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Our guide to muscle relaxant treatments for a rejuvenated face.*

Our faces. They’re what the show the world every day, how we express ourselves, and a large part of our identity. A face can look happy or sad, young or old, beautiful or entirely off-putting. So it can come as a nasty surprise when wrinkles start interfering with your most prominent feature. Lines that set in between the brows, outside of the eyes, or by the lips can cause people to have an angry or frowning appearance. They make people look older, sometimes significantly so.

Luckily, there’s now a surprisingly simple remedy to unwanted wrinkles or frown lines. Botox, with its incredible history and wide variety of applications, might be just what you’re looking for. Read on to learn how this king of the injectables came to be, why it’s so popular today, and what you should expect as a patient.

Quick, Easy, and Astoundingly Popular

If you’ve noticed a neighbor, co-worker, or acquaintance suddenly looking years younger with a remarkably wrinkle-free face, there’s a good chance they’ve had Botox injections.

According to the American Society of Plastic Surgeons (ASPS) there were 6.7 million Botulinum Toxin Type A injections performed in the United States last year. This reflects an astounding 750 percent increase in popularity since the year 2000.

In Australia, there were approximately 1.5 million Botox injections given last year. Adjusting for population, this makes the procedure nearly three times more popular in Australia than it is in the United States. Some have speculated that this is due to the average Australian’s extensive exposure to the sun, which can cause a constant squinting appearance.                            

The annual report, released this past February, showed Botox injections to more popular than the rest of the top five cosmetic minimally invasive procedures (soft-tissue fillers, chemical peel, laser hair removal, and microdermabrasion) combined. According to a study from the British Journal of Dermatology, eight in ten patients rated their experience with Botox as “satisfactory” or “very satisfactory” and over three-quarters of patients went as far as to say that they felt “more comfortable with their body” after receiving the treatment.                          

Though the procedure is quite simple, patients report that is can have profound impacts on their lives. Patients often talk about how their self-esteem and body confidence are up after having the procedure. Melissa, a Botox patient in California, is a perfect example.

“I am in my mid-40s and take good care of myself, [but] recently I noticed there were some small facial features that were causing me to look my age…Botox made my forehead lines and small crow’s feet disappear…I look subtly younger and fresher.”                              

A Brief History of Our Favorite Muscle relaxant

Our desire to eliminate wrinkles is nothing new. Remedies ranged from foolish, to painful, to downright bizarre. In the 15th century, women in the Court of the French Emperor Louis XI, believing that chewing caused wrinkles, went on all liquid diets. In the following century, Elizabethan era beauticians prescribed women seeking smoother skin “ceruse,” a mixture of white lead and vinegar. By the 1700s, the crackpot theories were mostly ditched in favor of dark patches, meant to look like beauty marks, which women could stick to their faces in order to conceal blemishes. These asinine wrinkle treatments give us one more reason to be thankful to live in the age that we do.

Though the first strains of what was to become Botox were discovered in 1820 by the German medical officer Dr. Justinus Kerner, it wasn’t until over one hundred years later that scientists recognized its medical potential. Dr. Kerner, investigating a case of “wurstgift” (poisoned sausages) found that the culprit was a toxin known as “botulinum.” At the turn of the century, a Belgian doctor, Emile Pierre van Ermengem (again investigating a food poisoning case) discovered that there were seven strains of botulinum toxin. Through further research, Dr. van Ermengem revealed that four of the types – A, B, C, and D – were toxic, while three more – E, F, and G – were not.

Now you might think to yourself, “What could spoiled German sausages possibly have to do with eliminating wrinkles?” It’s certainly a reasonable question. But here’s the kicker – in the 1950s, scientists discovered that botulinum toxin type A, long thought to be nothing more than a spoiler of European meats, actually had an incredible variety of medicinal applications. Over the following decades, scientists found that its muscle-relaxing effects could be used to treat strabismus (crossed eyes), facial, neck, shoulder, and even vocal cord spasms.

In 1989, after the distribution rights were acquired by the drug maker Allergan, botulinum toxin type A underwent a rebranding as “Botox.” The story may well have ended there, with Botox a successful muscle relaxing agent, if it weren’t for a Canadian ophthalmologist named Jean Carruthers. Dr. Carruthers’ discovered that while treating patients for drooping lids or crossed eyes with Botox, she simultaneously eliminated the wrinkles and frown lines on their faces. In 1992, she and her husband Alistair, a dermatologist, published their findings in the Journal of Dermatologic Surgery and Oncology.

Their findings led to a boom in the new off label use for the injection. By the mid-90s, it was in higher demand than ever and in 1997 there was even a Botox shortage, with demand outpacing supply. Finally, in the early 2000s, the FDA began to approve Botox for the cosmetic uses it was already known for. In 2002 “Botox Cosmetic” was approved to treat “glabellar lines” (wrinkles of the brow), and two years later it was approved for the treatment of “crow’s feet” (wrinkles around the eye).

How it Works

Now that you’ve got a historical context for the popular wrinkle-remover, you may be curious as to exactly how the injection works. Essentially, its mechanism involves tinkering with neural transmissions by blocking the release of acetylcholine at the neuromuscular junction. Botox prevents the presynaptic motor neurons from picking up any acetylcholine.

Translation for those of us without advanced biochemistry degrees?

According to Dr. Arthur W. Perry, MD of Plastic Surgery and author of Straight Talk about Cosmetic Surgery, Botox is best thought of as a “chemical knife.” “Wherever it is injected,” he explains, “the junctions between the nerves and the muscles are destroyed.” This results in a paralysis of the muscles that are contracting and causing the wrinkles. When those muscles cannot be used, the wrinkles cannot be recreated. Over time, the skin will begin to take on a smooth appearance.

Botox is most commonly used to target forehead lines, crow’s feet, and frown and smile lines. Each of these areas work because these lines are predominantly caused by muscles contracting. Other areas that may have wrinkle lines or sagging – for example, the cheeks or neck – cannot be treated as effectively because the creased appearance is due to sun damage or loss of skin elasticity. Sagging can be combated through minor surgical procedures such as lifts.

The amount of improvement that each patient sees varies depending on the factors causing the wrinkles. Boston Plastic Surgeon Dr. Jeffrey M. Darrow explains that the best candidates for Botox are those who have wrinkles only when contracting a muscle (e.g., the raising of the eyebrows causing wrinkle lines in the forehead). For these patients, Botox will cause lines to completely disappear. The treatment may not work as well for patients who have wrinkle lines even while they are not flexing. Since Botox targets the muscle, not the wrinkles themselves, these patients will notice much less of an effect from the surgery.

The Procedure

Prior to receiving Botox injections, it is recommended that patients do not consume alcohol, aspirin, or other anti-inflammatory medications in the weeks leading up to the procedure. Alcohol impedes the body’s ability to heal itself quickly, and aspirins act as blood thinners, making it more difficult for the body to clot bleeding, resulting in increased bruising from the procedure. The Botox procedure itself is a simple in-and-out treatment that typically doesn’t require anesthesia. It can be performed in a doctor’s office. The doctor or nurse will inject a patient with a very fine gauge needle directly into the muscles causing wrinkles. Depending on the size of the area treated, the number of injections will vary. Most patients will experience only minor discomfort during the procedure – some patients have compared it to an ant bite.

In some cases, e.g., patients receiving injections in the palms of their hands or soles of their feet, the doctor may use topical or vibrating anesthesia prior to the procedure. After the surgery, patients can expect to resume their normal day-to-day activities. The key warning that surgeons offer is to avoid rubbing or massaging the treated areas, as this can lead to the toxin spreading to other, unintended regions. Patients are reminded not to engage in vigorous exercise the day of their procedure and to ask their doctor whether painkillers are appropriate for their case.

Within one to two weeks patients will see their treatment begin to take full effect. As the muscles of the face relax, wrinkle lines should substantially subside. Each treatment will normally last anywhere between three and six months depending on a variety of factors including the patient’s age, skin condition, diet and hydration habits, and sun exposure.

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A Word of Warning

One thing that Botox candidates should be aware of is the importance of having the procedure in a professional setting (specifically a doctor’s office) under the care of a trained professional.

Though this advice may seem patronizingly obvious, it is not as common sense as you might assume. “Botox parties,” in which patients, usually women, will include Botox injections as part of a social gathering in a private residence.

These Botox parties, which are also referred to as “plumping parties,” can be attractive for a number of reasons. They’re often cheaper than a visit to the doctor or surgeon’s office.

The parties have a social aspect to them, so what might otherwise feel clinical is a “fun” event. There is typically alcohol involved. But there are a number of even more compelling reasons to skip these parties and have the procedure done under professional supervision.                              

“There are a number of people undertaking injection treatments apparently without supervision – we don’t encourage that at all,” Explains Dr. Geoff Lyons the President of the Australian Society of Plastic Surgeons “Non-invasive procedures like fillers and Botox are considered low risk, but that doesn’t mean no risk. Most risks are minor, but they’re there.”

Horror stories abound – consider the case of two nurses who lost their medical credentials and went on to start a business throwing Botox parties in the United Kingdom. The two men, one of whom went by the alias “Johnny Botox,” staged these events at homes and beauty salons, offering the treatment at half price. Unfortunately, many of these party attendees ended up with migraine headaches and other complications, leading some to speculate whether the substance injected was not up to par.

Dr. Gregory Wiener, a practicing plastic surgeon in the United States, further warned about the dangers of having Botox treatments done outside of a professional setting. “You are not receiving a formal evaluation explaining your facial structure, nor is there any documentation if something goes wrong.” Patients who end up with complications – facial asymmetry, drooping eyelids, and headaches are among the most common – may be completely without recourse, legal or otherwise.

Finally, because many of these parties involve alcohol, it is adding unnecessary risk to what should be an easy and very safe procedure. One of the rules for Botox patients is to avoid alcohol as it inhibits the body’s ability to repair itself. As such, patients who do have Botox treatments while they are drinking are far more likely to have extensive bruising after the procedure.

How to Get Started

To talk about Botox treatment options, give us a call at (02) 4934 1540. Our warm approach, expertise, and state-of-the-art equipment and techniques make us a leader in the industry. In depth one-on-one consultations with Dr. Beldholm will enable you to thoroughly understand the options available to you and determine a course of action that best suits your needs. Allow us to help you attain the shape and size that makes you feel confident and comfortable in your skin. We look forward to hearing from you!

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