Botulinum and facial fillers

Botulinum toxin and various injectable fillers are used either alone or with face-lift or blepharoplasty surgery as part of a total facial rejuvenation.

BOTOX, or Botulinum toxin Type A, temporarily weakens various specific facial muscles responsible for creating a wrinkle or group of wrinkles.  The best examples are the "you look cross and/or angry" frown lines around the top of the nose and the "crow's feet" or smile lines around the eyes. By weakening these muscles Botox causes the wrinkle(s) to flatten, fade and becomes less noticeable. Botox acts only where injected and very selectively on the treated muscle(s). It does NOT spread anywhere else in the body. It does not freeze the face or the expression. Areas which have been shown to be effectively treated are listed below:

• frown lines
• forehead lines
• crow's feet
• upper lip
• chin
• neck bands

Treatment involves simple and relatively painless injection (said to feel like an ant bite sting). This is performed in the consulting room and requires no anaesthesia. Small bumps and a slight redness due to the injection last about half an hour. Muscle weakness starts only 1-2 days after injection and takes about a week to reach full effect. Muscle function will begin to return after about 3-6 months, but this is often slightly weaker than before. The injections can then be repeated regularly for sustained effect.

Botox is safe provided it is given by an experienced practitioner who has a reputable practice and pharmacy to provide the drug. In the United Kingdom a GMC registered doctor must prescribe Botox before it is given to a patient. Despite widespread use, overdose toxicity has not been reported. Occasionally the local effect in the face can be excessive and temporary problems such as eyelid droop or excess tear formation can occur. Some bruising (especially if you are on aspirin or other blood-thinning drugs) and occasional headache may be experienced for a few days after injection. Pregnant or lactating mums should not receive Botox and anyone with neurological conditions such as myaesthenia gravis should also be cautious.

First used in 1973 for the treatment of squints, Botox has recently been licensed by the FDA for the cosmetic treatment of wrinkles. Botox works by inhibiting the release of acetylcholine, a neurotransmitter, at the junction of the nerve with the muscle. For more information, go to www.botox.com. A good medical reference is: "Consensus Recommendations on the Use of Botulinum Toxin Type A in Facial Aesthetics. Plastic and Reconstructive Surgery. Vol 114, No 6 Supplement. Nov 2004."

 INJECTABLE FILLERS are increasingly popular as they are often used as so-called "office" procedures. They are used to flatten wrinkles or to rejuvenate and enhance lip shape. All of these products have non-permanent effects and are slowly re-absorbed by the body.

Injectable poly-lactic acid, hyaluronic acid.

Skin wrinkles can be filled with off the shelf injectables. Although collagen injections were popular, allergic problems and the fact that injectable collagen was derived from cattle, have led to their decline. The availability of safe, bio-engineered human collagen may change the situation (Isolagen is such a product although I have no experience with this - www.isolagen.co.uk) . Instead I use non-animal derived hyaluronic acid, a naturally occurring substance which forms much of the so-called ground substance which lies between collagen fibres in our skin. This is available as Restylane, Perlane and similar products. It is useful for filling lines around the face. Newfill (poly-lactic acid) is another product which I use and have considerable experience of in treating HIV patients who may get facial lipo-atrophy as a result of their medication (www.new-fill.com).

Fat Injection (Coleman Liposculpture)

Deeper filling may be accomplished with off the shelf injectables or with fat. Areas treated in this way include lips, frown and forehead lines and cheeks. Liposuction is used to safely harvest a small quantity of fat which is then treated and re-injected where needed. As the fat is derived from your own body, there are no problems with allergic reactions or other safety issues. Fat survival at its new site is a little unpredictable and like all injectable fillers, the procedure may require repeating. I currently use the Coleman technique which is associated with more predicatble results.