Since its approval for cosmetic use, millions of Botox injections have been delivered for all kind of aesthetic purposes, and it is now considered, by far, the most popular injection in the field of cosmetic and aesthetic medicine. The first aesthetic use of Botox was in 2002 for frown lines, and its used extend to include most of upper face wrinkles corrections. This post will discuss the mechanism of action and the most popular use for Botox injection.
Botox is botulinum toxin type A, which is a toxin produced by bacterial strain. This toxin has a very specific action by paralyzing and relaxing the muscles. To better understand why we use Botox to correct wrinkles and lines in the upper face, we need to understand the mechanism of wrinkle formations. Multiple layers form our skin, and each layer has its function. The Dermis is the middle layer that works as a scaffold for the outer layer of the skin. To be functional, the Dermis contains lots of proteins, namely Collagen and Elastin. The Collagen is our natural fillers, so it is responsible for the volume in our face, and the Elastic is elastic with high recoil properties, so it is responsible for our skin elasticity and the ability to fold and unfold. Our facial expressions are results of contracting and relaxing specific muscles in the face. For example, to frown, we need to contract a muscle called the Procerus, the contraction is usually voluntary and lasts for a couple of second only (at least let us hope so). Muscles are buried deeper under skin layers and attached to the skin through some fibers. Upon contraction, the Procerus muscle will pull the skin medially, and this will form the frown as we know it. Once, we are not angry anymore, the muscle will relax, and the skin will go back to normal due to its elasticity that comes from collagen and elastin. With aging and exposure to different environmental factors such as UV and smoking, our skin loses its ability to procure enough protein and become less full and less elastic. With the unlimited need to frown over the years and decreasing skin ability to unfold (less Elastin) and loss of volume (Less collagen), we start to notice fine lines forming and crawling slowly.
According to what we explain, we can divide wrinkles into Dynamic and Static.
The Dynamic wrinkle is temporary and last only as long as the facial expression lasts. So, if you are angry, you frown, the wrinkles show only for the time you are frowning.
Static wrinkles stay forms over time due to the inability of the skin to unfold as we explained, and they are permanent. Therefore, any static lines or wrinkles started as dynamic. At this stage, we get a client coming and complaining about having feedback from co-workers of looking angry or mean all the time.
So how Botox fits in this puzzle? As you figure out, Botox injection will relax the muscle and reduce our ability to show extreme and frequent facial expression (in this case frowning). This will prolong the time required for the dynamic lines to turn into static deep wrinkles and stop the static wrinkles from getting deeper and bigger.
Therefore, it is recommended to start Botox early while the lines are still dynamic as it is considered more as a preventivemeasure rather than correction treatment. And you guessed right;Botox will not, alone, correct deep static wrinkles, it needs to be combined with fillers for best results. It is important to understand that Botox is not instant nor permanent. It takes two weeks to show the effect and it last 4-6 months.
Botox is most effective in the upper face for one reason, the skin in the upper face is very thin, the muscles are superficial, and except smiling, most of out facial expression are performedthere. Therefore, Botox is mainly used to prevent upper face lines and wrinkles such as frown lines, smile lines, and forehead lines.
The vial of Botox contains an amount of powder, correlated to 100 units, that is dissolved using water for injection to prepare the injection solution. We inject the solution to target specific muscle only without affecting any other muscles. The higher the concentration of the Botox, the lower the risk of diffusion to other muscles and having side effects.
The Botox is priced per unit, the average price of one unit in Edmonton is $10. The amount needed depends on the area treated and patient expectation (how much relaxation needed). In general, upper face treatment required between 30-40 units to cover frown, smile and forehead lines.
Most of the patients concerns are about the safety of Botox. In general, Botox is very safe taking that is injected by experienced medical staff. Most of the complaints about Botox is due to wrongly targeting a muscle during the injection or due to Botox diffusion. Some inexperienced practitioners dissolve the power with a large amount of water as their fingers are not trainer enough to injection small fractions, this large volume will result in Botox diffusion to different muscle and producing side effects such as droopy eyelids or eyebrows. Botox is not permanent, and side effects will resolve over time 2-3 months.
In summary, the take-home message is, start Botox as soon as you notice lines forming and choose wisely when it comes to the clinic or the medical spa. Price is one factor, but it is not everything.
Written by Dr. Kamal Alhalla