Botox injection fundamental

• For physicians and qualified healthcare providers who want to incorporate aesthetic medicine into their practice, administering Botox injections is a must-have skill. . An understanding of relevant anatomy and an appreciation for facial aesthetics, in addition to injection skills, are required to achieve desired results when performing Botox procedures 

Aging Skin

Aging of the Skin Wrinkles are a common sign of skin aging. Dermal collagen, hyaluronic acid, and elastin deplete over time, causing the skin to thin and lose volume. Sun exposure and other extrinsic factors such as smoking hasten and exacerbated the process of dermal atrophy. The formation of visible lines and wrinkles is also aided by hyperdynamic facial musculature. Dynamic lines and wrinkles appear only when you make an active facial expression like frowning, laughing, or smiling. Dynamic lines become permanently etched into the skin over time, resulting in static lines visible when the skin is at rest. Skin laxity, facial fat redistribution, and biometric changes such as bone resorption contribute to skin folds and changes in facial contour. Dychromia, such as mottled pigmentation, vascular ectasias, telangiectasias, cherry angiomas, and benign and malignant degenerative changes, are common in older skin. 

Botox Side effects

• Botox Side Effects (Year Approved) • Botox is approved by the FDA for the temporary treatment of moderate to severe dynamic glabellar frown lines in adults aged 18 to 65. (2002). • Botox is approved by the FDA to treat primary axillary hyperhidrosis for a limited time (2004). • Blepharospasm (1989), strabismus (1989), cranial nerve VII disorders (1989), cervical dystonia (2000), upper limb spasticity (2010), and prophylaxis for chronic migraine are some of the other FDA-approved indications (2010). • Other off-label cosmetic uses include reducing wrinkles in the upper and lower face, neck, chest, facial lifting, and facial asymmetries correction. 

Botox Mechanism

• Action Mechanism Botox is a neurotoxin protein produced by the bacterium Clostridium botulinum. Localized chemical denervation occurs when small amounts of Botox are injected into target muscles, as acetylcholine release at the neuromuscular junction is inhibited. This reduces muscle contractions and smoothes skin wrinkles in the treatment area for a short time. 

Botox Procedure

• Procedures (Basic and Advanced) Basic. When treated with botulinum toxin, hyperdynamic muscles in the upper third of the face (frown lines, crow’s feet, and horizontal forehead lines) produce the most predictable results with the highest efficacy and fewest reported side effects. These areas are referred to as basic treatment areas (Table 1) in this book and are ideal for providers just getting started with cosmetic Botox injections. Advanced. Botox injections in the lower face are more advanced procedures (Table 1). This is a highly functional region, and lower face muscles serve important functions such as mastication, elocution, and facial expression. Lower-face muscles that have been treated must retain some functionality, which necessitates more practiced injection skills and precise placement of small doses of toxin. Advanced procedures in this book include Botox treatment of neck bands, hyperhidrosis, and all facial areas other than the basic treatment areas. These procedures carry a higher risk of complications, so new injectors should gain experience and confidence with basic Botox treatments before moving on to more advanced Botox treatments. 

Botox Treatment Objectives

• Treatment Objectives Botox injections temporarily stop muscles or muscle groups from contracting to achieve desired results, such as smoothing the skin or elevating the face. An ideal outcome has a pleasing aesthetic effect, minimal to no functional impairment in the treatment area, and no other undesirable effects or complications. Patient preference and the need to preserve functionality in the treated muscles determine the degree of muscle inhibition achieved with Botox in a given treatment area. Some patients, for example, may prefer complete glabellar complex muscle inhibition with Botox treatment of frown lines, whereas others may prefer partial muscle inhibition with some ability to frown. Treatments in the upper third of the face typically require more muscle inhibition than those in the lower third. Because the treated muscles must still be able to perform essential functions like eating, drinking, and speaking, partial muscle inhibition is the desired outcome in the lower face. The following chapters’ treatment goals are based on common patient preferences and considerations of muscle functionality in the treatment areas. 

Botox Contraindications

  • Pregnancy or breast-feeding 
  • Infection is present in the treatment area (e.g., herpes simplex, pustular acne, cellulitis)
  • Bleeding abnormality (e.g., thrombocytopenia, anticoagulant) 
  • Hypertrophic or keloidal scarring 
  • Healing issues (e.g., due to immunosuppression)
  • Skin thinning (e.g., chronic oral steroid use, genetic syndromes such as Ehlers-Danlos syndrome) 
  • Dermatoses in the treatment area that are active (e.g., psoriasis, eczema) 
  • Sensitivity or allergy to Botox ingredients (including Botox serotype A, human albumin, lactose, or sodium succinate)
  • Milk allergy caused by abobotulinumtoxinA-containing products 
  • Severe motor weakness in the treatment area (e.g., as a result of polio or Bell’s palsy)
  • Amyotrophic lateral sclerosis, myasthenia gravis, Lambert-Eaton syndrome, and myopathies are examples of neuromuscular disorders. 
  • Periocular or ocular surgery within the previous 6 months 
  • Inability to actively contract muscles in the treatment area before treatment (e.g., laser-assisted in situ keratomileuses, blepharoplasty)
  • Drugs that block neuromuscular signaling and may enhance Botox’s effects (e.g., aminoglycosides, penicillamine, quinine, calcium channel blockers)
  • Uncontrolled systemic condition • Occupation that necessitates a full range of facial expressions (e.g., actors, singers) • Body dysmorphic disorder or unrealistic expectations Advantages • Easy to use, with a quick treatment time
  • Safe and effective, especially in the upper third of the face • High patient satisfaction Disadvantage
  • The action lasts a short time compared to other cosmetic procedures, though effects may build up over time with recurring treatments.


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