Non-Surgical Treatments
Botulinum Toxin

Injections of botulinum toxin have been used since 1980 in the treatment of abnormal spasms such as writer's cramp, spasmodic torticollis, etc. but in recent years it has become increasingly popular in the treatment of facial lines and wrinkles. It has recently received a product license for this purpose.

Botulinum toxin is produced by Clostridium botulinum bacteria. There are four commercial preparations of botulinum toxin type A which are commonly used. Botox and Vistabel manufactured by Allergan Inc. in the United States, Dysport and Azzalure manufactured by Ipsen in the United Kingdom. The toxin acts on the junction between the nerves and muscles preventing the release of one of the chemical messengers called acetylcholine from the nerve endings which would normally cause the muscle to contract. If the messenger is prevented from being released this results in weakened muscle activity. When injected in very small quantities into localised areas of the face botulinum toxin Type A will reduce wrinkles and furrows in the skin by weakening the muscle activity responsible for them. It should not obliterate facial expression or stop muscles from functioning but modify expression so that wrinkles are less severe. If muscles are weakened excessively an abnormal appearance will result.

Botulinum toxin type A is most beneficial in the upper third of the face where it is extremely effective in reducing wrinkles and furrows in the region of the brow, root of the nose and Crow's feet area. It can also be helpful in preventing drooping at the corners of the mouth and reducing the visibility of transverse wrinkles in the upper lip. It is used most commonly in individuals aged between 30-50 years though there is no age limit.

In addition to treating facial lines and wrinkles, botulinum toxin is very helpful in preventing excess sweating (technically known as hyperhydrosis). This is especially applicable in the armpit area.

The administration of botulinum toxin Type A is via a series of small injections which cause little discomfort and take little time. For most individuals there would be a delay of 24-48 hours before a reduction in muscle activity is noted but in some it may take as long as a week before it begins to work. The duration of action for most is between 3-6 months. It is helpful to exercise the treated muscles as much as possible for the first hour or two after the injection and, when it is used in the face, not to lie down for 3-4 hours after the treatment.

Complications are extremely rare. Allergy is known but exceptional. The most talked about complication is of weakening a muscle unintentionally, such as the one which opens the upper eyelid, creating a drooping eyelid as a result. Careful technique should avoid this but if it were to occur, it is treatable with eye drops

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