the treated area will no longer sweat 
• Treatment of migraine
  The injection of botulinum toxin reduces the number of migraine attacks in people suffering from chronic migraine (headache more than 15 days per month with a migraine on at least eight of these days). If the response is favorable, the patient could benefit from a migraine surgery.
  
  
• Treatment of the disease of Verneuil (hidradenitis suppurativa)
  It is a chronic, suppurative and fistulating condition of pilosebaceous follicles of cutaneous regions containing apocrine glands: axillary hollows, inguinal folds, perineal region, inframammary folds, neck and retro-auricular region. It would be an infundibulo-folliculitis followed by occlusion of the apocrine glands. It affects about 1% of the population, most often between puberty and age 40. Contributing factors are smoking, obesity... The treatment can be medical (antibiotics, antiseptic application), botulinum toxin, surgical (resection, skin graft, musculocutaneous flap).

Contraindications

• Pregnancy, lactation
• Hypersensitivity reaction to human albumin
• History of neuromuscular disorders (myasthenia, Amyotrophic Lateral Sclerosis…)
• Medications that potentiate the action of the toxin (Quinine…)

Complications

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