Botulinum toxin injections

Botulinum toxin (Botox°) is a substance produced by a bacterium called Clostridium botulinum, which is responsible for botulism. It blocks neuromuscular transmission and, at high doses (through ingestion of non-pasteurized or spoiled preserved foods), it can cause death due to respiratory failure.

The development of its laboratory production and the precise control of its mechanism of action are the result of long and costly research carried out in the 1960s. Its first medical use in the 1970s was for the treatment of diplopia in ophthalmology. Observing a reduction in crow’s feet wrinkles in treated patients led to the idea of using botulinum toxin injections as a cosmetic treatment.

Plastic surgeons, who have been at the forefront  of facial wrinkle treatment for decades, ave since  refined  techniques and conducted research to maximize results  in reducing the visible signs of facial aging.

The basis of treatment lies in the fact that certain wrinkles appear due to repeated contraction of facial muscles. By reducing these contractions with botulinum toxin, wrinkle formation is diminished, and, if the skin is not too damaged, wrinkles may even disappear.

The key to successful treatment lies in respecting the muscular balance of the face. Dosage must therefore be precise: sufficient to treat wrinkles, without excess, in order to preserve facial expression and avoid a frozen appearance.

The name Botox is the commercial name of botulinum toxin marketed since 1993 by Allergan laboratories. It is therefore a brand name that has entered everyday language. In 2002, SwissMedic authorized the use of botulinum toxin for aesthetic purposes in Switzerland under the name Vistabel° (in 2003, the Afssaps did the same in France). Other laboratories have since obtained marketing authorization. A parallel market of unregulated products also exists, which is why one should be cautious of prices that are too low and of treatments performed outside authorized medical practices.

As the effect of botulinum toxin is fully reversible within 4 to 6 months, it is preferable to consider long term treatment at a frequency of 2 to 3 sessions per year. Injections are performed using ultra fine needles, making discomfort very tolerable and not requiring anesthetic cream.

After a careful examination and photographic documentation in static and dynamic positions, you are seated in the treatment room. The skin is disinfected and specific injection points are marked. Injections are then carried out with great precision, most often in the forehead, between the eyebrows, and in the area of crow’s feet. Each injection point is recorded on a diagram with the number of units used and the reference of the product injected.

A cold gel and a moisturizing cream are then applied. Since 1993, I have used botulinum toxin marketed by Allergan°, the first product to obtain regulatory approval, which has proven effective in hundreds of patients treated over more than 25 years.

Immediate after effects are very simple. A slight discomfort may be felt for a few days during the very first treatment, but it disappears with habit. This treatment requires no social or professional downtime. For my patients, who are often professionally very active, it truly is a lunch break procedure.

The action of Vistabel° or Botox° is immediate, but the final result stabilizes within one to two weeks. For this reason, a follow up visit during the first month is recommended to assess effectiveness and, if necessary, to add a few units at a specific point. Once the optimal result is achieved, the same doses can be used for several years and further efficacy checks are no longer required.

Occasionally, a small bruise may appear the following day, particularly in patients taking blood thinning medication.

Results are consistently very good for :

• Glabellar lines (frown lines)
• Crow’s feet wrinkles
• Horizontal forehead wrinkles

Results are more subtle but still beneficial for :

• Chin wrinkles and irregularities
• Neck wrinkles and bands
• Marionette lines

Botox can also be used in younger women to lift the outer third of the eyebrows, known as a brow lift.

Intolerance to botulinum toxin is exceptional and presents as lack of effectiveness.

Adverse effects :

Méphisto effect, easily corrected, secondary to muscular imbalance due to hyperactivity of the frontalis muscle.

Ptosis, secondary to diffusion of the toxin toward the muscle that lifts the upper eyelid. It is treated with ophthalmic drops.

These adverse effects are exceptional, if not virtually nonexistent, in experienced hands.

Botulinum toxin injections are contraindicated in patients with neuromuscular diseases (such as myasthenia), certain autoimmune diseases, and are not recommended during pregnancy or breastfeeding.