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CHAPTER 9 - NON-SURGICAL OPTIONS FOR COSMETIC ENHANCEMENT
There are a number of smaller procedures that are easily performed at the same time as facial and body rejuvenation surgery to complement your overall result. These procedures can also be performed in the office setting independently of a surgical procedure. Many of these procedures and treatments are used by people who are not "ready" for surgery yet or who want to avoid a "surgical" procedure.
Botulinum Toxin
Botulinum toxin was originally used to treat to eye spasms and central nervous system disorders, and since the late 1980’s, it has been used for cosmetic purposes as well as medical therapies. BOTOX® (Botulinum toxin A), a natural purified protein made from Clostridium botulinum bacteria "sticks on" to nerve endings and prevents the release of the chemical transmitters that activate muscles. When injected in very low doses into specific areas of the face and neck, it inhibits the small muscles that cause frown lines, crow's feet and other wrinkles that result from making facial expressions.
Botulinum Toxin treatment weakens muscle activity thereby preventing the appearance of "dynamic" wrinkles that are caused by repeated facial expressions. The toxin acts on the junctions between nerves and muscles, preventing the release of a chemical messenger called acetylcholine from the nerve endings. Tiny amounts of the fluid are injected into a specific facial muscle so only the targeted impulse stops the muscle contractions that are the underlying cause of the unwanted lines. The lines gradually smooth out because of the prolonged relaxation and disuse and the muscle blockade prevents new wrinkles from forming.
Muscles needed for important functions like eating, kissing, smiling, and eye opening are not treated and their continued function helps to maintain a natural look. Only muscles that are treated with botulinum toxin are affected and there should be no effect on skin sensation in the treated areas. Although botulinum toxin injections can have a dramatic effect on dynamic wrinkles, it has no overall effect on the texture of the skin.
We use botulinum toxin most often for treating the creases between your eyebrows and across your forehead, but other areas of your face and neck can be treated. Improvements can be seen in a few days but you may not see the final result for up to two weeks. The effect generally lasts from four to six months with the lines gradually reverting to the pretreated appearance.
Some studies indicate that after multiple treatments, results can last longer in between treatments. Every person responds differently, and different areas may have longer lasting results than other areas. Some people have a lasting partial effect or memory response, whereby the lines and creases never completely return to their appearance before any injections.
First, a thorough assessment of facial wrinkles and creases is performed by examining your face at rest, and then having you perform a number of muscle movements including raising your eyebrows, furrowing your eyebrows, squinting your eyes and wrinkling your nose. The location and depth of creases are noted and symmetry is assessed. Based on this evaluation, we decide which areas to treat and how much botulinum toxin to use in each area.
How do we do it?
We perform the procedure in our office and it takes between 15 and 20 minutes. The skin may be treated 20 to 30 minutes ahead of time with a topical anesthetic. A thin, fine-gauge needle like that used in acupuncture is then used to inject the botulinum toxin through the skin and into the muscle of a specific part of the face.
Crow's feet are treated with three or more injections on the side of the face close to the outer eye area or orbital rim. Horizontal forehead creases are typically treated with 10 to 16 small injections, thereby weakening rather than paralyzing the forehead muscles. The muscles that create the vertical frown lines between your eyebrows are treated with four to six small injections.
Paige's Frown Lines
Paige was someone who would never have elective surgery. As a breast cancer survivor she had already been through a lot. Paige's husband kept asking her if she was angry. She wasn't - in fact, she was quite relieved that her breast cancer was behind her and she could now go on with her life. By the third time he mentioned that she looked mad, she picked up the phone and called our office. The expression her husband was noticing was nothing more than a deep crease between her eyebrows that sent the wrong signal. We treated her with some BOTOX® and her crease relaxed after a few days.. When she came back for her next treatment, about four months later, she told us that her husband noticed a change right away. She had not told him that it was the BOTOX® until he mentioned that she looked "softer" and more "relaxed". Then, she gave away her secret.
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