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It relaxes the small muscles involved in facial mimicry, and a small dose is enough to make those unnecessary expression wrinkles disappear, which have no function and, above all, are aging. Also, among other common applications, botulinum toxin is a great ally in the treatment of hyperhidrosis. Its use in the field of aesthetic medicine has had several decades of experience with positive results, and although in its beginnings it instilled a bit of fear and an almost excessive respect for the burden of its name -since it is a neurotoxin produced by the bacterium known asclostridium botulinum-, the advances in its handling and the rigorous application protocols have guaranteed its success, with a minimum percentage of side effects or complications.
“It is true that nowadays the toxin can be used wherever there are wrinkles, especially if they are caused by a muscle. You just have to know in which planes and in what dose to apply it so as not to cause paralysis of a functional muscle ,” says Dr. Melvis Anaya, a physician and surgeon from the University of Havana, Cuba, and teaching director of EIMEC. Therefore, depending on the area we are going to treat, what we do is to reduce the amount and the appropriate level so as not to create an adverse side effect. That is why it is a drug known as a neuromodulator, because it causes a denervation or paralyzation of those small muscles, which results in a temporary relaxation of the affected muscles”.
Dr. Anaya in one of her neuromodulator application trainings.
Anaya points out that botulinum toxin has also been used for a long time in other specialties. Blepharospasm, or intermittent contraction of the orbicularis oculi musculature, was the first focal dystonia treated with local infiltration of botulinum toxin. Although it is in the field of neurology where it provides one of its greatest therapeutic benefits, to treat conditions such as dystonia or spastic paralysis. “Precisely from there comes its history in medicine, and later it was incorporated into aesthetics,” the expert adds.
Those surprised faces that characterized an era of the 1990s, with expressionless and unnatural faces, are hardly ever seen anymore, but Anaya confesses that there are still patients who come to the office with some resentment.
“The dosage we use in aesthetic medicine is very low, nothing to do with the dosages used by a neurophysiologist in muscular spasticity. Therefore, the effects are not comparable and it does not cause any complications. In addition, it is a reabsorbable product with very good results,” reinforces Anaya. At the beginning, people were afraid of it because it paralyzed them a lot, left their faces expressionless and it was an effect they did not like. Today, the botulinum toxin treatment is adapted to the patient’s needs, always seeking facial harmony and taking into account that it can be combined with any other esthetic medicine procedure to recover the skin, beautify it and slow down the aging process”.
There is no starting age, assures Anaya, since the treatment can be both corrective of expression wrinkles and preventive, which means that in the world of aesthetic medicine it can be used from the age of 18. “The most common use, and the most demanded, is to relax the muscles that intervene fundamentally in the upper third, which includes the forehead, the glabella or between the eyebrows, and the orbicularis oculi muscle, which are the crow’s feet wrinkles”, details the specialist.
In spite of being a treatment that has been in the portfolio of esthetic medicine centers for years, there are still misconceptions about its application. People confuse botulinum toxin with other types of treatments, such as hyaluronic acid fillers. Why? “It is easy for patients to believe that it is a universal treatment and that it can be used for everything. They confuse the product itself with the application techniques, and therefore it is very common, and wrong, for them to ask for botulinum toxin to give volume enhancement or to make another type of correction. It is important to remember that the products that are going to volumize, generally, are hyaluronic acids, while the toxin treatment is to relax the muscle that causes expression wrinkles to appear. It always acts at a muscular level.
Dr. Lembert in a tailor-made personalized training.
Why does the effect last less time, ask some patients who return to the office looking for a new application of botulinum toxin. The duration of its effects is one of the most recent scientific debates at the door. “Well yes, there is a lot of controversy today with the durability, especially of patient satisfaction, because there are people who have become addicted to this treatment. We would really like its effect to be more prolonged,” says Anaya, and adds: “The patient does not want paralysis, he does not want a mirror effect, but a natural, harmonious look. Therefore, this is achieved by putting less concentration of toxin in the muscle. Although it also depends on the metabolism of each person, people who are very expressive, who do a lot of exercise, because it is metabolized much faster and tends to last longer. There are other explanations in terms of laboratories, detailed in the way they are prepared and so on, but in reality with almost all the types of toxins we currently use, the durability is much less than we would like”.
The antibodies that the body can develop due to the frequent use of the toxin are another of the topics that enter the debate, and Anaya agrees that, of course, there are different causes that can cause the toxin to last less time. “It is a drug, a toxin, and as such the body is going to create antibodies to reject it. That is why one of the things we do in aesthetic medicine practices to prevent this from happening is not to apply it before three months, since during this period the antibodies that generate resistance and work to eliminate the drug are active.”
The side effects of the treatment and the associated risks are very low. “The truth is that there are no serious complications. Effects like any treatment that is done with a needle, because it involves a puncture and, therefore, pain. Whenever we do damage to the skin it can cause erythema, and when working in a vascularized area it can cause a hematoma. But these are very short term. When it causes some other effect, such as asymmetry, it is important to emphasize that it is not because of the toxin, but because of the application technique,” says Anaya, and insists: “It is not because of the treatment itself but because of the technique or the amount of product applied, which may not be correct. This can cause an undesired result for the patient, such as paralysis instead of relaxation, asymmetry or drooping of the eyebrows,” he concludes.
