Botulinum toxin injections

Botulinum toxin is a substance that temporarily reduces muscle contraction by acting at the neuro-muscular junction (muscle relaxant action).
Botulinum toxin under the name BOTOX received approval in the United States from the Food and Drug Administration (FDA) in 2002 for its use in the treatment of interbrow wrinkles or "lion's wrinkles".
The principle of botulinum toxin consists in the use of the muscle relaxation properties of this product. This is not a filling in.
The most common goal is to reduce the action of the muscles located on the forehead and eyebrows in order to reduce both horizontal and vertical wrinkles caused by the contraction of these muscles. This is not a "filling in".
Such use makes it possible to smooth the skin's relief, thus obtaining a rejuvenating effect by relaxing muscle tension and a preventive and protective effect against ageing when the treatment is maintained over the long term.
From a more global point of view, it should be noted that the position of the eyebrows is ensured by a balance between two opposing forces, constituted by lowering muscles (located in the vicinity of the eyebrows) and a lifting muscle (the frontal muscle).
Horizontal wrinkles are due to the contraction of the frontal muscle which is lifting. Vertical interbrow wrinkles are caused by the contraction of the lowering muscles.
The muscles of the temple are responsible for crow's feet wrinkles and their relaxation can lead to a slight rise in the tail of the eyebrows.

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No special preparation is required.
On the day of the injection, you do not need to fast. For women, it is advisable to plan to come without make-up or to remove it before the injections.
It is very important to minimize the risk of bleeding in the treated areas by avoiding taking aspirin for 15 days before and 15 days after the injections.
The following contraindications should be observed:
• Certain neuromuscular diseases such as myasthenia gravis.
• Pregnancy and breastfeeding: being pregnant, even for only a few days, requires that the date of injections be postponed after pregnancy and that breastfeeding be stopped. It is therefore advisable, in case of doubt, to carry out the necessary tests and communicate the results to your doctor.
• Botulinum toxin is contraindicated in cases of known hypersensitivity to botulinum neurotoxin A or serum albumin and treatment with aminosides (family of antibiotics including Amiklin and Gentalline).
A number of precautions must also be taken:
• If you are also treated with botulinum toxin injections for pathological spasms, if you have had an episode of paralysis of the facial muscles, if you have a neuromuscular disease or bleeding disorders, you must inform the practitioner who is treating you for these Botulinum toxin injections. The doctor will then judge with your attending physician whether it is appropriate to inject your person and how to proceed if necessary.
• If you are taking anticoagulant or aspirin or antibiotic drugs before the injections, or if you have any health problems (such as infection, flu, dental abscess, etc.), you must inform your doctor before the injection.
• In general, you should not hesitate to mention to your practitioner any health problems encountered so that he/she can assess the appropriateness of the injections. In the same vein, you must inform him/her of all your questions and mention any processing operations that may have been carried out on you or that are still carried out on you.
TYPE OF ANESTHESIA
As the injections are not very painful, in the vast majority of cases no anaesthesia is necessary.
However, in some very sensitive patients, a superficial anesthetic cream such as Emla may be used.

The main objective of this treatment is to reduce wrinkles and fine lines at rest and not to prevent muscle contraction: the result will therefore be judged mainly on the appearance of the wrinkles at rest. However, it will be possible to observe, in dynamic terms, an attenuation of the contraction power of the targeted muscles, without them being "paralysed" if the patient does not wish it and the doses have been well adapted.
With regard to the balance between the lowering and lifting muscles, botulinum toxin, by attenuating the action of a group of muscles, reduces the wrinkles caused by these muscles but releases the action of the antagonistic muscles: the aim is to treat the muscle balance and thus obtain a harmonious face.
Botulinum toxin treatment must be designed and managed over time: it is therefore important to treat gradually and avoid the risk of "overdoing it" during the first injections.
It is better to have a moderately effective first session than too effective: it is therefore not desirable to want an optimal result from the first injection. Product can always be added if the effect is insufficient, while it cannot be removed if it is considered excessive.
In some cases, it may be necessary to perform several injection sessions before the product's possibilities can be best adapted to each patient.
The treatment will be carried out in the practitioner's office or in a clinic according to the choice and habits of the doctor.
This treatment consists of a series of facial injections. The needle is thin and the injections are usually painless.
The duration of the treatment is about a few minutes.
During the two hours following the injections, it is recommended that you do not do intensive sports and do not lie down.
It is also advisable to avoid facial manipulations or heavy massages as well as wearing a helmet/ cap/hat that is too tight within 24 hours of the session.
It is very important to minimize the risk of bruising or bleeding in the treated areas during the 15 days before and after the injections (in order to limit the risk of leakage of the product to the peripheral muscles, which could lead to unwanted effects).
In addition, during the three days following the injections, it is advisable to contract the muscles injected three times a day for about 5 seconds per muscle.
Usually, the consequences of these injections are simple. A few slightly swollen marks remain for 20 to 30 minutes and then disappear. Patients can resume their normal activities after the injections.

The result is a reduction in wrinkles with a retention of small movements: it is obtained three to fifteen days after the injections.
Effects: the results are visible after a few days but for about 15 days the effects on the face can be variable (even asymmetric at times) before finally stabilizing.
The result obtained after the first session lasts on average 3 to 6 months at the end of which the injection can be repeated.
The purpose of these injections is to improve, not to achieve perfection. If your wishes are realistic, you should be very satisfied with the result.
Frequency of injections: injections should be given several times with intervals of 3 to 6 months in order to obtain a certain stability of the result. From the second injection onwards, the results can be more durable (6 to 8 months). The injections should then be repeated every 3 to 6 months.
However, it is recommended never to bring the injection sessions closer than 3 months to avoid creating resistance to the product by a "vaccine effect". The appearance of the result can be stabilized beyond 3 injections but in some cases, at least 8 to 10 injections should be used to achieve some stabilization of the result.
On the other hand, it should be noted that the action of the toxin remains temporary if the injections are stopped even after several years of treatment, the treated muscles regain their normal function before the injections.

About Botulinum toxin injections

Headaches: they may be present during the first injections and disappear after a few hours to a few days.
Eyebrow ptosis: forehead injection can cause a slight lowering of the eyebrows. This descent is usually due to the fact that the eyebrows were already in the low position before the injection. This slight lowering of the eyebrows usually subsides within a few weeks.
Eyelid ptosis: injecting the lion's wrinkles can cause a partial fall of the upper eyelid that can last 4 to 8 weeks. It is rare (less than 1% of cases) and always disappears after a few weeks.
Smile and swallowing discomfort: injection into the lips can cause discomfort to the smile or small abnormal movements. The injection in the neck may cause difficulty swallowing.
Muscle contraction: in the days following the injection, the treated muscles may present some paradoxical movements (spontaneous contractions) without gravity.
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