Treatments with Botulinum Toxin (Botox®)

Wrinkle Treatment by Injection.

Botulinum toxin (Botox®️) has become an integral part of aesthetic medicine and will lead to a naturally beautiful result completely without the necessity of a surgical procedure.

But there are still a lot of misconceptions and fears revolving around wrinkle treatment using botulinum toxin (Botox®️). Paralyzed facial features, an expressionless stare, frozen expressions - many people have a fixed view when confronted with the phrase botulinum toxin (Botox®️).

In our dermatology and beauty practice in Zurich, we are confronted daily with questions and insecurities revolving around the treatment options using botulinum toxin (Botox®️) and the possible side effects. Because of this, we have comprised an article covering what botulinum toxin (Botox®️) is, how it works, where it finds application and which advantages and disadvantages the treatment has.

The commonly distributed toxin can be found in multiple variety. In specialist circles, these are known as Botulinum A-G, where the use Botulinum A is primarily used for medicinal purposes. Most people will have heard of this in connection with aesthetic medicine by the name Botox®. It has been although used in many different medical fields since the last century. First it was used in the field of neurology to counteract movement disorders. Today it is commonly found in therapies against migraines, depression and excessive sweating (hyperhidrosis) as well as the treatment of various tremors (involuntary muscle spasms) and cramps. Due to its muscle relaxing effects, botulinum toxin (Botox®️) has found its way into the aesthetic medicine throughout the past decade, where it is used to tighten wrinkles.

The active agent will be degraded by the body's own functions and so the effects are only temporary. How long it takes for the effects to wear off differs from individual to individual depending on where the botulinum toxin (Botox®️) is injected and how fast the active agent is degraded.

Hyperhidrosis is considered as the excessive production of sweat. It occurs unrelated to temperature, physical strain or season. Some people only sweat profusely in specific areas, others may experience an enhanced sweat production throughout the entire body. Besides a laser, the hyperhidrosis therapy can also be accompanied by botulinum toxin (Botox®️) injections. The botulinum toxin (Botox®️) will be injected into the affected area, in order to block the nerve impulses which are controlling the sweat production.

The aesthetic medicine uses a tiny low dose increments of botulinum toxin (Botox®️) injections into the muscle to smooth out wrinkles. This allows a precise muscle obstruction, which makes a smoothing possible. It is especially used for the therapy of wrinkles caused by facial expressions, on the neck and cleavage areas as well as on the back of the hands.

Following wrinkle types/problem areas can be treated by botulinum toxin (Botox®️) injections:

• Crow’s feet/laugh lines
• Thinkers forehead/worry lines
• Strawberry chin/chin lines 
• Eye brow lift
• Puppet lines/mentolabial lines
• Mouth wrinkles/pleats
• Bunny Lines/nose wrinkles
• Sorrow lines/nasolabial folds
• scowling wrinkles/glabella lines
• Turkey neck/platysma lines

We can furthermore treat the so-called gummy smile. This term defines the circumstance, when too much strain is put on the muscle while smiling which reveals the gums. The application of botulinum toxin (Botox®️) does not make sense for every form of wrinkle treatment. A consultation should therefore be done in order to find the fitting treatment method for you.

Even though the professional use of botulinum toxin (Botox®️) injections will only seldom cause risk or side effects, there are reasons to forgo a treatment. The attending person should enlighten you about these risks during your first consultation. Inform your doctor about your medical history as well as the possible intake of medication beforehand, in order for us to consult you in the best possible way.

The contraindications for a botulinum toxin (Botox®️) therapy especially include:

• Pregnancy and Nursing Period: Non-medical procedures should always be postponed during a pregnancy or the nursing period.
• Infected Treatment Area: Any infections in the area which is meant to be treated, should first be fully healed before the begin of the procedure.
• Illness: If weakness of the muscles caused by illness such as myasthenia gravis is acute, the treatment should be postponed.
• Intake of Medicine: Injections should be postponed if you are currently on or have just stopped the intake of certain antibiotics (aminoglycoside antibiotics). Medication which contains acetylsalicylic acid (ASS) should as well not be taken beforehand.

The proper botulinum toxin (Botox®️) therapy conduct is essential to ensure a naturally beautiful and safe result. Most side effects of the treatment have their origins in the miss handling or unprofessional processing of the active agents. Indispensable for the success of the treatment are proper technique, a lot of experience, specialized education, high quality compounds and clean injection needles. In order to ensure such a standard, a doctor must regularly follow up with the latest developments in this field. This means that while you are choosing a doctor, always pay attention to the presented qualifications, certificates and tenured experience. The attending person should be knowledgeable in the field of cosmetic medicine and have a lot of experience in mater of injections.

Before you begin your botulinum toxin (Botox®️) treatment, you should undergo an extensive consultation which should result in the creation of a detailed treatment plan. A consultation appointment will also be a good possibility to attain a first impression of the treating physician. It is important that you feel welcomed and safe in the practice of your choosing and that your wishes and visions are being taken seriously.

This applies for Switzerland: Only medical doctors are allowed to handle and inject botulinum toxin (Botox®️). Cosmetic artists are generally prohibited to inject botulinum toxin (Botox®️).

In our AVORYA beauty practice in Zurich, all treatments with botulinum toxin (Botox®) are carried out by the experienced specialist in dermatology and owner of AVORYA, Dr. med. Bettina Kerbler. Dr. Kerbler is a specialist in injections and has been working as an instructor, contact partner and speaker for Allergan for many years. The pharmaceutical company Allergan offers a number of leading products in the field of medical aesthetics and dermatology, including Botox®. Wrinkle treatment Zurich – We advise you holistically and in detail about the different treatment options for wrinkles in our practice AVORYA. Schedule your appointment now. We are looking forward to your visit.

Before you start the actual therapy, you should definitely always conduct a consultation in the practice of choice, which will go over your medical history as well as your momentary intake of medicine and involve an examination of the skin area in question. Furthermore, you should have the opportunity to put forth your expectation for the treatment. After this, an experienced doctor should explain the possible treatment methods to you, as well as the risks and side effects which may occur as a result of the treatment. The cost should also be openly discussed. Moreover, a successive picture documentation of the affected area should be created. This will enable you to have a direct comparison after the treatment and make it easier for you to see the treatment results at first glance.

Should you already have chosen a treatment method after the consultation, you will, as long as fine needles are used for the injection, no longer have the need for an anesthetic of the affected area. We will of course apply a local anesthetic ointment if you so wish. With assistance of fine needle punctures, we will then inject the botulinum toxin (Botox®️) into the muscle. The active agent will be injected in multiple areas in order to ensure a successful treatment despite the low concentration of active agents. If applied professionally, the muscle will then relax just enough to allow for a smoother skin, yet keep full range of facial expressions.

The duration of a session depends on the scope of treatment. In our practice in Zurich, it usually takes about 15 minutes. First results can be seen after three to five days. The final effect occurs after 14 days at the latest and lasts about three to four months after smoothing wrinkles and four to six months in case of a hyperhidrosis treatment. This varies from patient to patient and depends on physical conditions and the treated body region.

A follow up appointment to monitor even progress should be arranged 14 days after the initial treatment. During which specific areas can be reinjected if this is deemed necessary.

Professionally conducted, treatments using botulinum toxin (Botox®️) harbor hardly any side effects:

• Swelling and Redness: Slight swelling and redness may occur around the point of injection. These are although only temporary and diminish naturally.
• Unwanted Dispersion: In seldom cases, the Botulinum toxin (Botox®️) disperse into the neighbored muscle groups and create temporary unwanted side effects.
• Bruising: If vessels are punctured during the injection process, bruising may occur around the point of injection. Due to the use of fine needles, bruising is although very uncommon.
• Bruising due to Medication: Specific blood thinning medication can cause a delay the clogging of the injection point, which raises the risk of bruising. This is why it is important to inform your doctor about all medicines you are taking.

Although, unwanted side effects may also occur due to false or poor treatment execution. If, for example, too much active agent is injected, the communication between muscles and nerves can be hindered completely. This can cause weakness of muscles, or in case of a treatment of platysma lines in the neck area, lead to difficulties in swallowing. The cause of this does although not, as commonly perceived, in the active agent, but in the problematic implantation of the treatment.

Treatment A botulinum toxin (Botox®️) injection refers to an anti-aging treatment, which is minimally invasive and can be conducted with little effort or restrictions. This type of wrinkle reduction, furthermore, is low in risk, offers a quickly visible result and leads to no downtime. The body will also break down the botulinum toxin (Botox®️) over time. This fact also presents its largest disadvantage of this active agent of having to repeat the treatment in regular periods in order to maintain the results.