Botulinum Toxin Treatment for Wrinkles

Botox is a purified botulinum. A toxin which is used to block nerve impulses and temporarily paralyse muscles that cause wrinkles. It is widely used now for facial rejuvenation. It treats and diminishes dynamic wrinkles caused by facial movements like frown lines, forehead creases and crow’s feet. It has additional use of reducing prominent muscle bulges under the lower eyelid lashes and creating a lateral brow lift without surgery. It can also be used in conjunction with surgeries like forehead lifts, direct brow lift, facelifts and eyelid surgery to enhance the results. In conjunction with collagen or filler injections, it can be used to reduce deep permanent vertical creases over the glabella frown lines and nasojugal lines (tear trough).

It is a safe and effective treatment, which can be done in the clinic with little or no discomfort in 15-20 minutes (lunch time procedure). Patient can return to their normal routines immediately after the procedure. The most common side effect (<10%) include bruises at localized spots around the eyes due to bleeding from punctured blood vessels and excessive lateral brow kick up or heavy brows or eyelids due to ptosis. These side effects are temporary and can be minimized by careful injections techniques, cold compress during procedure, wide and balanced distribution of Botox around the eyes. Patients are advised to avoid any medication that may lead to easy bleeding like aspirin, cholesterol lowering medication, vitamin E, fish oil products, ginseng or lingzhi for a duration of about 1 week before treatment. There is no known long term side effect on the patient’s health.

The effect of Botox treatment starts to set in after 2-3 days. It achieves the optimal effect after a month and usually last about 4-6 months. 2-3 treatments a year is the optimal frequency to maintain a continuous rejuvenated look.


Botox Treatment for Facial Contouring

Square face is one of the facial features common among Asians. It is characterized by a prominent and broad cheek and angular jaw. The angular shape of the jaw is caused by 2 main factors, a strong and prominent mandibular bony angle and a prominent masseter muscle. To smoothen the contour of the jaw at the angle, conventional surgery to reduce the angle of the mandibular bone and reduction of the masseter muscle is done. This is a complex surgery, which has significant downtime and risk.

Botox can be used to slim down the angular shape of the jaw without surgery by reducing the bulk of jaw (masseter) muscles. Botox prevents the masseter muscle from actively contracting during mastication, chewing or grinding of the teeth unconsciously in the night. By reducing the activity of the masseter muscle, it relaxes and becomes less bulky due to disuse atrophy. The result is a smoother contour of the jawline at the angle. The treatment does not affect normal eating, chewing or swallowing because not the entire muscle is “paralyzed” and there are many other muscles involved in the process eating. In order to maintain the reduction, once or twice a year treatment to the muscle jaw is recommended.



Collagen or Fillers for Facial Soft Tissue Contouring

The most common collagen used today is crossed linked hyaluronic acid, which is manufactured in the laboratory and not derived from the animals. This product is compatible with the body and does not generate any foreign body reaction. It is totally biodegradable and gets absorbed into the body after about a year, thus it is temporary. It is safe and does not have any longterm side effects. The filler comes in various grades of viscosity to suit different applications and locations.

The finer and less viscous filler is used for injection into the middle layer of the skin to smoothen wrinkles or lines. The most commonly used moderately viscous filler is injected into the deep layer of the skin to fill up deep permanent wrinkles or grooves like deep nasolabial groove, deep lines at the angle of the mouth (Marrionette lines), frown lines or forehead creases and vertical lines around the mouth. It may also be used below the skin in soft tissue spaces to augment soft tissue deficient areas like nasojugal groove (tear trough) and nasolabial groove. Lips that are too thin may be augmented using similar collagen injection to give more fullness to the vermillion and white roll with immediate result.

The procedure usually takes about 20-30 minutes as an office procedure. Usually no anaesthesia is required except for lip augmentation where a regional nerve block is used to reduce the pain in some patients. Cold compress is applied after the procedure to reduce the discomfort. For lip augmentation, it is likely the lip will be swollen over the next 24-48 hours due to fluid retention and body inflammatory response to the injection. Cold compress is advised during this period to help reduce the swelling.

Recently, another more viscous filler (called voluma) has been developed to give soft tissue volume enhancement over the face as well as enhancing the facial profile. It is commonly used to augment the flat anterior cheek and lateral cheek, lower lip, chin, and jawline. This is a non-surgical alternative to fat grafting for soft tissue augmentation of the face, which has minimal downtime. The effect is temporary and last about 2 years. It can be repeated for maintenance and there is no known long-term side effect.