BOTOX® Cosmetic is indicated for the temporary improvement in the appearance of moderate to severe glabellar (frown) lines associated with corrugator and/or procerus muscle activity in adult patients aged 65 years or less.
Frown lines are the result of gathering or pulling the tissue between the eyebrows into a fold. These unattractive folds and furrows are caused by the repeated action of underlying muscles associated with facial expression. Years of squinting and frowning tend to leave deep wrinkles in the skin between the eyebrows and on the bridge of the nose, across the forehead, and at the corners of the eyes. Frown lines produce an angry or sad look that can detract from a pleasant facial appearance.
Dermatologic surgeons can now remedy these wrinkles and lines by a simple injection of botulinum toxin.
What is BOTOX®?
Botulinum toxin type A (BOTOX®) and botulinum toxin type B (MYOBLOC(™)) are purified substances derived from a bacteria that blocks the nerve signals from the brain to the muscle. By injecting very tiny amounts into a specific facial muscle, only the impulse of that muscle will be blocked, causing a local relaxation and weakness. In this way, botulinum toxin acts as a muscle blockade to immobilize the underlying cause of the unwanted lines and prevent “wrinkly” expressions.
Botulinum toxin type A (BOTOX®) has been used since 1980 to treat many muscle disorders, such as lazy eye, and uncontrolled blinking. It was pioneered by dermatologic surgeons for cosmetic use in 1987. The FDA has granted approval to botulinum toxin type A (BOTOX® COSMETIC) for the temporary improvement in the appearance of moderate to severe glabellar vertical lines in adult men and women 65 or younger. The approval specifically applies to the vertical lines between the eyebrows.
Botulinum toxin type B (MYOBLOC(™)) may be employed for off label use in certain cases.
Treatment involves injection of very small amounts of botulinum toxin into the underlying muscles to relax them. The actual treatment is well tolerated and takes just a few minutes with no “down time” or prolonged recovery period.
Botulinum toxin takes effect about 3 to 7 days after treatment. The improvement generally lasts about 3 to 4 months before the effect gradually fades and muscle action returns. It is anticipated that the average patient will require reinjection at various intervals. With repeated treatments, atrophy (thinning) of the muscle may occur which usually produces longer-lasting results.
Botulinum toxin is injected directly into the target muscle to treat vertical lines between the eyebrows and on the bridge of the nose, squint lines or crows feet at the corners of the eyes, the forehead horizontal lines, and the muscle bands often visible on the neck, commonly known as “turkey neck.” Once the muscle is weakened and relaxed, it cannot contract. Since there is no way to make the undesirable facial expression, the lines gradually smooth out from disuse, and new creases are prevented from forming. Other muscles like those needed to raise the eyebrows are not affected; so a natural expression is maintained. Botulinum toxin therapy may be used in combination with other cosmetic skin procedures such as chemical peels, laser resurfacing and wrinkle fillers for optimal results, and to help prevent the formation of new lines and wrinkles. Botulinum toxin is less useful for the smile lines around the mouth because the muscle action in this area is needed for important functions like eating and talking.
Are there any side effects?
Side effects are minimal and typically relate to the local injection. Soreness or mild bruising, while uncommon, may occur around the injection site. Makeup may be worn after treatment, but care should be taken to avoid pressing or massaging the area for several hours. A temporary headache is not uncommon after injections in the forehead area, especially after the first treatment. In rare instances, patients may develop temporary weakness of the neighboring muscles, a temporary droopy brow or eyelid. All of these possible effects are likely to be mild and temporary, and in most cases, do not significantly limit routine activities.
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