INTRODUCTION
BOTOX® (Botulinum A) has been used safely by physicians for 20 years to treat patients with certain
medical conditions such as eye spasms, central nervous system disorders and excessive muscle contractions.
The more recent use of BOTOX® to reduce wrinkles was discovered almost by accident. Vancouver dermatologist,
Dr. Alastair Caruthers, began using BOTOX® to treat signs of aging in 1986 after his wife Jean, an ophthalmologist,
observed that her patients who were treated for eye spasm lost their crow's feet. According to Dr. Caruthers,
one patient actually commented that she looked "much happier" and "less angry" because
the BOTOX® also improved the wrinkles between her eyebrows.
Since that time, Dr. Gurney F. Pearsall, Jr. began using BOTOX® injections to reduce horizontal creases
in the forehead, frown lines and other areas of the face. The overall effect of BOTOX® is a relaxed,
smooth appearance. If administered properly, the final result is natural and pleasing to the majority of
patients.
Dr. Pearsall has observed that BOTOX® is most effective in the upper third of the face (eyes and forehead)
but other areas of the face and neck can be treated as well.
BOTOX®, short for Botulinum Toxin A, works by binding to nerve endings and preventing the release
of chemical transmitters that activate muscles. Botulinum toxin therapy is used to paralyze small muscles
of the face which cause frown lines, crow's feet and other wrinkles. It decreases the ability to frown
or squint, thereby preventing the appearance of lines and wrinkles caused by repeated facial expressions.
BOTOX® affects the ability of the muscle to move, but does not impair sensory perception.
How is BOTOX Administered?
An extremely diluted amount of Botulinum Toxin A is administered by Dr. Pearsall in the area where a
person desires an elimination of wrinkles. Dr. Pearsall uses a fine-gauge needle to inject BOTOX® into
the skin and muscle. To treat crow's feet, three injections are given on the side of the face close to the
outer region of the eyes, known as the "orbital rim." Patients should know that injection of BOTOX®
in the orbital rim, reduces, but does not abolish wrinkles in this area. The result, however, is very satisfying
to many people who are self conscious about the appearance of their crow's feet, especially when they smile.
To treat forehead lines, 6 injections are administered over the forehead area. The goal is to weaken,
rather than paralyze the forehead muscle, according to Dr. Pearsall. In certain cases, BOTOX® can be
used to improve the appearance of "laugh lines," the folds in the area between the nose and lips
(naso-labial folds). There is a risk, however, of lip drooping or other unfavorable cosmetic results in the
mouth area when treating the naso-labial folds. The outer portion of the fold is better treated by other
means, such as facelift surgery. Unwanted horizontal lines on the neck, nasal flares and chin creases have
also been treated successfully with BOTOX®. These areas are treated less frequently.
An alternate method of delivery BOTOX® involves the use of a needle, which is connected to an EMG
(electromyography) recorder which guides Dr. Pearsall in locating muscles. An audio signal can be heard when
the probe comes in contact with the most active part of the muscle. While this technique may allow for more
accurate placement of BOTOX®, it can be more painful. Experienced physicians like Dr. Pearsall do not
require the use of EMG.
People who wish to reduce the appearance of wrinkles around the eyes and on the forehead, but don't want
cosmetic surgery are good candidates for this procedure. For this group, BOTOX® is an effective but temporary
treatment. The effect of BOTOX® usually lasts four to five months. However, more frequent treatments
seem to produce a "build up" of BOTOX®. Studies show that individuals who have had at least
five treatments had results that lasted longer.
BOTOX® is not recommended for:
Pregnant women even though there have been no reports of birth defects with its use and women who are
breast feeding. This is because only limited data in this area is available. Persons with neuromuscular
disease, such as muscular dystrophy or generalized movement disorders, may not be candidates for BOTOX®
and should consult their neurologists before being treated. Persons with known allergies to the components
of BOTOX®, such as saline solution and human albumin. Persons such as actors or on-air broadcasters,
for example, who use their face for expressiveness should consider whether BOTOX® is right for them because
BOTOX® has a paralyzing effect on the muscles.
Treatment
Patients who are considering BOTOX® should not take aspirin or any other non-steroidal anti-inflammatories
(NSAID) such as Motrin or Advil for two weeks before treatment. Aspirin can increase the risk for bleeding
and bruising at the injection site. Also be certain to advise Dr. Pearsall of any medications you are taking
and any known allergies.
BOTOX® Injections: Side Effects and Risks
Soreness or bruising at the injection site can occur. Applying ice packs over the treated site before and
after the injections can reduce this problem.
Another side effect when BOTOX® is used around the forehead is eyelid droop, known as ptosis. This
temporary condition occurs in about 5% of patients. It usually appears 7 to 14 days after the injection and
can last 4 to 6 weeks. A more speedy method of treating ptosis is the application of prescription eye drops
(iopidine). In many cases, these drops will help resolve the droop within a few days. Dr. Pearsall is well
aware of this potential side effect and takes all of the necessary precautions to reduce the risk of ptosis.
It is also important for a patient to remain vertical for 4-6 hours after the injection. This allows the
BOTOX® to be taken up in the treated area and reduces the chance of displacement to other muscles. It
is also helpful to contract the treated muscles repeatedly (smile or squint depending on the area treated).
Do not touch the injected sites for two to three hours.
A welcome side effect for some patients is the disappearance of "tension headaches." Researchers
are now experimenting with BOTOX® to determine whether it can help in eliminating migraine headaches
for persons who are affected by them.
BOTOX® can reduce or eliminate wrinkles without surgery. It is a unique treatment because unlike other
non-surgical treatments such as chemical/laser peels and collagen injection, BOTOX® corrects underlying
muscle instead of the skin surface or subsurface.
BOTOX® appears to be a safe cosmetic procedure when administered by a well-trained physician to an
appropriate candidate. In terms of safety, muscle biopsies taken from patients after repeated injections
of BOTOX® have not shown any evidence of muscle weakness or degeneration.
Furthermore, the Food and Drug Administration state that there have been no reports of systemic toxicity
from injections. BOTOX® is recognized by the American Academy of Neurology, the American Academy of Ophthalmology
and the National Institutes of Health as safe and effective.
According to Dr. Pearsall, BOTOX® may be the "ideal cosmetic procedure" because it produces
"dramatic results, has few side effects and is reversible." For persons who are not candidates
for cosmetic surgery or cannot afford it, BOTOX® may provide the solution for their quest for a more youthful
appearance without the risks of other procedures.
