Botulinum toxin is a protein that disrupts the transmission of a nerve impulse from a nerve ending to a muscle. Normally, when an impulse is transmitted, acetylcholine is released at the point where the nerve ending connects to the muscle. This is the "intermediary" that causes muscle contractions. Bubbles of acetylcholine approach the outer sheath of the nerve ending. To release acetylcholine, the vesicles must unite with the membrane. For this to happen, you need a complex of proteins – SNARE.

Botulinum toxin penetrates the membrane of the nerve ending and "cuts off" certain proteins. Which – is determined by the type of botulinum toxin. In our case, this is a type A toxin that attacks the SNAP-25 protein. That is, the SNARE complex immediately becomes defective, and without it, the vesicles with acetylcholine are not able to combine with the cell membrane. Therefore, they remain inside the nerve ending. As a result, although the nerves send signals, the muscles do not contract. The muscle into which the injection is made relaxes, the skin straightens without the effect of tightening, wrinkles disappear.

Pros and cons of application in cosmetology

Before understanding the advantages and disadvantages of botulinum therapy, it is important to understand botulinum toxin – what is it? When it enters the digestive system, this neurotoxin causes severe damage – botulism.

In aesthetic medicine, purified from impurities and specially prepared botulinum toxin type A is used. This is the strongest muscle relaxant, a substance that relaxes muscles. With it, you can remove wrinkles even on the most delicate areas of the face – for example, around the eyes.

The advantages of Botox injections include:

Fast correction of wrinkles;
Painlessness;
Increase skin elasticity;
The ability to raise eyebrows and eyelids;
Smoothing small scars;
The speed of the session (10-15 minutes);
Affordable price of the procedure;
Almost instant results.

In some cases, botulinum toxin injections help to correct the contours of the face and make it more harmonious by removing asymmetry. If, for example, the drug is injected into the eyebrow area, the look becomes more open and expressive.

Such "beauty injections" are given with syringes with very thin needles, so for most it is a completely painless procedure. But for patients with a low pain threshold, cosmetologists can offer local anesthesia in the form of a cream. After injections, as a rule, no discomfort occurs.

One of the main advantages of Botox therapy is its quick effect. Patients see the final result in an average of 7-10 days. If the wrinkles are deep, it will take longer.

In addition to the advantages, this technique also has disadvantages:

Temporary action;
Side effects due to incorrect dosage or lack of experience with the doctor.

Although Botox does an excellent job with wrinkles, it won’t be possible to say goodbye to them for a long time – everything will return to its place in 3-5 months, when the drug is removed from the body in a natural way.

It is imperative that the doctor who performs the procedure is competent enough. If you calculate the dosage of botulinum toxin incorrectly or make a mistake with the injection site, this can lead, for example, to facial asymmetry.

Mechanism of action

Botulinum toxin is a neurotoxin. It blocks the release of acetylcholine, which is involved in the transmission of nerve impulses at neuromuscular synapses. Thus, if the nervous system sends a signal to the muscles, it does not reach the point of application. Therefore, the muscle remains in a relaxed state. Local administration of a substance in small concentrations allows you to achieve relaxation of certain muscles. That is why botulinum therapy with spasticity allows you to achieve a positive result.

The direct action of botulinum toxin is to influence the motor and parasympathetic nerve fibers. Acetylcholine is blocked, does not leave the presynaptic part of the neuron, so the transmission of the nerve impulse becomes impossible. The introduction of Botox and other drugs into the muscle leads to a decrease in the cross section of muscle fibers and the number of myofilaments. Thus, the volume and strength of the muscle are reduced. This process is reversible.

The indirect action of the substance is also described. At the level of the central nervous system, botulinum toxin leads to inhibition of alpha motor neurons, normalizes reciprocal inhibition between antagonist muscles (flexors and extensors). This allows you to deal with such a phenomenon as skeletal muscle dystonia.

The analgesic effect of drugs for botulinum therapy was also revealed. This property was discovered by accident when using the toxin for anti-aging purposes. Doctors noticed that botulinum therapy for migraine reduces the intensity of pain, so they began to actively study this property. To date, it has been proven that BTA has an analgesic effect in dystonia, spasticity, tension headache, lockjaw, migraine, and chronic pelvic pain. This is explained by several theories. The first is the decompression of pain receptors due to the elimination of muscle spasm. The second is the normalization of contraction of muscle spindles. The third theory is to reduce inflammation of a neurogenic nature.

Indications

Among anti-aging procedures, botulinum therapy in Moscow is one of the most prescribed and widely known. There are many indications for it. The main ones are wrinkles in the area:

forehead and bridge of nose;
nasolabial folds;
lips (on the sides);
chin.

Doctors achieve the best results in the upper part of the face. However, when prescribing a procedure, cosmetologists take into account that the corrected areas may differ in appearance from intact ones, so they often use the “whole face" method.

The use of botulinum toxin in cosmetology is also relevant for:

strands on the neck;
age-related changes in the decollete zone;
fuzzy oval of the face, its asymmetry;
the presence of wide wings of the nose and its lowered tip;
uneven location of the eyebrows;
excessive sweating.

In order to clearly understand whether such a procedure is suitable for you, you need to make an appointment with the beautician of the Seline clinic.

Contraindications

The list of conditions and diseases in which doctors do not recommend the use of botulinum therapy of the lower third of the face or another area differs depending on the drug used. However, general contraindications to botulinum therapy can be identified:

the period of waiting for the birth of the baby and his breastfeeding;
oncopathology;
inflammatory reactions and/or rashes in the area to be corrected;
hyperthermia;
allergic reaction to protein, botulinum toxin and other components of the drug;
blood pathology.

In some cases, you will be asked to wait, in others – to use an alternative method of rejuvenation and treatment.

Preparations for botulinum therapy

In modern cosmetology clinics, the following preparations for botulinum therapy are used:

Xeomin ("Xeomin"). Does not contain any protein compounds, which reduces the risk of allergies and side effects. The agent acts locally, only on the desired muscle, so after the injection, natural facial expressions are preserved, the face looks alive. Well smoothes horizontal wrinkles on the forehead, in the area between the eyebrows, corrects the lower third of the face. Due to the unique composition, it is not addictive. The effect after application lasts for 3-4 months.
Dysport ("Dysport"). The composition contains stabilizing proteins, therefore, in patients prone to allergies, an acute immune response may develop after injections. This is an analogue of Botox, but Dysport acts faster, so fewer injections are required per session, which is a definite advantage. The drug smoothes mimic and age wrinkles, helps to get rid of hyperhidrosis, chronic migraines.
Botox ("Botox"). The composition includes botulinum toxin with associated proteins and stabilizing proteins, so an acute allergic reaction may develop after administration. Botox contains the highest concentration of ona botulinum toxin. Best of all, the tool is suitable for correcting the line of the eyebrows and corners of the eyes. The effect lasts for 3-6 months.

Areas for use in cosmetology

What results can be achieved with therapy?

Clear facial contours (Nefertiti Lifting);
Getting rid of forehead wrinkles, wrinkles between the eyebrows, crow’s feet, wrinkles on the back of the nose, "purse-string", bags;
The shape and corners of the lips;
Neck rejuvenation;
Removal / correction of scars;
Reducing sweating;
Elimination of gingival smile;
Eyebrow lifting.

1) Periorbital zone (crow’s feet and eyebrows) –

The main indications for the use of botulinum toxin in the periorbital zone are: elimination of crow’s feet, hypertrophy of the lower eyelid, narrow palpebral fissure, the need to raise the eyebrows. Wrinkles in the periorbital zone are formed as a result of 3 combined causes: aging of the body, photodamage to the skin, and repetitive contractions of facial muscles.

Injection technique –
for this zone, usually 3 injection points of the solution, located at a distance of 1.-1.5 cm from each other, are usually sufficient. To determine the points, the patient is asked to squint. The injection sites should be 1 cm away from the edge of the orbit (moreover, the tip of the needle during the injection is directed in the opposite direction from the orbit). The introduction of the solution should be carried out superficially, the tissues should be relaxed. Before inserting the needle, it is desirable to stretch the skin, which will allow you to see the location of the blood vessels and reduce the risk of developing a hematoma.

In this case, all injection points should be strictly above the zygomatic bone in order to avoid the drooping of the corner of the mouth. Clinical studies on the effectiveness of 4 different dosages of Botox to eliminate wrinkles in the corners of the eyes showed that the optimal dose is 12 IU on each side. With the first use of Botox, the effect lasts a little less than after repeated courses. If, in addition to dynamic wrinkles, there are also static wrinkles in the corners of the eyes, then it is best to combine Botox injections with chemical peeling methods or light methods (for example, laser skin resurfacing).

If there are indications for injection into the region of the lower eyelid (to increase the height of the palpebral fissure), then the needle is injected 3 mm below the ciliary edge, along the middle pupillary line, and the dosage used should not exceed 2 units on each side so that sagging of the lower century (the latter will give your eyes a sad look).

Eyebrow Botox –
for eyebrow lifting, injections are carried out at the points: under the outer third of each eyebrow (2.5 units on each side), as well as in the muscles that lower the eyebrow located on the side of the nose (4.0 units on each side). If you need to increase the arched curve of the eyebrows, then Botox injections are placed in the frontalis muscle in the region of the extreme thirds of each eyebrow. This causes the frontalis muscle activity over the middle third of each brow to remain, while the lateral portions of the brows droop slightly (this effect can improve the appearance of women with flat brows).

Side effects –
local side effects include: soreness, swelling, hemorrhage at the injection site, redness of the skin. In rare cases, swelling of the lower eyelid may occur, which is especially typical for patients prone to the appearance of edema under the eyes (in this case, additional relaxation of the muscles will further disrupt the lymph flow). The most serious complications in this area relate to excessive relaxation of certain muscles. For example, with relaxation of the lateral rectus and internal oblique muscles of the eye, diplopia (double vision) may appear, the infraorbital part of the circular muscle – lagophthalmos or ectropion, hernial protrusion of infraorbital fat packages.

Rarely, increased dryness of the eye may occur due to a decrease in the secretion of lacrimal fluid. This complication is not typical, but temporary additional moistening of the eye with special drops may be required. In addition, if the injection points are too low (at the level of the zygomatic bone), then temporary paralysis of the zygomatic muscles is possible and, as a result, a drooping of the corner of the mouth occurs. Depending on the number of units, this effect can last from several weeks to several months. In patients with thyroid pathology, Botox can cause proptosis of the eyeball.

2) Botox injections in the forehead –

Forehead wrinkles are formed as a result of active movements of the frontalis muscle, for example, if you often wrinkle your forehead. Botox injections can help you get rid of these wrinkles by making them look smoother. However, in some patients, the constant contraction of the frontalis muscle is associated with ptosis of the eyebrows, i.e. their omission. Such patients try to keep their eyebrows raised, trying to compensate for their low position by tension of the frontalis muscle. And such patients already require more radical methods than botulinum toxin injections, for example, surgical brow lift.

Technique of administration –
selection of the number of units should be carried out in such a way as to try to maintain some activity of the frontalis muscle and at the same time reduce the severity of wrinkles. How many units of Botox are needed per forehead: 30-40 units of Botox are usually used to treat the forehead of a man, 25-30 units for women. This number of units can be distributed over 12-14 needle injection points (2 units per injection point). Sometimes the procedure is divided into 2 sessions: at the first stage, the main part of the total dose is distributed over the upper 2/3 of the forehead, after which the patient is asked to come back in 2 weeks in order to carefully work out the lower part of the forehead, while maintaining the desired position of the eyebrows.

How much does Botox cost on the forehead: the price at the rate of 1 unit = 300 rubles will be about 7,500 rubles for 25 units, and 12,000 rubles for 40 units

Difficulties that can be encountered –
performing botulinum toxin injections in the frontal region is not as simple a procedure as it might seem. This is due to the fact that the shape of your eyebrows can change dramatically. For example, the brows may lose their arched arch, or the arch may become more pronounced (which adds a feminine touch to a man’s face and looks quite ridiculous). Therefore, before starting injections, you need to decide whether you want to increase the severity of the arched bend of the eyebrows, or make the eyebrows more horizontal.

In addition, it is necessary to take into account the anatomical shape of the forehead and the location of the eyebrows above the upper edge of the orbit, because. low-set eyebrows can move down even more. In the latter case, it is necessary to inject botulinum toxin only into the upper part of the forehead. In addition, not only the wrong choice of injection points can lead to drooping of the eyebrows, but also simply an excessive injection of Botox units. Thus, the main dangers are: 1) undesirable shape of the eyebrows, 2) drooping of the eyebrows, 3) sagging of the eyelids, 4) no visible effect.

The lower part of the frontalis muscle controls the position of the eyebrows, therefore, to prevent their lowering, it is forbidden to inject into the area 1 cm above the eyebrows, and in the area another 1 cm above – do this with great care, choosing the correct dosage of Botox units. Therefore, patients with wrinkles in the lower forehead should be warned that such wrinkles cannot be completely eliminated by botulinum toxin injections alone, and additional injection of dermal fillers may be required.

Greater care must be taken with patients with low-set brows and/or excess skin on the eyelids. excessive injection of botulinum toxin units and incorrectly chosen injection points can lead to even more drooping of the eyebrows and / or drooping of the upper eyelids. Therefore, with excessive development of the skin of the eyelids, it is first recommended to do blepharoplasty, and only at the second stage, botulinum toxin injections to the forehead area.

3) Botox between the eyebrows –

According to the instructions of the Botox preparation and the FDA recommendations in the interbrow area, it is recommended to make 5 injection points – with a total dose of 20 IU. At the same time, in women with well-developed muscles in the interbrow zone, an effective dose can be 28 IU. At the same time, other well-known authors (for example, Baumann L.) recommend injections in women only at 3 points: alternately into the lower part of each “muscle that wrinkles the eyebrow”, as well as into the proud muscle. At each point, 0.1 ml of the drug is injected, containing from 4 to 6 IU of Botox. This dosage preserves the natural look.

As for men, the traditional starting dose is 40 IU. In rare cases (in very large men with pronounced muscles of the interbrow area) – the dosage can reach 60-80 units. However, a number of scientific papers show that in the absence of pronounced muscles of the interbrow region and the need to maintain a natural look in men, a minimum dosage of 20 IU can also be used, although in this case the effect of therapy will be less long-lasting.

Botox: video before and after injections

Complications –
it must be taken into account that injections of botulinum toxin into the area between the eyebrows can lead to some lifting of the inner and middle part of the eyebrows. In general, complications in this area do not occur often (provided that the doctor has good knowledge of the anatomy of the glabellar complex of the muscles of the interbrow). If eyelid ptosis (drooping of the eyelid) occurs, the patient is prescribed eye drops with phenylephrine or apraclonidine, which will allow the upper eyelid to be raised when it is lowered.

How to behave after the procedure –
after the procedure, it is important that the patient does not lie down for 4 hours, maintain an upright position, and actively contract the muscles between the eyebrows 1 time per minute for 2 hours. This is necessary for better penetration and binding of botulinum toxin to acetylcholine receptors.

4) Nasolabial folds –

It should be borne in mind that botulinum toxin is not a filler, and therefore it does not allow you to make the nasolabial folds less deep. However, it is used in situations where the patient has a significant contraction of the nasal muscle, the muscles that raise the upper lip and the wing of the nose, which leads to a strong elevation and deepening of the nasolabial folds during facial movements. To reduce their depth, 2-4 units of Botox are enough on each side. 1 or 2 injection points are performed along the nasolabial fold (needle injection points are located at the level of the lower third of the back of the nose).

Important: the lower third of the face is much more difficult for botulinum therapy, because. the introduction of toxin in the region of the orbicular muscle of the mouth can lead to a violation of its function (including difficulties in eating and drinking), asymmetry in the position of the corners of the mouth, and other disorders. Nevertheless, a number of highly qualified specialists successfully use Botox injections to eliminate vertical wrinkles of the upper and lower lips, as well as wrinkles at the corners of the mouth, called “puppet wrinkles”.

Possible Complications

Two decades of observation by clinicians prove that botulinum toxin therapy has a high safety profile. Complications are extremely rare. They are few and completely reversible. Possible side effects are divided into general and local reactions.

Common complications are due to the immune response. These include:

anaphylactic shock;
generalized weakness;
flu-like syndrome;
vegetative dysfunction – salivation, pressure decrease.

Local reactions include:

pain, swelling at the injection site;
ptosis of the upper eyelid;
dry eyes;
lowering the inner or lateral angle of the eyebrows;
pseudohernia of the infraorbital region;
transient diplopia;
swallowing disorder (when correcting the neck zone);
weakness of the upper lip;
headache;
facial asymmetry.

Exceeding the dose of botulinum toxin can cause the effect of a mask-like face. Long-term use of BTA in high concentrations and without interruptions is fraught with the formation of resistance to treatment.

The likelihood of complications depends on the knowledge of the methodology and the skill of the doctor, as well as the patient’s ignoring the recommendations during the recovery period.

Recovery after botulinum therapy

Compliance with the recommendations of a cosmetologist is a necessary condition for a quick recovery and maximum aesthetic effect. The rehabilitation period after the procedure takes 1-2 weeks. After the procedure it is recommended:

for 2 days, exclude face down slopes and drugs that affect blood clotting, do not use decorative cosmetics;
within 2 weeks, avoid ultraviolet, thermal exposure, excessive physical activity, give up alcohol and smoking.

If adverse reactions occur during the recovery period, consult a doctor!

Taking some antibiotics, physiotherapy (microcurrents, massage) reduce the duration of the drugs. The course application of botulinum therapy will help to effectively cope with the first signs of aging and maintain youth for a long time.

The main questions of patients after the procedure –

When Botox starts to work –
if you are injecting for the first time, the process will be gradual and can take up to 2 weeks (i.e. only after 2 weeks you will see the final result). After undergoing a second course of injections, Botox rises much faster – about 2-3 days.
How long does Botox last –
there is no exact answer to this question for several reasons. For example, it depends on the total number of units to be delivered. It also depends on the degree of dilution. For example, if you take the same amount of Botox units in a solution of 0.05 and 0.1 ml, then in the first case the effect will last longer. This is due to the fact that, firstly, the concentration of the toxin in this case in the solution will be higher, and secondly, the same amount of ED will be injected into each needle injection point, but a smaller amount of solution, which will lead to less diffusion (spread) solution in tissues. In addition, it depends on the implementation of the doctor’s recommendations after the procedure.

Post source: www.9linesmag.com