DEFINITION, AIMS AND PRINCIPLES
The botulinic toxin is a substance which decreases the muscle
contraction by acting at the level of the neuro-muscular
jonction (myorelaxing action).
The botulinic toxin, under the name of “BOTOX” received, in
USA, the Food and Drug Administration (FDA) authorization
in 2002 for its use to treat the wrinckles in between the two
In practice, the more usual indications for botulinic toxin
aesthetical injections are the wrinckles between the two
eyebrows, the frontal lines and the crow-feet wrinckles.
The principle of botulinic toxin consists of using its muscular
The main goal, we want to reach, is to obtain a decreased
muscular action at the level of the forhead and the eyebrows ,
in order to decrease either the horizontal wrinckles and the
vertical ones, done by muscles contraction.
Such a use allows to smooth the skin reliefs and so to get a
rejuvenative effect due to the muscular tension release.
From a more global point of view, we must know that the
brow position is fixed by the balance of two opposite forces,
one corresponding to lowering muscles (located around the
eyebrow) and the other one corresponding to one elevating
muscle (the frontalis muscle).
The horizontal wrinckles are due to the contraction of the
frontalis muscle, and the vertical ones are due to the
contraction of the lowering muscles.
This treatment main goal is to improve wrinckles and fine
lines, when in a resting position and not to avoid muscle
contraction. So, the result will be judge especially on the
wrinckles aspect of a quiet face.
Concerning the balance between the lowering and elevating
muscles, the botulinic toxin, by reducing the action of one
muscles group, decrease the wrinckles related to these
muscles and free, at the same time, the action the opposed
muscles : our aim is to treat the muscular balance, in order to
obtain so a facial harmony.
The botulinic toxin treatment must be done and think with
time : so, it is recommand, at the time of the first sesion, to
treat progressively and to avoid the risk of ”doing too much”.
We should prefer a moderately efficient first session then a
too efficient one : so, we don’t think, it is suitable to target an
optimum as soon as the first injection. In certain cases, it can
be necessary to practice several sessions before adapting, for
the best, this treatment potentialities, in respect with patient particularities.
BEFORE THE INJECTING
No need for special preparation.
We must also respect the following contra-indications :
- Certain neuromuscular deseases, like myasthenia
- Pregnancy and breast feeding
- Known hypersensibility to botulinic neurotoxin A or
- Present treatment with antibiotics from the aminosid group (Amiklin, Gentallin)
TYPE OF ANESTHESIA
No anaesthesia is needed
This treatment consists
on a serie of facial
injections. The needle is
fine and the injections are
usually less painful.
The time treatment is a
AFTER THE OPERATION : THE FOLLOWUP
During the two hours following the injections, it is advised
not doing itense sport and not lying down. It is also advised to
avoid facial manipulation or massage for 24 hours following
It is very important to minimize the risks of bruises or
bleeding at the treated area, for 15 days before and after
injections, in order to avoid the injected substance to run
away to muscles around what could produce undesirable side
Usually, the after injection is light. Some slightly swollen
marks may stay for 20 to 30 minutes before disappearing. The
patients can go back to their normal life after the injections.
Some rares undesirables but transitory effects may occur like:
- Redness at the injected points, rarely persisting
more than 3 to 6 days
- Ecchymosis (bruises), rarely observed and may stay
a couple of days
- Edema : a swelling, more often around the eyes,
may appear progressively within 4 to 5 days and
then decrease within a few days or weeks.
- Sensibility failure : an impression of tension or
fixity of the forhead, mouth or neck , depending on
the treated area, as well as a modified sensibility,
related to the feeling of a “cardboard” skin, may
stay for a few days.
- Ocular or facial fugacious pains : such pains have
been described in the treated region but remain
Whatever, if you have any worry in the post injection period, don’t hesitate to contact your physician.
Bruising have settled the final result
will begin to be visible 2 to 3 weeks after the procedure.
The expected result consists of wrinckles decreasing with
small motions keeping; it is obtained within 3 to 15 days
following the injections.
Effects : you can see the result after a few days, but for about
15 days, the effects on the face may be variable (even
sometimes possibly asymetrical) before ending to stabilize.
The result obtained after the first session stays 3 to 6 months
averagely, after what the injection can be renewed.
Injection frequency : the injections have to be done several
times, with space of 3 to 6 months, before getting a quite
Starting after the second injection, the results may stay longer
( 6 to 8 months). It is then suitable to repeat the injections
every 3 to 6 months.
But we recommand never reinjecting after a period of time of
less than 3 months, to avoid, especially, to cteate a resistance
to the substance, due to like “a vaccination effect”.
The result on the face aspect can be stabilized after 3 sessions
but, in certains cases, we may need at least 8 to 10 sessions to
get a quite stable result.
On the other way, we must remark that if we stop injecting,
the treated muscle will go back to its normal function, from
before the injections.
In a few cases, some localized imperfections (persistance of
small wrinckles) may be seen without speaking of real
complication. They depend to the previous aspect of the skin,
already marked with deep indelible “fracture” due to the
oldness of the wrinckle.
It may also exists insufficient or even asymetrical results :
they are related to the fact, we have more or less strong
muscles and often asymetrical too.
These imperfections are usually treated with a complementary
botulinic toxin injection, a month after th injection.
Concerning this, we must underline that if a localized
complementary injection may be indicated to improve the
result, it shouldn’t be done before 15 days after the session
because the balance between the different muscles takes 15
days to set up.
The complications are very rares.
The possible complications are the followings :
- Headache : it can appear after the first injections and
disappear within a few hours to a few days
- Eyebrow ptosis : frontal injection may produce a
slight droping of the eyebrows. This is generally due
to a previous low position of the eyebrows. It will
usually regress within a few weeks.
- Eyelid ptosis : the injection of the glabella region
may induce a partial droping of the upper eyelid
which can stay for 4 to 8 weeks. This is quite rare
(less than 1% of the cases) and always disappear
within a few weeks.
- Smiling and swallowing discomfort : lips injection
may induce a smiling discomfort or small abnormal
movements. The neck injection may produce
- Eye dryness : due to a decrease tear’s secretion,
which can produce a keratis, especially on patient
wearing contact lens (be aware to well hydrate the
- Paradoxical muscle contraction and mimic
disturbance : in the days following injection, the
muscles may present some paradoxical movements
(spontaneous contraction) whithout any gravity.
General complications They are absoluteley exceptional.
- Allergic reaction: cutaneous rash, urticaria, general
- Nausea, vertigo
- Tiredness, fever, flu syndrom
- Skin and buccal dryness