Wrinkle Treatment and Applications
It has been shown clinically that the duration of action increases when the injections of wrinkle treatment are performed at regular intervals. Botulinum A toxin injections are the most commonly applied cosmetic procedure in the USA. The first use on humans was carried out by Dr. Alan Scott in 1980 in the field of strabismus treatment and blepharospasm. The first studies on the use of wrinkle treatment were published in 1992 by Carruthers et al. The area they first applied was between the eyebrows.
Wrinkle Treatment Mechanism of Action
The toxin consists of 1295 amino acids and two disulfide bonds as 97 kDa (heavy chain) and 52 kDa (light chain).
The heavy chain allows penetration of the light chain into the cell fluid by binding to the membrane of the nerve cells, and the light chain prevents the transport of acetylcholine vesicles into the cell by binding the protein called SNAP-25. As a result, no neurotransmitter release occurs in the synaptic space and presynaptic nerve block is formed.
Wrinkle treatment does not affect the skin injected directly. It prevents the contraction of the muscle which causes a wrinkle in the skin and starts to show its effect.
Clinically, it begins to effect on the 2nd day after wrinkle treatment and it reaches maximum effect in 2nd -4th weeks. The beneficial effects of wrinkle treatment last about 3-6 months and this period varies from person to person. All effects of wrinkle treatment take much longer to disappear completely, but these effects are not visible but clinical effects.
It has been clinically shown that the duration of action increases as wrinkle treatment is performed at regular intervals.
Wrinkle treatment does not completely paralyze the muscles but causes a loss of strength, and this loss of strength is sufficient for the desired cosmetic result.
To sum up the conditions in which wrinkle treatment can be used;
Facial wrinkle treatment (face and above lips)
Treatment of hand and armpit sweating (duration of action varies between 12-14 months if done properly)
Migraine treatment (duration of action varies between 10-14 months if done properly)
Neck wrinkles and band treatment
Anal fissure (there are studies showing that it has results close to the surgical treatment)
Technical and Medical Information about Wrinkle Treatment
The difference between an experienced wrinkle treatment injector and a technician (non-related persons, nurse, aesthetician, etc.) is in the concept of the functional anatomy of the face. The facial structure and anatomy of each patient are different, so the dose injected to each patient varies according to this anatomy and many other dynamics.
For this reason, when having wrinkle treatment, make sure that the practitioner is a plastic surgery specialist or a dermatologist.
The effects of wrinkle treatment are completely transient because the nerve cell block in the mechanism of action returns to normal in time. The effects of wrinkle treatment vary from person to person and are 3-6 months on average.
When wrinkle treatment is applied at regular intervals and at deserved doses, it provides a much better image and improvement each time by showing the summation effect. It is not correct to expect benefits from wrinkle treatment with very low fees (often numbers lower than the cost of wrinkle treatment) with commercial concerns, and it is a waste of time and money for patients.
When considered, between the correct application of wrinkle treatment twice a year and the need to apply 4-5 times a year without knowing how much dosing injected in very low fees; not only time and financial loss but also the elimination of remedial effect on the facial wrinkles of the treatment of wrinkles is very worrying for us as plastic surgeons.
Which Areas is Wrinkle Treatment Applied?
Wrinkle treatment can be applied almost anywhere in the facial area. The most common areas where I apply are above lips, forehead, crow’s feet and the between of the eyebrow. The areas where I avoid applying although my patients insist are wrinkles on the lower eyelid area and wrinkles around the upper eyelid.
There are many techniques to apply wrinkle treatment on the forehead and every doctor can apply it differently. What I have told my patients for the forehead and what I like is the expression ‘you will be able to raise your eyebrows but not wrinkles occur’. This is one of the biggest signs of natural Botox, and many people cannot understand that you have wrinkle treatment.
In the application of wrinkle treatment for crow’s feet, it is required to be careful, and 1-2% of the patients may experience drooping in the upper eyelid. This is due to the fact that the muscle that lifts the upper eyelid is very close to the muscle forming the crow’s feet, and that these muscles are thinner in some people. This effect can occur as the Botox is spread from the injection point to adjacent points. Upper eyelid drooping is completely temporary. In 2nd – 4th weeks, it returns to normal and some eye drops are used to reduce discomfort.
The other area where wrinkle treatment is applied is between eyebrows and the biggest problem of many of us is in this region. One of the reasons why the wrinkles of the eyebrows are intractable is that there are more than one muscle causing wrinkles between the eyebrows. Wrinkles between eyebrows are corrected with wrinkle treatment. However, if there are a wrinkle and depth present in the normal posture, additional methods should be used for this (filler, fat injection, etc.). If the patient does not want additional methods, passive wrinkles between the eyebrows gradually decrease with the application of regular wrinkle treatment every 3-4 months. Also, the number of repetitions changes from person to person. They are in a much better position at the 6th-8th repetition than before.
Since the wrinkles between eyebrows occur as a result of the contraction of many muscles, I think it is the place where the most care and attention should be shown. An experienced specialist analyzes which muscles are contracted and cause the wrinkles when the patient knits eyebrows, and he/she applies to those areas and naturally, they produce better results.
Another area of application for wrinkle treatment is the wrinkles above the lips. Trying to remove all the wrinkles above the lips and doing this only with wrinkle treatment is a big mistake for me, and it means about 2-month suffering for the patient. Because when the wrinkle treatment is applied around in overdose, the contraction of the lip decreases and especially while drinking, a disturbing condition arises because of the insufficiency of the upper lip contraction. The other annoying situation is the asymmetry on the lip, and unfortunately, the asymmetry continues until the effect of wrinkle treatment disappears. For this reason, I do not only apply wrinkle treatment but also use the filler method, therefore I achieve an improvement of 50-80% by using low doses for wrinkle treatment.
Forehead Wrinkle Treatment and Eyebrow Lift with Wrinkle Treatment
There are two muscles called frontalis which help raise the eyebrows on the forehead. And wrinkle treatment injections to these muscles can be done in order to reduce the wrinkles of the forehead and lift the eyebrows up. Eyebrow lift with wrinkle treatment can be performed safely up to 6 mm. Briefly, in order to raise the eyebrows eyebrow lift injections are done into the muscles drooping the eyebrows. Apply too much wrinkle treatment to the middle of the forehead causes eyebrow structure like ‘Mr. Spock-looking’ and at the same time causes an increase in wrinkles above the eyebrow.
In order to maximize eyebrow lift by wrinkle treatment, eyebrow lift is provided by pulling up the regions lifting eyebrows, by injecting to the forehead muscle regions (i.e. the outer areas of the eyebrows) that are not responsible for raising eyebrows. But at the same time if we want to correct the wrinkles of the forehead area, then the eyebrows are not lifted to the desired extent. Injections are done on the areas above the eyebrows in order to remove forehead wrinkles. A detailed examination is necessary to lift the external parts of the eyebrows. For this, your doctor will ask you to laugh over and over again, thus he decides whether to lift the eyebrow tips. There are no fixed points to lift eyebrows, and these points differ according to the anatomy of each patient. Therefore, an effective examination is essential before the application.
Since the forehead is the most prominent area in the treatment of facial wrinkles, an effective
wrinkle treatment will make you look younger.
Application of Wrinkle Between Eyebrows (Glabella) Treatment
After the determination of the muscles by the specialist which cause the wrinkles between the eyebrows, the application is made according to the type of wrinkles. While some patients have vertical wrinkles when they knit their eyebrows, some patients develop horizontal wrinkles; and the wrinkle treatment injection points differ according to this type of wrinkle. For this reason, although wrinkle treatment seems to be an easy application, it is absolutely necessary to know the basis and anatomy of the patient for maximum results. Basically, the use of wrinkle treatment is particularly important for the area between the eyebrows.
Applications of Crow’s Feet and Around Eye Wrinkles Treatment
Crow’s feet are formed as a result of the contraction of the orbicularis oculi muscle in the outer part of the eye, and this muscle is rounded along the eyeball. Applying wrinkle treatment to certain parts of the muscle leads to different effects.
While the application is performed to 3-4 points on the outer side, each patient is not applied for wrinkles under eyes. Applying uncontrolled wrinkle treatment to the lower eyelid area may cause double vision, blurred vision, and spasm of the lower eyelid. Therefore, after each patient is examined in detail, it is decided whether or not to apply wrinkle treatment to the lower eyelid.
After applying wrinkle treatment to the crow’s feet, the tips of the eyebrows are lifted. That’s what many patients want. However, as previously described in the eyebrow lift section, in some patients this muscle is not the muscle that lifts the tip of the eyebrow. Therefore, the tip of the eyebrow may not be lifted in some patients.
In the same way, when wrinkle treatment is applied to the crow’s feet, it is felt that the wrinkles are increased in the lower eyelid section; it is a fact, not the illusion of perception. The reason is; although the side muscles are weakened, the lower eyelid muscles are not weakened; and in order to prevent this appearance, the lower eyelid is applied a little bit depending on the experience. In case of overdose, complaints such as double vision, blurred vision etc. may occur. Therefore, patients should be informed about this issue before the application.
Wrinkle Treatment Procedure
Botulinum A is a perishable but very strong toxin. It is stored in dried and frozen crystal complex. During the production process, the toxin is immediately frozen at temperatures of -5 °C or lower.
The toxin is diluted immediately before the injection. Dilution in 2,5 U/ml is the most appropriate one depending on the current experience. It is recommended by some practitioners to freeze the diluted but unused toxin. However, protecting agents in the toxin, alcohol used in cleaning, rapid and turbulent dilution can suffice to denature the molecule. Toxin should be used as soon as possible after preparation. Although it is recommended to be used for 4 hours after reconstitution, many users use it even in 30 days (18). However, the effect decreases especially after 48 hours of dilution. Nevertheless, the best way to store the toxin is to freeze it. Although the first practitioners and researchers state that 10-20 U is sufficient for each area, 2,5 U can even be effective according to the applied area. The low-dose and small volume of the application reduce the side effects. Even doses less than 2,5 U / 0,1 ml can be effective. However, the muscle weakening effect becomes shorter. Patients with large and hypertrophic muscles may require higher doses. The medicine should be prepared with a 1 ml injector and an 18 G needle and applied with a 30 G needle.
There are two commercial types of wrinkle treatments with The Ministry of Health license in the Republic of Turkey. One is ALLERGAN BOTOX and the other one is DYSPORT. Both can be easily used for cosmetic purposes. However, their preparation is different, the amount of unit and effect they contain is different. Therefore, it is useful to have these applications applied by those who are experienced in this work.
The commercial bottle, which is the brand of wrinkle treatment, is a 100-unit bottle. And when a bottle is used for facial wrinkles (forehead, eyebrows and crow’s feet), an average of 46-50 units are enough for one patient. That is, a bottle of wrinkle treatment has enough dose for only 2 persons.
But unfortunately; there are many places where wrinkle treatments are applied in lower fees than normal and to more than 2 persons by diluting much more than adequate. In this case, the effect of wrinkle treatment lasts less than 3 months or does not have an effect at all.
In very rare cases, in some patients, the body can produce antibodies against wrinkle treatment and therefore, if it is applied in normal doses, wrinkle treatment does not have the effect as desired. When I face such patients, I prefer wrinkle treatment methods that can be used out of Botox after looking at and analyzing the before/after photos together.
In the 2nd-3rd weeks when the first and maximum duration of the action occurs in the patients who I apply wrinkle treatment, after comparing the photos with my patient, I will show the patient in the mirror when he/she should come again for wrinkle treatment. When we repeat the wrinkle treatment application in the period the effect begins to decrease, the effect of wrinkle treatment and the duration of the action lasts much longer.
Sweating Treatment with Wrinkle Treatment
Wrinkle treatment is an effective method of sweating treatment. It has very effective results in the treatment of armpit sweating and palm and sole sweating. For wrinkle treatment used for sweating treatment, firstly the sweating test is performed. Wrinkle treatment is applied after the perspiration areas are diagnosed.
When sweating treatment with wrinkle treatment has an average of 8-12 months, and every time your sweating amount devreases. When you have wrinkle treatment in the armpit, for the first 1 week you will feel an excessive sweating sensation and heat increase on your face, but then it will go back to normal.
Migraine Treatment with Wrinkle Treatments
We also use wrinkle treatment in the treatment of migraine attacks. About 1 bottle of wrinkle treatment as 100 units is used for a migraine, and we reduce the frequency of migraine attacks with different points on the scalp and neck. The duration of the action varies from person to person and lasts for 10-14 months in time, the increase in the frequency of attacks is a sign of the end of the effect of wrinkle treatment.
Side Effects of Wrinkle Treatment;
The upper eyelid drooping
Asymmetry and salivation, liquid food intake in case of overdosing in lips
Headache healing after 2-3 days in people with sinusitis
Redness and bruise in sensitive persons
Wrong Beliefs About Wrinkle Treatment
Another belief, which should be known and has been misunderstood in wrinkle treatment, is that wrinkles called passive wrinkles which are present on our face without making the gesture movement completely disappear with wrinkle treatment. Most of this myth is wrong because wrinkle treatment weakens muscle contraction through nerve cells and therefore removes the active facial wrinkles that appear when you make mimics. However, the contraction of these muscles for years and the uses of mimics leave marks on the skin in the direction of the movement of these muscles and they are simply passive wrinkles.
How are these passive wrinkles removed? When the application of wrinkle treatment is continued for 4 to 6 months at regular intervals, the contractions of the muscles are weakened and the marks on the skin begin to heal and although they change from person to person, they are lost to a great extent with repetitive applications.
Another myth related to wrinkle treatment is the belief that ‘after wrinkle treatment effect is over, wrinkles occur much worse than before’. This is completely unrealistic and after the effect of wrinkle treatment is over, you will only return to before. However, if we think we are getting older over time, the amount of wrinkle can increase on people with dry skin structure and fast aging after 6 months, but this is the effect of time, not wrinkle treatment.
Our most common myth is that ‘wrinkle treatment gives very dull and dazed expression, so it does not look natural’. Yes, it’s not a myth. However, since wrinkle treatment is a very easy procedure since many people are applying this treatment except for plastic surgery and dermatology specialists, they do not have the necessary experience and knowledge, they have performed wrinkle treatment in the wrong places and as more than adequate, and therefore dull and dazed expressions have emerged. Unfortunately, this is a matter of supply-demand, and there are demands for our brave-hearted friends that they can do so easily because there is no effective audit in our country.
When the wrinkle treatment is performed correctly in the right places, and especially if the patient does not want it, it does not cause dazed and dull expression. Even if my patient demands this, I certainly don’t perform the application called dazed and dull expression. First, I ask my patient what he wants and expects, if our expectations are different, I can easily tell him what she/he should do by telling him/her in a proper language. The most expectation of my patient’s centres on ‘Doctor, please do not let anybody understand that I have a wrinkle treatment’. Although such a request is a little more than expectation, I can easily achieve this between the brows and on the forehead.
To Whom Is Wrinkle Treatment not Applied?
We do not recommend wrinkle treatment in pregnancy and breastfeeding.
We do not apply to people below 12 years of age and those with neurological disorders (neuromuscular diseases such as myasthenia, Lambert-Eaton).
It is risky for patients receiving aminoglycoside-derived antibiotics and cyclosporine.
Medicines containing D-penicillamine cause the production of antibodies against wrinkle treatment in the body and cause the effects of wrinkle treatment to disappear very quickly and even prevent to affect.