BOTOX OR BOTULINUM TOXIN INJECTION

Botulinum toxin is a substance which decreases the muscle contraction by acting at the level of the neuro-muscular junction, it has a muscle myorelaxing action.

Botulinum toxin has been used since the mid-1970s in ophthalmology and neurology. The discovery of its effectiveness in cosmetic surgery is fortuitous. A Canadian ophthalmologist noted in the early 1990s that the botulinum toxin injected near the eyelids decreased wrinkles around the eyes of his patients.

In cosmetic surgery and medicine, botulinum toxin is used to attenuate: glabella wrinkles (frown lines) wrinkles of the forehead and wrinkles around the eye (crow’s feet wrinkles) (Figure 1).

Figure 1: facial topography of the botulinum toxin injections

The most common indications for botulinum toxin injections are the frown lines, the forehead wrinkles, and the crow’s feet wrinkles.

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The positioning of the eyebrows is the result of a muscular balance between the forehead muscle (which allows raising the eyebrows) and the eyebrow muscles (which make it possible to lower the eyebrows).

Contraction of the forehead muscle causes horizontal wrinkles on the forehead, contraction of the eyebrow muscles causes vertical wrinkles between the eyebrows.

The myorelaxing capabilities of botox will be used. The plastic surgeon will seek to diminish the eyebrow and the forehead muscle functions which will help to reduce the horizontal and vertical wrinkles due to muscular contractions.

The injection of botulinum toxin will allow to smooth the skin and will give a younger aspect by relaxing the muscular tension.

The main objective is to reduce wrinkles and fine lines when the face is at rest, it is not to prevent the contraction of the muscles. Therefore, we seek the attenuation of the wrinkles at rest and not during the facial movements.

The botulinum toxin will modify the muscular balance between the frontal muscle and the muscles of the eyebrows in order to obtain a more harmonious and rested face.

Botulinum toxin treatments should be considered over time: it is therefore necessary to carry out a progressive treatment to avoid an overcorrection. It is then better to have a first moderately effective session than a too effective one.

It is imperative to respect the contraindications linked to botox injections, hence the importance of a detailed examination performed by your cosmetic surgeon:

– Myastenia (neuro-muscular disease) and certain other neurological diseases;

– Pathology related to coagulation;

– Pregnancy and breast feeding.

– Known allergy to botulinum neurotoxin A, albumin serum, or to aminoglycosides (antibiotics: Amiklin, Gentalline).

– Recent taking of anticoagulant, aspirin or any medication likely to cause bleeding.

Most often, there is no need for anesthesia, not even a local anesthetic. A preparation with EMLA (Eutectic Mixture of Local Anesthetics) can be made, but it is mostly useless.

It is better to come to the appointment without any make up.

Avoid taking aspirin or any medication favoring bleeding 10 days before and 10 days after the injection.

The treatment will be performed in the office of Dr. Jean-Charles BAYOL at Laclinic-Montreux, or at the Beauty Suite in Lausanne, (only 30 minutes from Geneva by train).

The procedure consists in several injections with a very fine needle in different points of the face.

A botox injection takes only a few minutes.

Do not lie down in the hours after the injection and sleep in a semi-sitting position on the first night (with 2 pillows).

Do not massage the face where the injections were performed for 3 to 4 days.

The week following the botox injection, it is necessary to strongly contract the muscles which were treated for 1 minute 3 or 4 times a day so that the botulinum toxin can diffuse throughout the muscle.

The daily activities can be normally resumed after the injection.

The secondary side effects:

• Redness: around the injection areas, it disappears in a few days.
• Bruises and swelling: bruising and swelling can occur especially and frequently around the eyelids, they disappear within a few days.
• Sensitivity troubles: the forehead may appear rigid and insensitive, as well as the area around the eyes.
• Pain in the face: felt in places that have received botulinum toxin, this is very rare.

The result of the botulinum toxin injection appears on the third day and is settles between one and two weeks. Wrinkles are attenuated, but do not disappear completely, muscle movements are still possible.

The result after the first session of botulinum toxin injection in Switzerland lasts 4 to 6 months at the end of which one can resume the injections.

To achieve a stable, long-lasting result, botox injections should be repeated with an interval of 4 to 6 months. It is only after the second injection that the result can be more durable.

To obtain a natural result, do not inject botulinum toxin following too short periods of time, at the risk of having a facial rigid appearance, as it is still too often seen in magazines and on television. 4 to 5 months between each injection is paramount to keep a natural result.

On the other hand, if the injection is not repeated, the treated muscle will regain its former appearance.

These imperfections are most often localized: persistence of small wrinkles or deeper wrinkles, asymmetrical result.

Dr. Jean-Charles BAYOL always performs his botulinum toxin injections in two sessions separated by a period of 10 to 15 days. During the second session, these small localized imperfections can be corrected by a complementary injection.

It should be remembered that botulinum toxin attenuates the forehead wrinkles, the one between the eyebrows and around the eyes, but does not completely make them disappear. Additional medical treatment may be carried out secondarily: filling of a residual wrinkle by an injection of another filling product such as hyaluronic acid, resurfacing of the skin by peeling, laser or dermabrasion.

Complications are very rare.

The choice of a qualified cosmetic surgeon, specifically trained in this injection technique, helps to limit the risks without completely eliminating them.

• Localized complications:
  • Headache: it can appear right after the injection, after a few hours or even days. Do not take aspirin to make it disappear, because it promotes bleeding and bruising. In case of headache, paracetamol will be preferred.
  • Sagging of the eyebrows: too important botulinum toxin injection on the forehead will cause a ptosis of the eyebrows. This ptosis will correct in a few weeks.
  • Sagging of the upper eyelid: a botox injection too close to the orbit or a strong massage after the injection may cause a partial ptosis of the upper eyelid that can last 4 to 8 weeks.
  • Difficulty to smile and to swallow: a treatment in the labial region can hinder the smile or cause small abnormal movements. An injection on the neck may interfere with swallowing.
  • Drying of the eyes: A reduction of the tear production by the lacrimal glands. There is a risk of keratitis which can be prevented by applying artificial tears for patient wearing contact lenses.
  • Paradoxical contraction of a muscle and mimic anomalies: in the following days, the treated muscles can have painless paradoxical movements (spontaneous contractions).

• General complications:

They are exceptional:

• Allergic: skin rash, urticaria;
• Fatigue, fever, body aches;
• Nausea, dizziness;
• Mouth or skin dryness.

A botulinum toxin injection is a cosmetic medicine act that most often gives great satisfaction to the patient.

The inconveniences and complications are exceptional.