Wrinkles (rhytides) are partly due to the contraction of underlying muscles and partly
due to a loss of elasticity, thus paralyzing the muscles with the toxin will reduce wrinkles.
The effect of toxin A on glabellar lines was noted incidentally when it was used
therapeutically for strabismus and torticollis, and it subsequently gained FDA
approval specifically for the treatment of glabellar lines. There is extensive use in cosmetic
surgery for a wide variety of indications, generally in an ‘off label’ manner, as
the indications for which the toxin is specifically licensed are fairly limited. Botulinum
toxin is also used in conditions such as dystonias (blepharospasm and hemifacial
spasm) or hyperhidrosis (excess sweating) in the axilla or face (Frey’s syndrome).
The commonest areas treated with botulinum toxin are shown in Table 1.
Other areas include: lower and upper eyelid wrinkles, circumoral lines (orbicularis
oris), nasal lines (nasalis), marionette folds or drooping labial commissure, chin folds
or cobblestone chin (mentalis), platysmal folds or turkey neck, and decollete folds.
The toxin (about 5U per site for Botox—more is needed in men due to greater
muscle mass) is injected into muscle; some use EMG guidance. The action is delayed
for 1–3 days because the toxin needs to be internalized and cleaved to take effect. The
effects peak at 1–2 weeks and last for 8–12 weeks (if boosted, effects may last up to
9 months and may be due in part to muscle atrophy).
due to a loss of elasticity, thus paralyzing the muscles with the toxin will reduce wrinkles.
The effect of toxin A on glabellar lines was noted incidentally when it was used
therapeutically for strabismus and torticollis, and it subsequently gained FDA
approval specifically for the treatment of glabellar lines. There is extensive use in cosmetic
surgery for a wide variety of indications, generally in an ‘off label’ manner, as
the indications for which the toxin is specifically licensed are fairly limited. Botulinum
toxin is also used in conditions such as dystonias (blepharospasm and hemifacial
spasm) or hyperhidrosis (excess sweating) in the axilla or face (Frey’s syndrome).
The commonest areas treated with botulinum toxin are shown in Table 1.
Other areas include: lower and upper eyelid wrinkles, circumoral lines (orbicularis
oris), nasal lines (nasalis), marionette folds or drooping labial commissure, chin folds
or cobblestone chin (mentalis), platysmal folds or turkey neck, and decollete folds.
The toxin (about 5U per site for Botox—more is needed in men due to greater
muscle mass) is injected into muscle; some use EMG guidance. The action is delayed
for 1–3 days because the toxin needs to be internalized and cleaved to take effect. The
effects peak at 1–2 weeks and last for 8–12 weeks (if boosted, effects may last up to
9 months and may be due in part to muscle atrophy).
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