Botulinum Toxin (Botox/Dysport)

Botulinum toxin: the treatment that we know and love (or do not know and fear)

Botox injections are now widely known for the ability to reduce the appearance of facial wrinkles, although there is usually a lot of misinformation regarding this excellent treatment. It is a treatment with many applications in medicine as well as in many different specialties. Botox (Botulinum toxin) injections are used in dermatology for cases of excessive sweating (hyperhidrosis) as well as for relaxing the muscles in the face to smooth out fine lines and wrinkles (wrinkles correction), which is the most common application.

The applications of botulinum toxin type A as it has prevailed from the brand name of the first preparation in Medicine are many: in blepharospasm (or eye twitching), muscular torticollis, muscle dystonia etc. In Greece, there are 2 formulations of botulinum toxin type A, the Botox by the company Allergan and Dysport by Ipsen. Similar to Botox is Bocouture by Merz with fewer drug units, while Ipsen that is manufactured Dysport has also released Dysline in fewer drug units.

Any doctor chooses the preparation that is going to use depending on the application (patient, anatomical area, etc.), but all preparations in the hands of an experienced doctor are safe, reliable and effective. The result depends on many parameters: the dilution, the quantity, the injection site, the depth of injection, the good maintenance of the drug, the season, etc. For example, Dysport has a stronger effect in young patients, in men with stronger muscles, in large or strong muscle groups such as neck, glabella, etc. When we want a more targeted action or assess a risk of blepharoptosis (droopy eyelid), the Botox in small dilution is a safer choice. However, both Dysport and Botox are considered safe and effective for the temporary treatment of moderate to severe wrinkles.

In which areas Botox/Dysport is applied?

The application of Botox/Dysport is not a panacea for all wrinkles, but it is an excellent treatment for the forehead wrinkles and the wrinkles that are formed in the outer corner of the eyes (crow’s feet). There are also some other areas that is applied, such as the wrinkles that are formed on the nose of some people when they laugh (bunny lines), on the neck and lower jaw for the correction of the facial contour; in superficial microinjections for fine wrinkles on the cheeks and other areas depending on the case. It can also be applied for the lifting of the nose tip, on the eyebrows for the lifting of the eyelids, in hypertrophic masseter muscles and rarely in the treatment of bruxism (teeth grinding).

What should we expect from the Botox/Dysport treatment?

Botox/Dysport is injected with a very fine needle into the desired areas. As the needle is so fine, the pain associated with the injections is minimal.

Any Botox/Dysport application is individualized and the patient should discuss with her/his doctor about the result that she/he aims for. It is possible to simply "rest" a face maintaining the muscle mobility and not to give the impression of "frozen" facial features.

In my own practice I always use smaller doses during the first application and see the patient again in 15 days and fill in where it is needed. I should emphasize here that the complementary follow-up is necessary to ensure a good result as minor defects can be effectively corrected and the treatment fully satisfies the patient.

Many people hesitate to try the treatment fearing that their facial expressions may change, their eyebrows may be raised and the Botox/Dysport application may be noticeable by their friends. Another reason to fear the treatment is the misperception that they get worse after the Botox treatment fades away. This is totally untrue. The treatment is fast, without side effects, with predictable results and excellent response. In my opinion, it is the most value for money treatment for ages 35-60. At younger ages we have the best results. As the rejuvenated skin is in harmony with the rest of the face even if no other treatment is applied. It also acts as a deterrent to the wrinkles formation, not only because the muscle that causes them does not contract, but also because the patient learns how to limit the involuntary movement.

The treatment results are not immediately visible as it takes 3-4 days for the botulinum toxin to act and is completed in 2 weeks (where any corrections are made). After the application, the patient should avoid massaging on the injection site during the same day as well as the contact with heat (hair dryer on the forehead, sunbathing, facial steaming, sauna, etc.) for 3 days, as the toxin is inactivated with the heat and its activity is reduced. The exercise is allowed from the next day.

Botox/Dysport application is not the appropriate treatment for all types of wrinkles. Expression wrinkles disappear completely while those that are already "written" (such as between the eyebrows that some people have very intense wrinkles) become fainter. As the muscle does not "crumple", the wrinkle stops deepening, so the treatment acts as prevention in their creation.

Contraindications - Side Effects – Duration of Botox/Dysport Treatment

The treatment may be applied to men and women and there are no contraindications except for a rare disease that is called myasthenia gravis (MG). Allergies are practically unlikely to occur and the duration of botulinum toxin’s action lasts for around 5 months. There are some side effects that may occur such as upper eyelid heaviness that causes drooping of the eyebrow, eyelid drooping (less often) or abnormal eyebrow raising. However, the experienced doctor knows exactly how to avoid or correct them if they rarely occur. A small percentage of patients may experience headache for the next 1-2 days after the application that subsides with simple pain relievers (or painkillers).

There are no side effects during the application unless a small bruise is rarely caused (that it may be covered by concealer) and the patient can resume to his/her daily activities right after.

In some areas of the face where the expressions are very frequent (e.g. eyes), the treatment may need to be repeated earlier. The results from Botox do not last the same period of time in every person, as it takes a different time interval for each person to reconstitute the receptors that are blocked by the drug. On average, if we want to maintain the treatment result and at the same time to prevent the wrinkles formation, we need to repeat the treatment 3 times a year.