Botulism toxin has been in use for medical purposes for approximately twenty years. Initially it was used in the fields of ophthalmology, for the treatment of blepharospam (tremor of the eyelids), neurology for the treatment of neuromuscular diseases, and in otolaryngology, for the treatment of facial nerve disorders. It was during its use for facial nerve conditions, that physicians first realized that the botulism toxin improved the appearance of certain facial wrinkles. During this time it has proven to be an extremely safe product for both cosmetic and non-cosmetic purposes. To date, there have been no systemic reactions or allergies to botulism toxin.
A discussion of Botox® would be incomplete without an introduction to facial wrinkles. There are two types of facial wrinkles, dynamic and static wrinkles. Static wrinkles are those caused by a combination of gravity and loss of skin elasticity and are typically located in the lower third of the face. Dynamic wrinkles are those wrinkles caused by the activity of the facial muscles. Typically, these wrinkles are located in the upper third of the face and include the horizontal forehead wrinkles, the wrinkles in between the eyebrows (known as glabellar wrinkles), and those around the eyes (known as crows feet). Dr. Bustilllo believes that these wrinkles are best treated with Botox, which acts to relax the muscles that produce them. Additionally, Dr. Bustillo may use Botox for other uses. For example, the eyebrows may be elevated or downward slopping lower lips may be straightened with Botox injections.
Botox® and Dysport® are considered a minimally invasive procedure for facial rejuvenation. There are no absolute contraindications to the use of Botox® or Dysport.
Botox® and Dysport® are indicated for dynamic wrinkles of the face. When Botox® or Dysport® are applied to the area between the eyebrows, the resultant elimination of the wrinkles gives a vibrant appearance. In addition, this may provide a browlift for certain patients. Its application in the forehead area will help to smooth out the horizontal wrinkles. When placed in the area of the crow’s feet, it acts to smooth the skin around the eyes.
Botox® and Dysport® can be combined with other cosmetic procedures for an improved appearance. The use of Botox® or Dysport® does not preclude surgical procedures, such facelift or eyelid surgery. In fact, the application of Botox after these procures will help to enhance the appearance. This is because those surgical procedures do not typically treat the wrinkles amenable to Botox® or Dysport® treatment.
Typically, Botox® or Dypsort®® is an injection that is administered using small needles that are as thin as a hair. This allows for a relatively fast and painless injection. After the injection, the skin area is cooled with a small packet of ice to help reduce local swelling. The swollen area typically returns to normal in two hours.
Patients typically can return to normal activity, such as work on the same day. However, patients are asked to refrain from exercise the same day. The effects of Botox start to become apparent in five to seven days. Occasionally small touch ups may have to applied in the second week to perfect the appearance. Dr. Bustillo does not charge patients for touch-ups.
Treatments Botox® and Dysport® usually last about four to five months. As the patient continues to use Botox® or Dysport®, the time between the treatments may sometimes increase. This may be because the patient subconsciously learns not to use the specific muscles treated. This in turn, leads to improvement of the wrinkles with less Botox® or Dysport®.
Dr. Bustillo believes that a natural appearance should be maintained when treating patients’ facial wrinkles. There is a fine line between applying too much Botox and “freezing” someone’s expression. You will never see high arched “peaked” brows coming from our office. That is not how we do it.
Repetitive muscle contractions in the upper face can cause permanent wrinkles. Typically, these form in three areas. The glabellar lines (vertical lines between the eyebrows also known as the “11”), the horizontal forehead wrinkles, and the crows feet on the outer corners of the eyes. Other areas that can also be treated with Botox, are the vertical lip lines, the horizontal neck bands (not all patients are candidates for these), and droopy outer corners of the mouth. As we age, the skin becomes thinner, making these wrinkles more noticeable as the muscles contract.
Botox and Dysport work by relaxing muscles, so that their mobility is decreased. This loss of mobility smooths the skin overlying the muscles, thus effacing the wrinkle.
The procedure is performed in the office. Acupressure is performed by an assistant to decrease sensation on the face while Dr. Bustillo injects the Botox using very small needles. The procedure typically takes and few minutes. Patients can return to normal activity after without any restrictions. Patients are typically seen about one to two weeks later for a touch up, which is included in the cost of the procedure. Patients should avoid blood thinners a week before to avoid bruising. While most patients do not bruise, it is best to avoid having Botox right before an important event.
Dear Dr. Bustillo & Bridie, Thank you for the expert and professional care I received during my recent surgery. You were both so helpful in giving me peace of mind about something I was very nervous about. Even more importantly, I am sure your expertise will result in a very positive outcome as I further heal. Best regards.
What are Botox® and Dysport®?
Botox® and Dysport® are both botulinum toxins, each made by a different company. They are a sterile, purified protein that is produced in the laboratory from the bacteria Clostridium botulinum. Dr. Bustillo administers Botox® injections to treat dynamic wrinkles of the forehead, glabella, and the crow’s feet. Botox® has been used in the medical field for more than 25 years with a very good safety profile. It was actually first used to treat spasms in patients who had facial paralysis.
How does it work?
When injected into the muscles responsible for wrinkles and creases, Botox® temporarily weakens or relaxes the muscle. The wrinkles caused by the excessive contraction of the facial muscles disappear.
Who is the best candidate for it?
Good candidates for Botox® include men and women who are physically healthy, realistic in their expectations, and interested in improving the appearance of forehead creases, glabellar lines and crow’s feet. Botox® may not be appropriate for individuals with certain neuromuscular disorder like ALS, myasthenia gravis or Lambert-Eaton syndrome.
Where is the procedure performed?
Dr. Bustillo performs the Botox® procedure in the office. The procedure typically takes about 10 minutes to perform.