What is Botox?

Botox derives from a bacterium called Clostridium botulinum. This bacterium is present in many natural settings, including soil, lakes, forests, and in the intestinal tracts of mammals and fish.
Commercial versions of Botulinum toxin available:

• Botox (onabotulinumtoxin A)
• Dysport (abobotulinumtoxin A)
• Xeomin (incobotulinumtoxin A)
• Myobloc (rimabotulinumtoxin B)
• Jeuveau (prabotulinumtoxin A)

People use the term Botox interchangeably for these various products, though “Botox” is the registered trademark of Allergan Inc.

How does it work?

Botox is a neurotoxin. These substances target the nervous system, disrupting the nerve signalling processes that stimulate muscle contraction. This is how the drug causes temporary muscle paralysis.
In order for muscles to contract, nerves release a chemical messenger called acetylcholine at the junction where the nerve endings meet muscle cells. Acetylcholine attaches to receptors on the muscle cells and causes the muscle cells to contract or shorten.
Botox injections prevent the release of acetylcholine, which stops muscle cells from contracting. The toxin reduces abnormal muscle contraction, allowing the muscles to become less stiff.

What are the Cosmetic uses of Botox ?

The primary use of Botox is reducing the appearance of facial wrinkles.
According to the American Board of Cosmetic Surgery, Botox injections are the most popular cosmetic procedure nationwide. In 2016, over 7 million people had Botox treatments.
The effects of Botox are temporary, lasting 3–12 months, depending on the treatments.

Common facial areas people use Botox on include:
1. Frown lines:
Frown lines are the vertical lines that develop between the eyebrows as we age. Sometimes, they will be referred to as the “elevens”. The medical term for these lines are glabellar lines.

They are caused by the procerus and corrugator muscles that contract when we scowl or when we are squinting. Sun damaged and volume loss also play a role in the development of frown lines.
When we are younger the skin is thick enough and has enough elastin so the skin fold goes away when the muscles relax. As we get older, the skin loses collagen and elastin and the lines may remain even when the muscles are relaxed.

Some patients will begin noticing the frown lines in their early twenties. Frown lines can have a social impact as well. It is not uncommon for patients to complain about being asked why they are mad or sad. They are frustrated with being asked if they are OK.
Treating the glabellar lines can give the appearance of being happy and even more youthful.

Treatments to reduce Frown Lines

i) Sun Protection – of course, this is always better to start when we are younger but it is never too late to protect skin from sun damage. EltaMD has a great selection of sunblocks to be used on all skin types.

ii) Botox / Dysport – These products are the most common ways to treat frown lines. They relax the muscles that cause the lines and the skin will generally repair itself. These will need to be injected every 3 to 4 months to maintain your results.

iii) Dermal Fillers – Fillers such as Restylane, Juvederm or Bellafill can be used in patients where the Botox or Dysport did not get rid of the furrow completely. It is very important to only use a provider familiar with the anatomy in the area as it is possible to inject an artery and cause ulceration of the skin.

2. Crow’s feet

Crow’s feet are wrinkles at the outer corner of the eyes. They resemble the feet of a crow—hence the name. Before you start to freak out, crow’s feet are normal. When you age, the skin around your eye loses its elasticity and natural oils, making it more prone to wrinkles. “We develop crow’s feet due to the loss of collagen and elastic tissue within our skin. This happens naturally, with aging. Free radical formation from sun and pollution can worsen the effects. We also see these beneath the eyes as a result of excessive smiling, and muscle contraction. “As we age, the lines get deeper and longer.”
Crow’s feet develop over time because of tiny muscle contractions that happen every time you make a facial expression.
There are two different types of wrinkles: dynamic and static. Dynamic wrinkles are those that appear during muscle contraction. If your crow’s feet are primarily visible when you are smiling, they are probably dynamic. Static wrinkles may worsen with muscle contraction, but they are visible all the time, even when the face is at rest.

Treatments to reduce Crow’s feet

i) Botulinum toxin (Botox)

Botox works to smooth out wrinkles caused by repetitive muscles contractions that happen when you make facial expressions. This treatment is very effective for crow’s feet.
Botox is best suited for people age 30–50 whose wrinkles are just starting to develop. It’s not effective on the deep wrinkles common among older adults.
Botox is injected directly into the affected area with a small needle, which causes the muscles to relax. Botox prevents the muscles from contracting, which can reduce the appearance of wrinkles or cause them to disappear entirely. Botox is particularly effective in people with dynamic wrinkles.
Botox will not keep you from making facial expressions. It will only target those muscles around the eyes that are causing your crow’s feet. The effects typically last about 3 months.

ii) Topical creams

You can fight fine lines and wrinkles with both prescription and over-the-counter topical creams. Tretinoin (Retin-A) is widely used to fight the signs of aging because it stimulates the production of new skin. There are also many antiaging moisturizers that are similarly effective. They may help reduce the appearance of fine lines around the eyes, but will not improve deep crow’s feet. Results of topical creams are usually seen within 24 weeks.

iii) Chemical peels

Chemical peels can improve the appearance of crow’s feet and promote younger, healthier looking skin. This is accomplished by putting a chemical solution on the face that removes the outer layer of old skin, leaving behind new, smoother skin.
There are three different types of chemical peels:

• superficial peels
• medium-depth peels
• deep peels

Superficial peels can be done with a certified esthetician, but deeper peels should be done in your healthcare provider’s office. The effects of the peel and the recovery time involved will depend on the type of peel you get.
Superficial peels are relatively painless and require little or no down time. Deeper peels can be very painful, and may even require anesthesia. For best results, superficial peels should be repeated every 2–4 weeks and medium-depth peels every 6–12 months until the desired results are achieved.

iv) Dermal fillers

Dermal fillers, also called soft-tissue fillers, can also be used to treat crow’s feet.

Some dermal fillers you may use include:

• Juvederm
• Radiesse
• Restylane
• Sculptra
• Belotero

Dermal fillers are injected directly into crow’s feet with a small needle. The different fillers available have slightly different components, and some are more permanent than others. Talk to your healthcare provider about which one is right for your skin type.
Dermal fillers are particularly effective for static crow’s feet, which appear constantly, even when the face is at rest. The effects of dermal fillers usually last anywhere from 3–12 months, but they can last longer.

v) Laser resurfacing

Ablative laser resurfacing is a procedure that removes the upper layers of skin, revealing newer, younger looking skin. Laser resurfacing works well for crow’s feet because it heats up several layers of skin, which promotes collagen production. Increased collagen production can help the skin around the eyes heal in a smoother, more even way.
You may be given pain medicine before the procedure. The procedure involves a laser wand focused on the face. Your face may be wrapped in a dressing for several days after the procedure. Complete heeling can take several weeks.
Laser resurfacing tightens skin, and claims to make you look 10–20 years younger. Results last for up to 10 years. Laser resurfacing may not completely eliminate crow’s feet, so doctors may combine it with other techniques, such as Botox injections.

3. Horizontal creases in the forehead

The horizontal lines on your forehead are often called “worry lines” for a reason. Having these lines indicates that you bottle up a large amount of stress. They are a sign that you may need to take a break and relax with a vacation or a little bit of alone time.
These forehead lines are also directly connected to your stomach. They may be an indication that you are getting too much sugar and fat in your diet and not enough water. If you have these lines, you may need to focus a little more on exactly what you are putting into your body.

Treatments to reduce Horizontal creases

i) Botox and other neuromodulators

In recent years, Botox has become more and more popular for skin that is showing signs of aging. While technically Botox is a brand name, many people use it to refer to any of several injectable ingredients that relax (paralyze, actually) the muscles under your skin, making wrinkles less noticeable.
Compared to other medical procedures, Botox is affordable, and the risk of side effects is minimal. On the other hand, Botox is a temporary fix that wears off after a couple of months. It also stops your face from showing its full range of expression, which can result in a stiff appearance.

ii) Juvederm and other soft tissue fillers

Soft tissue fillers are meant to mimic the collagen and other structural components of your skin. Products in this treatment category include:
Restylane
Sculptra
Juvederm
There are some notable differences between Botox and dermal fillers, but both have a low risk of complications. Dermal fillers do have a possibility of side effects, and they can be more costly than Botox.

4. Mouth Lines : Lines at the corners of the mouth

Many people have vertical lines on the sides of their mouths. The side of the mouth is connected to the colon. While colon health is not always on everyone’s minds, it is very important, especially later in life.
Deep lines around your mouth (also called nasolabial folds) become more visible as we age. That’s because the ligaments around the mouth and chin loosen, allowing fatty tissue in cheeks to sag.
Age, sun damage, and smoking are the biggest culprits of deepening nasolabial folds. The sun’s ultraviolet (UV) rays break down the collagen and elastin fibers in your skin that keep it smooth and supported. Smoking also breaks down these fibers. As you age, cumulative skin damage can make your nasolabial folds more prominent.
Typical aging can also play a part, even without sun damage or smoking. As you age, the structure of your cheekbones flattens out. This can cause the skin of your cheeks to sag or droop downwards. Add to that years of gravity tugging on your skin and the natural decrease in collagen and elastin, and you have the perfect recipe for wrinkles, loose skin, and nasolabial folds.

Treatments to reduce Nasolabial lines

i) Fillers

Fillers are most often the first step toward reducing nasolabial folds. Dermatologists and other aesthetic professionals inject fillers into the skin around the cheek. This adds volume to the area and lifts the skin. What type of filler and how much is used depends on the severity of the fold. The most common fillers are made from hyaluronic acid, a natural building block of skin, and calcium hydroxylapatite, typically found in bones. Both have been shown to help stimulate the growth of collagen in addition to plumping the skin.
Fillers are easily injected in the office and require little to no recovery time. Some people experience slight bruising, but makeup can be worn immediately after treatment.
However, fillers are a short-term solution. They last 6 months to 2 years, with most lasting 6 to 9 months. How long a filler lasts depends on the type of filler and how quickly your body dissolves it.

ii) Skin tightening

If loose skin is the cause of unwanted nasolabial folds, dermatologists or skin care professionals may also use a skin-tightening treatment. These can include a fractional radiofrequency device, ultrasound, or a fractional laser.
The procedures work similarly. They damage microscopic areas of the layer of skin beneath the top layer. This stimulates collagen growth for thicker, tighter skin. However, skin tightening alone is unlikely to make a significant difference for most people’s nasolabial folds, according to Arron.

iii) Surgery

A cheek lift or a full-face lift can reduce the appearance of nasolabial folds and other signs of aging. However, cosmetic surgery is expensive and often not covered by insurance. It also has a long recovery time and comes with the risk of complications.
There is no permanent fix for nasolabial folds. While some treatments can last years, you can’t completely halt natural aging. Even surgical alterations will look different over time and begin to show signs of aging.

5. “Cobblestone” skin on the chin

A cobblestone chin is the appearance of a knobbly or ‘orange peel’ chin. This is often exaggerated with certain facial expressions and tends to become more noticeable with age (due to the natural loss of overlying fat). A cobblestone chin can make the face appear asymmetrical, older and more tired.

Treatments to reduce Cobblestone skin on chin

Botulinum toxin has been used in medical treatments for over 4 decades and was first approved by the Food and Drug Administration (FDA) for the treatment of wrinkles in 1989. It is now one of the most popular cosmetic treatments in the world. It works by temporarily blocking the connection between nerves and muscles, thereby enabling muscles to stay relaxed. A safe and effective treatment to reduce the appearance of a gummy smile is the injection of botulinum toxin into the Mentalis muscle. Botulinum toxin is used to relax the Mentalis muscle, reducing the over-activity of the muscle with facial expressions, speaking or chewing. This treatment does not affect normal expression, speech or eating.

Beyond cosmetic applications, we can also use Botox to treat a variety of medical conditions related to muscles.

Benefits of Botox

Botox is most effective on wrinkles that haven’t quite set — “dynamic” wrinkles that appear while you’re moving your face, such as when you frown. “If you don’t move the muscle too much, you won’t form the wrinkle and botox prevents from this . If you’re breastfeeding, pregnant, or plan to become pregnant, the FDA recommends that you talk to your Dermatologist before starting Botox, Dysport, or Xeomin is pure protein administered by many physicians around the world produces a notable improvement to your appearance. It is the most popular and successful cosmetic surgery procedure people use to preserve their looks from ageing

According to the AOCD, the Food and Drug Administration (FDA) has approved Botox for the following uses

• crossed eyes, or strabismus
• eyelid spasms, or blepharospasm
• a neurological movement disorder called cervical dystonia
• excessive sweating, known as primary focal hyperhidrosis

What Are the Side Effects of Botox?

Temporary bruising is the most common side effect of Botox. Headaches, which end in 24 to 48 hours, can happen, but this is rare. A small percentage of patients may develop eyelid drooping. This usually ends within three weeks. Drooping usually happens when the Botox moves around, so don’t rub the treated area for 12 hours after injection or lie down for three to four hours.

Who Should Not Receive Botox?

People who are pregnant, breastfeeding, or have a neurological disease should not use Botox. Since Botox doesn’t work for all wrinkles, you should consult with a Dermatologist first.
The botox and Xeomin gives the best results and these procedures are approved by FDA and at Elements of Aesthetics clinic under Dr.Stuti Khare Shukla perform these techniques are administered and performed and scientifically Dr.Stuti research and clinical studies published in top international journals and how this botox treatment works and their results in efficacy and longevity.

Shome, D., Kapoor, R., & Khare, S. (2019). Two different types of botulinum toxins: Is there a difference in efficacy and longevity?. Journal of cosmetic dermatology, 18(6), 1635-1641.