Maintaining a youthful appearance has become an accepted part of mainstream American culture. The aged appearance of the face may be related to sagging of tissues, sun damage to the skin, and the development of deep "dynamic" lines caused by the repeated action of the delicate facial muscles found under the skin's surface with laughing, frowning, and smiling. Dynamic lines usually appear between the eyebrows, on the forehead, and at the outside corners of the eye in the "crow's feet" region and may suggest that someone looks is worried, tired, or angry. An effective, safe, nonsurgical, treatment for dynamic lines is now available.
With a procedure known as chemodenervation, Botox, a purified version of the substance responsible for botulism, is used to soften or even eliminate dynamic facial lines. Botox exerts its effect by blocking the impulses from the nerve to the facial muscles responsible for the development of dynamic lines. Following a Botox injection, the muscles gradually become relaxed, allowing the overlying skin to appear smooth and unwrinkled. Untreated muscles are not affected by a Botox injection, allowing normal facial expression to be unaffected.
The cosmetic denervation treatment is simple and safe. A tiny microneedle is used to deliver a minute, exact amount of Botox into several locations on the face. Because the needle is so fine and the amount of liquid injected is so small, the pain associated with injections is minimal. Sedation or anesthesia is not required, and there is no special recovery Period necessary. Mild bruising may occur at injection sites, but they may be easily covered with makeup. The result of the injection usually becomes apparent within 2 to 4 days.
The effect of a Botox injection generally lasts from three to six months. Injections are given when the effects of the previous treatment begin to wear off. Initially, patients receive from 2 to 4 treatments per year. After receiving several treatments, many patients find that they require Botox even less often. Some even find that they have achieved a permanent improvement, although this is the exception rather than the rule.
The side effects of Botox are minimal and are not permanent. Each molecule of Botox is relatively large, and thus does not migrate far from its injection site. Consequently, the effects of a Botox injection are limited to the area into which it is delivered. Rarely, an eyelid may droop temporarily. Many patients express concern about the total dose of drug administered. While this is a valid question, Botox has been used in doses many times greater than that required for cosmetic denervation for more than ten years to treat patients with various muscular spasms and disorders. There have been no reports of adverse systemic side effects even with administration of large doses on a regular basis for many years.
There are very few (if any) cosmetic procedures which may be performed as quickly, safely and effectively as Botox injections and, not surprisingly, patient acceptance of this procedure is extremely high. Botox injections do have limitations. Sagging of the jowls, eyelids, or eyebrows requires surgical lifting, and sun damaged skin is best rejuvenated with a laser treatment or chemical peel. Botox should be given only by a physician experienced in its use.
Fat Transplantation is another technique that can be used to treat dynamic wrinkles. It is also useful for correcting facial grooves and depressions. The patient's own fat cells are removed with low-pressure liposuction using local anesthesia. The fat is processed and then injected into the area that requires treatment. In most cases, two to three transplants are needed to achieve the best results.
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