Botulinum toxin is an injectable neuromodulator designed to decrease dynamic wrinkles. Derived from Clostridium botulinum bacteria, its action involves inhibiting neurotransmission.
Botulinum toxin type A, more commonly known by its brand name "Botox," remains the go-to cosmetic solution, though there are various other products on the market with differing dosage and formulation requirements.
1. Forehead Wrinkles
Botulinum toxin injection has quickly become one of the most sought-after cosmetic procedures https://fa.premiumdermalmart.comhttps://fa.premiumdermalmart.com . Botulinum toxin can provide a safe, minimally invasive, and effective approach for improving glabellar lines, forehead lines and peripheral rhytids. First Used medically as a muscle relaxant, botulinum toxin now commonly used cosmetically helps soften or eliminate wrinkles altogether through weakening or paralyzing muscles and making wrinkles soften or even disappearing altogether.
Since 1989, onabotulinum toxin A (Botox Cosmetic; Allergan of Irvine, CA) was the first injectable neurotoxin approved for aesthetic use by FDA for use against glabellar lines: Dysport by Ipsen Biopharm Limited of Berkshire UK), Myobloc by Allergan and incobotulinum toxin A by Merz Pharmaceuticals Frankfurt of Germany have all received approval to treat this area of concern. All three formulations utilize active components derived from Clostridium botulinum bacteria whereas formulation differences alter how much is released or spreads/duration.
Cosmetic botulinum toxin injection can dramatically diminish glabellar lines and the horizontal forehead wrinkles ("11's") between them. The frontalis muscle (blue) raises the brow to create horizontal forehead lines while corrugator supercilii muscles (yellow) furrow brows to produce vertical "11 " lines between them; orbicularis oculi muscles (green) close eyes to cause crow's feet lateral to them.
Botulinum toxin injections along the convergence between medial and lateral canthus of eyebrows can effectively treat both crow's feet and horizontal forehead wrinkles, providing for more targeted, precise application with reduced side effects or adverse events.
Recent research compared patients according to pre- and post-treatment dynamic wrinkle score using a validated brow positioning score; this demonstrated that botulinum toxin type A treatment along the C-line reduced by 47% the distance between right medial canthus and left lateral canthus from lower brow margin, and distances between both canthuses was reduced by 50% as was their length crease lateral-medial length, as measured using this validated measurement tool.
2. Glabellar Lines
Botulinum toxin A (BoNT) has become an established treatment option for correcting dynamic glabellar lines worldwide, and also used for other facial rhytides like nasolabial folds, chemical browlifting and forehead wrinkles, as well as periorbital rhytides.
Glabellar lines, commonly referred to
as "frown lines," are caused by muscle activity during repeated
facial expressions and are the result of repetitive muscle activity. By
injecting BoNT in this area, muscle relaxation occurs, leading to significant
reduction or elimination of these lines at rest.
Over the years, the primary aim for
treating glabellar lines has shifted away from complete paralysis of muscles
toward dampening muscular activity in order to achieve more subtle effects that
still give the impression of smiling or frowning.
To achieve a more natural-looking
outcome, we offer personalized assessments and injection plans based on
anatomical references during contraction (the One21 technique). At a single
center and using an evaluator-blinded methodology, we conducted a therapeutic
cohort study comparing standard 5-point BoNT-A injection to new One21 technique
treatment with personalized assessment and injection scheme tailored
specifically to glabellar line patterns in 130 patients who presented moderate
to severe glabellar lines. Subjects were evaluated on Day 28 using the
validated MAS grading scale and their photographs blindly evaluated by two
experienced raters. Primary efficacy was defined as any 2-point reduction in
frown lines from T0 (time of treatment) to T28 (4 weeks post treatment).
Results demonstrated that taking a
tailored, One21 injection strategy approach to glabellar lines was more
successful than using the standard 5-point technique. This injection strategy
significantly increased the percentage of subjects who saw at least 2-point
improvement on Day 28 with its application, particularly among those with
asymmetric lines or those who contracted other muscles like orbicularis oculi
or depressor supercilii during their contractions of their glabellar muscle
groups during contractions.
3. Perioral Lines
Botulinum toxin injections have long
been utilized to address lateral canthal lines; however, their use on upper lip
lines hasn't been widely researched. The authors demonstrated in this study
that applying botulinum toxin directly to the perioral area significantly
reduced visibility of these lines; additionally a conservative injection site
and superficial dosage provided satisfactory results.
BoNT works to control muscle
contraction by inhibiting nerve ending release of neurotransmitter
acetylcholine. This disrupts repetitive muscular movements which contribute to
facial wrinkles. For best results, initial treatment should focus on four points
in the perioral area and dose should range between 2 to 4 units of botulinum
toxin per lip quadrant (though some studies recommend up to 15 units).
This procedure can be completed in the
office under local anesthesia, while its authors advise patients to be
counseled carefully regarding desired effects and potential side effects of
this procedure. Furthermore, they stress the significance of selecting an
experienced practitioner to perform it.
Botox injections administered at low
volumes proved successful for treating the lateral canthal lines and patients
were delighted with the results. The authors believe this to be an easy,
minimally risky procedure that provides an alternative to surgical brow lift
procedures or chemical brow lifts. Further, the authors state their optimism
regarding future formulations of BTA, such as those with enhanced diffusion
capabilities and faster onsets of action. These agents would allow simultaneous
treatment of multiple lines and muscles, significantly increasing efficacy
while decreasing injection frequency. Future products could improve handling
during injection, speed up onset of effect time and allow more precise
placement of injection sites. These may include onabotulinumtoxinA (Botox
Cosmetic; Allergan, Irvine, CA), abobotulinumtoxinA (Dysport; Ipsen Ltd
Berkshire UK), and incobotulinumtoxinA (Xeomin; Merz Pharmaceuticals Frankfurt
Germany).
4. Neck Lines
Botulinum Toxin Injection for Neck
Lines Botulinum toxin (BoNT) is an FDA-approved neuromodulator approved for
cosmetic treatment of glabellar lines and crow's feet near the eyes. When
injected, it relaxes the muscles that cause these wrinkles while smoothing
overlying skin - with results usually visible three days post procedure that
last up to several months post administration.
BoNT works by inhibiting presynaptic
release of the neurotransmitter acetylcholine at the neuromuscular junction by
binding to binding sites, leading to loss of muscle tension and temporary
paralysis when injected directly into muscles or surrounding tissue. For
optimal clinical results, injection points must be strategically positioned at
motor endplate zones where minimal-intensity, short duration electrical
stimulation will cause contraction of muscles treated.
Variety of formulations of neurotoxin
can be found, including onabotulinumtoxin A (Botox), abobotulinumtoxin A
(Dysport), incobotulinumtoxin A (Xeomin) and daxibotulinumtoxin A (Daxxify).
Each has their own advantages and disadvantages for use; choosing one depends
on your physician's experience and patient preferences as well.
BoNT can also be used for non-cosmetic
uses, including treating axillary hyperhidrosis, chronic migraine headaches,
cervical dystonia and severe primary axillary hyperhidrosis. Furthermore, this
medicine has been employed in facial plastic surgery procedures such as
chemical brow lifts or treating forehead lines or perioral rhytides.
BoNT holds great promise as an
aesthetic treatment, with numerous studies currently taking place to gauge its
efficacy in other areas, such as thick bands in the neck, gummy smiles, and
chin creases. BoNT can quickly improve facial aesthetics without needing local
anesthesia; patients usually love its results and return for further
treatments; it should also be noted that possible side-effects are rare but
generally mild and short-lived.
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