Botox Injections

Facial furrows form mainly in response to normal aging (increased by sun exposure), and the pull of underlying muscles. Botox® works by decreasing the pull of these muscles. This allows treatment of some skin creases without surgery.

What is Botox® and How Does it Work?
Botox® is the brand name for botulinum toxin type A, nature's most potent blocker of nerve impulses. Botox® is costly because it is tedious to manufacture and because no generic substitute is available. Botox® partially blocks the nerve to the injected muscle. It takes 3-5 days to notice the effects of Botox®, and the effect lasts 4-6 months. Botox® is a registered trademark of the Allergan Cororation; please visit their website at http://www.botox.com for more details.

Kinds of Skin Creases Botox® Will Improve
Botox® injections are best on the upper third of the face. Forehead lines, furrows between the eyebrows, and lines around the eyes ("crow's feet") respond favorably to Botox®. Frown lines (below the mouth) and chin creases may also be improved with a Botox® injection, but response here varies among individuals. Please visit the first hyperlink below for a detailed and intersting article.

Precautions
A Botox® injection is a medical procedure, and you will be asked to sign a consent form. Injections to the face can be painful, and cause bleeding and brusing. I minimize this by injecting with the smallest available needle (30 gauge). If Botox® migrates to the wrong muscle, drooping of the eyelid or unevennes of the eyebrows may develop. With skilled technique, knowledge of the 36 muscles in the face, and use of electromyography (EMG) when necessary, the chance of this happening is reduced to about one in a thousand.

Very important: Botox® injections are temporary. The effect wears off in about four to six months. If desired, the injection may be repeated, and modified to achieve a different result each time. 

Blockade of Neuromascular Transmission
Binding
 
        
  
Botulinum Toxin Type A binds to the motor nerve terminal. The binding domain of the type A molecule appears to be the heavy chain,2 which is selective for cholinergic nerve terminals.

Blockade of Neuromascular Transmission
Internationalization


Botulinum toxin type A is internalized via receptor-mediated endocytosis,3 a process in which the plasma membrane of the nerve cell invaginates around the toxin-receptor complex, forming a toxin-containing vesicle inside the nerve terminal.4 After internalization, the light chain of the toxin molecule, which has been demonstrated to contain the transmission-blocking domain,5 is released into the cytoplasm of the nerve terminal.4

Blockade of Neuromascular Transmission
Blocking
 
        
Botulinum toxin type A blocks acetylcholine release by cleaving SNAP-25,6 a cytoplasmic protein that is located on the cell membrane and that is required for the release of this transmitter.7 The affected terminals are inhibited from stimulating muscle contraction. The toxin does not affect the synthesis or storage of acetylcholine or the conduction of electrical signals along the nerve fiber.

 Blockade of Neuromascular Transmission
Nerve Sprouting
 
    
Evidence indicates that chemical denervation of the neuromuscular junction by botulinum toxin type A results in an expansion of the end-plate region and growth stimulation of collateral axonal sprouts.1

Blockade of Neuromascular Transmission
Nerve Connection Reestablished


 
A nerve sprout eventually establishes a new neuromuscular junction,1 and muscle activity gradually returns. However, new research suggests that this new nerve sprout retracts and the original junction returns to functionality.9 In either case, repeat injections of BOTOX® Purified Neurotoxin Complex may be required to maintain the desired clinical effect.


 

Botox® is a relatively new procedure using Botulinum Toxin which was developed to treat the visual signs of aging by reducing or removing wrinkles.  The procedure is considered a safe, effective way of treating aging skin.  Common areas for Botox® injections include horizontal forehead furrows, vertical lines between the eyebrows and "crow's feet" around the eyes.  Botox® has proven to be the best non-surgical form of facial rejuvenation and is capable of producing phenomenal improvements in your appearance.

Reasons for Considering a Botox Treatment:

  • Excessive facial wrinkles.
  • Large wrinkles or furrows in your forehead.
  • Small wrinkles or “crow’s feet” around your eyes.
  • A vertical “frown line” between your eyebrows.

General Procedure

The procedure works by altering the facial muscles beneath the skin that are related to wrinkles.  A cream with local anesthetic will be placed on your skin prior to treatment, and ice will be immediately applied upon completion of the Botox® treatment.  Typically a small amount (1-2 cc’s) of Botox® is injected into the area of the wrinkle.  Botox® works by blocking the impulses from the nerve to the facial muscles, thereby relaxing them.  The result is the underlying facial muscles relax and the skin begins to smooth out.  The effects of a Botox® treatment will last approximately three to six months after which the patient may choose to repeat the procedure.

Recovery Process

Patients generally return to their normal activities immediately after the procedure, however following the post-procedure guidelines will dramatically reduce the length and intensity of the recovery period.  Patients should avoid engaging in heavy physical exercise, applying cosmetics, or laying down flat for a minimum of 4 hours after the injections.  It is also advisable to avoid rubbing or massaging the injected area for at least 24 hours.

Michael C. Fasching, MD, operating from his Minneapolis cosmetic surgery offices, has helped  Minneapolis breast augmentation, liposuction, facelift, rhinoplasty, and tummy tuck (abdominoplasty) patients improve their image and self confidence. He treats patients from Minneapolis, St Paul, Plymouth, Edina and throughout Minnesota.

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