The most important clinical feature of skin aging is wrinkles. Volume loss and natural skin thinning are seen in the skin due to the decrease of collagen, hyaluronic acid and elastin over time. This dermal atrophy process is accelerated by the influence of external factors such as sun exposure and smoking. In addition, hyperdynamic facial muscles contribute to the formation of visible lines and wrinkles. Initially, lines and wrinkles appear during active facial expressions such as anger and laughter. These are known as dynamic lines. After a certain time, these lines turn into static, that is, permanent lines, which are also seen at rest.
Botox Usage Areas
Botox was approved as a treatment by the FDA (American Food and Drug Administration) for adults aged 18-65 years with moderate and severe dynamic glabellar, that is, frown lines between the eyebrows (2002).
Botox was approved by the FDA for the treatment of primary axillary hyperhidrosis (excessive sweating) (2004)
Other FDA-approved uses: blepharospasm (blinking excessively) (1989), strabismus (strabismus) (1989), treatment of chronic migraine (2010), cranial (intracranial) nerve VII disorders (1989), cervical dystonia (curvature of the neck) (2000), upper extremity spasticity (excessive contractions) (2010),
Other cosmetic uses: Reducing upper and lower face, neck and chest wrinkles, facial lifting and correcting facial asymmetries.
Effect Mechanism
Botox is a protein obtained from the bacteria Clostridium botulinum. When a small amount of botulinum toxin is injected into the muscles, the target is chemical conduction interruption due to the suppression of acetylcholine release at the neuromuscular junction, and skin wrinkles are smoothed out in the treated area.
Basic and Advanced Applications
Basis
With Botox, the best response is obtained and the least side effects are seen in the upper part of the face, in areas with hyperdynamic, that is, very active muscles (frown lines, crow's feet and horizontal forehead lines).
The application of Botox treatment in the lower part of the face is known as advanced application. This region is very active and in addition to facial expression, the lower facial muscles play an important role in chewing and speaking. The toxin should be administered in low doses, leaving a partial functionality in the muscles, as it requires more practical application ability in the treated muscles of the lower face.
Patient Selection
The best responses with Botox treatment are obtained in patients with dynamic wrinkles and static, that is, no or minimal wrinkles. Therefore, it is recommended to start Botox at the beginning of the 30s, before wrinkles appear.
In patients with static (not deepened) wrinkles, the response develops slowly and after two or three consecutive treatments, the best response is obtained due to the cumulative effect. Deep static (settled) lines may not respond to botulinum toxin therapy alone. These patients should be combined with treatments such as fillers or skin resurfacing for best results.
Products
For glabellar region muscles, the FDA has approved two botulinum toxin serotype A products. These products are onabotulinmumtoxinA (OBTX) (Botox Allergan, Inc, Irvine, CA) and abobotulinumtoxinA (Dysport Medicis Pharmaceutical Company, Scottsdale, AZ).
Contraindications (Do Not Do)
Pregnancy or breastfeeding
Active infection in the treatment area (eg, herpes simplex, pustular acne, cellulitis)
Hypertrophic or keloidal scar tissue
Bleeding disorder (thrombocytopenia, use of anticoagulants)
Impaired wound healing (due to immunosuppression)
skin atrophy
Active dermatosis (psoriasis, eczema) in the treatment area
Sensitivity or allergy to botulinum toxin components
Milk allergy with ababotulinumtoxinA products
Major muscle weakness in the treatment area (polio, Bell's palsy)
neuromuscular diseases
Inability to actively contract the muscle in the treatment area prior to treatment
Eye or eye surgery performed in the last 6 months (LASIK, blepharoplasty)
Drugs that inhibit neuromuscular transmission and increase the effects of botulinum toxin
Uncontrolled systemic conditions
People who need the perfect facial expression (actors, artists)
Advantages
A technically simple method in a short treatment time
Safe and effective, especially in the upper face area
High patient satisfaction
Results and Follow-up
2-3 days after the Botox treatment, partial loss of the function of the treated muscles, and after 1-2 weeks, the maximum loss is experienced. The effects are most evident in the treatment of dynamic lines. Static lines respond more slowly and better results can be achieved with several consecutive treatments or with accompanying minimally invasive aesthetic interventions (dermal filler) and reshaping procedures.
If the desired loss of muscle function is not achieved, correction can be made 2 weeks after the procedure. The botulinum toxin retouch dose depends on the residual muscle function in the target muscle.
The results of Botox treatment are not immediately noticeable in the lower part of the face, but more dramatic changes are observed in the upper part of the face. Minimal or more in the mouth for the desired aesthetic effect on the lower face More functional changes can be seen.
Muscle function in the affected area returns after 4-6 months, depending on the dose applied, the area of application and the patient's physiology. When the muscles in the treated area begin to contract again, it is recommended to perform the next application before the facial lines return to their original state.
Botulinum Toxin Treatment in Multiple Facial Areas
Botulinum toxin treatment in the upper third of the face can be safely and easily combined with treatment of the lower face in one visit.
Let's look at the myths about botox applications in order to ensure that the right decisions are made by accessing real information,
Botox Indications (Confirmations)
Botox was approved by the FDA as a temporary treatment for adults aged 18-65 years with moderate to severe dynamic glabellar (between eyebrows) frown lines (2002).
Botox was approved by the FDA for the temporary treatment of primary axillary hyperhidrosis (excessive sweating) (2004)
Other FDA-approved indications: blepharospasm (multiple involuntary blinking of the eye) (1989), strabismus (1989), cranial nerve VII disorders (1989), cervical dystonia (2000), upper extremity spasticity (2010), chronic migraine prophylaxis (2010) .
Other cosmetic uses: Reducing upper and lower face, neck and chest wrinkles, facial lifting and correcting facial asymmetries.
1- Is Botox snake venom?
No. Botox is a drug. It is a natural, purified protein-based medicine produced from a special bacteria.
2- Is Botox safe?
Yes. Botox is a drug approved by the Ministry of Health in Turkey and in more than 70 countries in the world, and over 2000 scientific studies have been made. It has been used for 20 years. Millions of people prefer these applications with confidence every year.
3- How many months is the effect of Botox application?
The effect of BOTOX may vary from patient to patient and depending on the dose applied, the average duration of action is 4-6 months. The effect of the drug begins to appear 2-3 days after the injection, it is fully manifested in 1-2 weeks.
4- As Botox is repeated, does its effectiveness decrease?
Although it is theoretically possible to develop antibodies against Botox, no antibody development against Botox has been detected so far in facial aesthetic applications that reduces clinical effectiveness.
5- Since the production process of Botox has been changed, does the effect not last as long as before?
There has been no change in the production process of Botox. For many years, high-tech production has been carried out in accordance with the same standards, FDA and European Drug Administration criteria.
6- Is Botox application painful?
Before this application, the application area is anesthetized with local anesthetic cream, so the injection is quite painless.
7- What should be considered after Botox application?
There may be temporary sensitivity, swelling or bruising on your skin after the application, but this does not prevent you from returning to your social life. Make-up should not be applied for 12 hours, and hot environments such as direct sunlight, Turkish bath, sauna, solarium, steam bath, hot shower should be avoided for 2 weeks.
8- It is said that facial expression disappears when Botox is applied, is it true?
No, this is not true. This is an application that takes place under the control of the physician and at the request of the patient. It is possible to both remove wrinkles and use mimics with the applied dose and region selection.
9- Will my wrinkles get worse if I do not continue Botox applications?
No. Your wrinkles will gradually return to their pre-treatment state.
10- Are Botox and dermal fillers used for the same purpose?
BOTOKS is used for dynamic, dermal fillers for static (settled) wrinkles and face shaping. Their mechanism of action and application areas are different from each other. A patient may need both Botox and dermal fillers. Dermal fillers consist of a natural substance, hyaluronic acid.
11- Is Botox used on lips?
No. BOTOKS is used in dynamic wrinkles. Dermal fillers are used to plump the lips.
