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International Academy of Cosmetic Dermatology


BOTOX® and DYSPORT® are among the commercial trademarks of botulinum toxin, a substance produced by a bacterium. This toxin is harmless and totally eliminated from the organism after a certain amount of time. For many years, it was used to alleviate facial muscles spasms and to correct double vision due to an unbalance of the related muscles, because it is a muscular paralyzing substance that promotes a muscle relaxation.

For rejuvenation, in dermatology, micro drops of botulinum toxin are injected with a very small needle on the muscle that shows a wrinkle. Once injected, the toxin blocks the nerve impulse, preventing it from reaching a specific area.  As a result, it produces muscular relaxation. The wrinkles relax gradually and frequently disappear.  Botulinum toxin’s effect occurs only in the area near the injection site, so that the muscles related to other expressions are not affected. The results are, in general, observed in five days.

Associated pain at the injection site is minimal. The majority of patients compare its sensation to an insect bite.  Local anesthetics are not necessary, but topical EMLA, an anesthetic in cream form, may be used.  The procedures are fast.  The patient can return to regular activities immediately but should not perform any physical effort or make sudden movements of the head for the next four hours.

It is a simple, safe and effective method to improve facial expression lines. The only possible adverse reactions are temporary and located at the injection area. Some patients suffer a temporary contusion at the site of injection that can be camouflaged by makeup.

The most common areas for the use of botulinum toxin are between the eyebrows, around the eyes, along the crows’ feet, at the horizontal expression lines on the forehead, on the outer side of the eyes, at the smile mark, and along the muscular bands on the front of the neck.  Many of these problems are hereditary and all are signs of skin aging.

The effects of botulinum toxin usually persist for about six months before a new course is needed.  With repeated treatments, the length of benefits can be extended upwards to eight months; however, there are individual variations.   Patients in the 65 plus age group often have the effects last longer than in the younger age group.

Botulinum toxin’s advantage is the elimination of wrinkles without the need for plastic surgery or at least for a long time. There are very few restrictions or relative contraindications to the use of botulinum toxin therapy, save for pregnant women and neurological patients who should not use it. To be ready for the procedure, patients must avoid aspirin or medications that contain it.

Marcia Ramos-e-Silva, MD, PhD
Rio de Janeiro, Brazil

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