Title : Botulinum toxin for correction of facial rhytides - Current scenario
Abstract:
Background: In 1992, Alastair and Jean Carruthers were the first to suggest that Botulinum toxin (Botox) could be used for cosmetic purposes. Botox was first used to treat forehead wrinkles in 1993. In 2002, the FDA approved Botox to treat frown lines. Since then Botox has greatly expanded its therapeutic range to address a wide variety of Medical conditions. Today, it is widely employed in the management of various neurological disorders, including chronic migraines, cervical dystonia, as well as its widespread use to correct dynamic wrinkles on face and axillary and palmar hyperhidrosis. Full assessment for botulinum toxin treatment includes anatomical and functional analysis of the musculature in the context of facial morphology and the qualitative and quantitative status of hard and soft tissues. A fully patient-tailored approach considers physiologic and chronologic age, ethnically associated facial morphotypes, and aesthetic ideals based on sex and culture. Lower toxin dosing, to modulate rather than paralyze muscles, is indicated where volume deficits influence muscular activity. Focus on aesthetic units, rather than isolated rhytides, optimizes results from toxin. The emerging objective of injectable treatment is facial harmonization rather than rejuvenation. The response rate to botulinum toxin type A for aesthetic applications is very high.
Aim: Treatment of forehead wrinkles and periocular rejuvenation with botulinum toxin A
Objectives:
1)To assess face for botulinum toxin injection
2)To ensure optimum patient selection
3)To demonstrate alignment of patient expectations to ensure maximum satisfaction
Materials and Methods: Twenty patients were administered botulinum toxin A for forehead lines, crows feet and infraorbital lines after assessing their face at rest and in dynamic phase. Pre-treatment pictures were taken at rest and while smiling, frowning and worried expressions. Facial asymmetry was assessed and the patient was made aware of the same. Optimum dosage and points of injection was individualised for each patient. 13 females and 7males were included in the study. Any co morbidity was noted. If patient was hypertensive or diabetic, optimum control was ensured. Contraindications were ruled out. Botulinum toxin was administered at the desired points and post treatment assessment was done at 7 days and 14 days. Patient satisfaction score was determined using 5-point likert scale.
Result: 95% of patients (19) gave a score of 4 or5 on 5-point likert scale. One patient gave a score of 3. Overall patients were happy to achieve the desired result and it boosted their self-confidence and improved their quality of life greatly.
