Neuromodulators like Botox, Dysport, and Zeomin In New Jersey
There are two types of wrinkles in the face: those that are caused by muscle action and those that are due to gravity or forces. The wrinkles that are related to muscle action are called active wrinkles and the best way to improve them is by eliminating the muscle activity in that particular area. The area between the eyebrows and the crows feet are good examples. We must mention that the active ingredient in all these products is a toxin produced by a bacteria that if ingested in high doses could be lethal. However, the toxin is administered in such a small quantity that it only exerts its action in an area of the muscle less than half an inch without systemic effect on the rest of the body. It prevents the release of acetylcholine, the neurotransmitter at the junctions between the nerve and the muscle. Even though it is called a toxin, this substance works in the same way as other medications. For example, an over-the-counter drug like Tylenol is safe when taken at the recommended dose, but lethal at an exaggerated dose. The industry doesn’t like to call these products toxins because it may unnecessarily scare people away. Instead, they are referred to as neuromodulators, a much less scary name.
We will go through all the areas that are amenable to the positive effects of the toxins. We’ll call them toxins for the sake of transparency and ask our readers not to be scared of this name as all drugs and even some foods could be considered toxins depending on the dosage.
This is the frowning area between the eyebrows. The corrugator muscles have an oblique direction and create the two vertical lines frequently referred to as “elevens.” There is another muscle in the midline called procerous, which creates the horizontal line across the nose. Typically about 5 injections are used in this area to eliminate the function of these muscles. The effect lasts about three months after which the muscles regain their function and it is time to go back for another injection. The injections are usually not painful, but Dr. Rafizadeh uses ice in the area before the injection. This is very helpful to eliminate the sensation of the injection and works much better than topical anesthetics.
Crows Feet Area
The orbicularis oculi is a flat muscle that goes around the eye, within the lids and partially outside the lids. The part that is closer to the lid margin is responsible for closing of the eyelids. The other parts are mostly for expression. The part that is lateral to the eyes makes the crows feet and pulls the lateral part of the eyebrow down. Three injections of toxin in that area improves the crows feet and allows the lateral eyebrow to go up. The lateral eyebrow position depends on the tone of the lateral orbicularis and lateral frontalis muscle, which pulls the eyebrow up. If one muscle is weakened, the brow moves to the direction of pull from the other muscle. We see so many people with bad Botox jobs coming to the office with brows drooping as the injector went after the lines forgetting that the muscle controls the position of the eyebrow. If you are going to get Botox, you are better off getting it from a doctor who knows every bit of detail and knows the anatomy of the facial musculature. The consequences of not selecting the correct specialist for the job will not only give you bad results, but will also cost you more time and money in the end.
The platisma muscle is a flat muscle in the neck that goes from the lower cheeks to the area of the clavicle. The front part of the muscle forms these bands that can be active, worsening with muscle contraction, or passive, hanging loose due to gravity. The active bands can be helped by a toxin injection. Once again, in this case knowledge of the anatomy of the neck is critical to achieving a great result. There are other muscle in that area that should not be affected and two or three injections in each band will do the job.
Depressor Anguli Oris
This a triangular muscle that is the most superficial under the skin and will pull the corner of the mouth down giving the patient a “pouting” look. Careful injection just in the muscle will give the patient a happier and more youthful appearance. This is definitely for someone who knows the anatomy very well, otherwise the patient could end up with a lower lip droop.
The medial border of orbicularis extends to the side of the nose making the oblique wrinkles. They are commonly referred to as bunny lines, as is especially evident when the patient laughs. One little injection on each side of the nose will take care of these wrinkles.
Questions and Answers about the Toxins.
Q: What is the difference between the different brands of botulinum toxins?
A: They are similar molecules with slight differences in dosage and their ability to diffuse in the tissues. Every surgeon has his or her preference based on their own experience. Some products are more stable and do not need to be refrigerated.
Q: Are these products used for other conditions beside aesthetic improvements?
A: The answer is yes. Botox was first used for blepharospasm, a condition where the eyelid muscle continuously and uncontrollably contracts. It is also used in conditions like torticulis which is the abnormal contraction of the long muscle in the neck. A relatively new indication for Botox is in treating migraines. It is believed that the muscle contraction in the forehead area causes irritation of the terminal branches of the trigeminal nerve and that is what induces the migraine attacks. Many of our patients notice improvements in their migraine headaches, while at the same time getting the cosmetic benefit of the toxins.
Q: Who should I go to for Botox or filler injections?
A: Any physician is allowed to give these injections. The advantage of going to a plastic surgeon is that beauty concerns are at the core of the plastic surgeon’s education and business. A plastic surgeon has seen these muscles in surgery and has a better idea of the other nearby structures. A plastic surgeon is also more aware of the traps and potential complications. For example, if you own a fancy BMW car you would only let the BMW dealer take care of it. You wouldn’t bring that car to the corner gas station to be repaired because that mechanic wouldn’t do the best job. It is always hard to understand why some people trust their body to someone who is less qualified. We believe the body, like a piece of art, should never be trusted to anyone who doesn’t possess the necessary expertise.