A primary expectation from every cosmetic procedure is to produce a natural look. The lively, natural movements of the face should not be abolished during treatment of dynamic wrinkles with botulinum toxin A. Movements of the forehead, elevation of the eyebrows, and the resultant horizontal forehead lines are all part of showing interest in what someone else is saying or doing. These are „good wrinkles“. In contrast, complete ablation of the „angry wrinkles“ or vertical wrinkles between the eyebrows is desirable. Removing them gives the face a relaxed look; we all agree „No one needs to look angry!“.
What is botulinum?
One usually speaks of Botox treatment when talking about treatment with botulinum. The active ingredient, botulinum toxin A, is a natural product produced by the bacteria Clostridium botulinum. This bacterial toxin is used both for medical indications and in aesthetic approaches. It can be administered in minimal amounts directly to targets such as muscles or sweat glands. Botulinum blocks the release of the messenger chemical acetylcholine by nerve endings. Thus signals for muscle contraction or sweat production are not transmitted to their targets - muscles remain relaxed or sweat glands produce no sweat.
I only use the licensed products for treating wrinkles and for increased sweating. Botulinum toxin A has been used medically for over 20 years; thus we have a good feeling for its precise use, action and side effect profile.
What is the procedure?
Botulinum is injected with a very fine needle in extremely low doses into the muscle of facial expression or tissue one wishes to block. Multiple injections are needed to achieve the desired results. The injections are relatively painless and no anesthetic is required.
Initially you notice just nothing! After about 30 minutes the redness and slight swelling around the injection sites disappear. At this point you should use your muscles of facial expression - raise your eyebrows or wrinkle your forehead. But you must keep your hands away from your face - no facial massage or other cosmetic treatments in the first 24 hours after the treatment. The relaxing, smoothening effects begin to appear slowly after 1 week and achieve maximal results after around 14 days. Thus one should wait two weeks before trying to evaluate the procedure. One is most impressed by the results after the first treatment and when looking at the frown wrinkles - one simply cannot frown and look angry any more Those around you will notice a new relaxed person - „You look so fresh and rested“ - but not a treated patient. This pleasant situation last for about 4 months. Then the positive effects begin to disappear and the treatment should be repeated. Regular treatment leads to a permanent smoothening of the facial skin so that wrinkles can no longer appear or progress - this is known as botulinum prophylaxis.
Which combinations are recommended?
Botulinum alone cannot prevent or hide skin aging. After the mid-30s regular skin booster therapy with hyaluronic acid can counter the loss of elasticity and fluid in the skin and thus delays the appearance of aging. The structure and pigmentation of the skin surface can also be improved with fractionated lasers and flashlamps. Eliminating permanent folds, such as the nasolabial folds, or restoring fullness to the corners of mouth and cheeks can be accomplished with the injection of fillers or autologous fat transfer.
What else can one do?
A healthy life style also has a positive influence on the skin. Too little sleep, lots of stress, and too much sun exposure, as well as alcohol and nicotine, all accelerate skin aging and should be avoided as much as possible. In addition good skin care is absolutely essential.
In a personalized consultation, I will be happy to discuss with you which approaches are best for your facial rejuvenation. If you wish, I will be happy to show you examples of before and after pictures from other patients I have helped.