Botulinum Toxin or Botox

Used since the 1970s by our neurology colleagues for problems such as cervical dystonia or muscle spasticity, and 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 the 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: a gram-positive anaerobic bacillus, of the genus Clostridium) 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 neurotransmitter release by cleaving SNAP-25).

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

Re-innervation of the muscle occurs as nerve endings grow back after three to four months. This is why injections should be repeated every three to four months, the first year and then every six to seven months thereafter.

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

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

Other less-known indications

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

  • 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 platysma muscles tend to contract, revealing their free edges. In early stages, Botox injections help smooth these jowls to provide a neck region rejuvenation.
• Uneven chin contour
• Wrinkles on the lower eyelids

  This injection will be performed only for precise indications. You should discuss this with Dr. Zirak.

• Prevention of aging of the lower third of the face

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

• Prevention of the downward displacement of the lip corners (corners of the lips)

  This injection targets the Depressor Anguli Oris muscle which lowers the corners. Its treatment by botulinum toxin helps prevent "frown lines" and thus a sad look.

• Treatment of bruxism (injection into the masseter muscles).
• Treatment of hyperhidrosis (excessive sweating of the forehead, axillary region, palms or soles)
  In the past, to address this problem we used surgical sympathectomy, not without 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 can reduce the number of migraine attacks in people with 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 migraine surgery.
• Treatment of Verneuil's disease (hidradenitis suppurativa)
  This is a chronic, suppurative and fistulating condition of the pilosebaceous follicles of skin regions containing apocrine glands: axillary hollows, inguinal folds, perineal region, inframammary folds, neck and retro-auricular region. It would be an infundibulofolliculitis followed by occlusion of the apocrine glands. It affects about 1% of the population, most often between puberty and age 40. Contributing factors include smoking, obesity... The treatment can be medical (antibiotics, antiseptic application), botulinum toxin, surgical (resection, skin graft, myocutaneous flap).

Contraindications

• Pregnancy, lactation
• Hypersensitivity reaction to human albumin
• History of neuromuscular disorders (myasthenia, Amyotrophic Lateral Sclerosis …)
• Use of medications that potentiate the toxin's action (quinine…)

Complications

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