Botox and wrinkles (No. 2)

“the treatment to erase wrinkles with Botox”

Our clinic is in a small town in Tokyo but with many foreigners here in the town of Hiroo. As mentioned in this homepage, Botox is currently widely used for treatment other than wrinkle, such as slimmer of muscle of jawline, hyperhidrosis of armpits and limbs, migraine, and the like. In our clinic, in particular, there are many patients who use Botox for treating headaches.

Today we will talk about Botox treatment example for wrinkles. The unit used here is discussed based on Botox of Allergan Inc.

Frown lines: wrinkles between the eyebrows are types of vertical wrinkles (also called 11 o’clock signs) that can only be made when expressing difficult expressions, or types that always exist irrespective of facial expressions. In the former case, Botox often works, the effect usually appears within one week after treatment and the effect lasts for 4-5 months. Botox works at the site of the nerve endings, making the muscles paralyzed by not transmitting mediators between the muscle junction and making it less likely to wrinkle.

The target muscle is the muscles running parallel to the eyebrows called the corrugator muscle and the muscles running up and down at the base of the nose called the procerus muscle. Normally 4-6 places slightly above the eyebrows, 1 injection at the root of the nose (to the procerus muscle). The dose is 15 – 20 units. Furthermore, when injecting, the outside of the eyebrow shall be shallow and the inside will be treated deeply. Even if you do not make a difficult expression, if there is always vertical wrinkles between the eyebrows, injected materials such as hyaluronic acid may be better (though extreme caution is required for hyaluronic acid injection at this site). Avoid lying down for about 4 hours after injection, avoiding swimming and other exercise, the effect will appear after 4-5 days. It is said that the peak of the effect appears after two weeks, but we check the result after one week and if necessary, carries out additional touch-up injections for free (the guarantee system one week later ). The cost will be 30,000 yen plus tax when only eyebrows wrinkles.

Wrinkle of the forehead: The transverse wrinkle of the forehead can be made when looking upward, and this is due to the frontalis muscle which is one of the expression muscles, the muscles running above and below the forehead, 90 degrees to the wrinkle lines. Wrinkling of the forehead may also always exist regardless of facial expressions, or it can only be seen when making facial expressions. Botox will be a good application in the latter case, and we will inject a total of 15-20 units to the eight forelocks of the forehead.

The point to pay particular attention to in terms of the procedure is that it is often better not to treat the sideways of the forehead at the part near the outside of the eyebrows. If Botox is effective in this part, the eyebrows will drop. Another problem is that when you open the eyes, sometimes you use forehead muscles (forehead muscles) for some people. If Botox treatment is given to the forehead of this type, eyelids become difficult to open. In order to prevent such problems, block the action of the frontal muscle by putting your fingers above the eyebrows in advance and check how much the patient uses the frontalis muscle to open the eyelids. When the frontalis muscle is heavily involved, avoid botox injection in the lower part of the forehead.

By the way, even with the same botulinum toxin preparation, products made in Europe are more likely to diffuse and seem to be prone to the problems described above. Treatment expenses are 30,000 yen plus tax in case of forehead only, but if you join the frown lines or the crows feet, somewhat cheaper on 50,000 yen in two of these parts. The effect is longer than the eyebrows and often lasts more than 5 months. Like the eyebrows, there is a guarantee system one week later. Another thing to note when injecting Botox on your forehead is that you can change the shape of the eyebrows in the way of injection. This method is also used when you want to fist up the crawl outside the eyebrows. This method is also suitable for patients whose eyelid slack is progressing.

Wrinkles in the corner of the eyes (crows feet) can be made fan-shaped from the outer corner of the eyes when laughing with eyes, there are types that can be upward from the outer corner of the eye, downwards, and upwards and downwards. Also, like wrinkles in other parts, there are deep wrinkles that are made even when you are not smiling with your eyes, and not so obvious types of wrinkles when not laughing. The type that Botox shows effective is the latter type. If you have deep wrinkles even when you are not laughing, hyaluronic acid may be injected into that wrinkle.

The treatment amount depends on the number of wrinkles, but it is about 18-25 units on the left and right. The addition of one more thing in the treatment of Botox to the wrinkle part of the corner of the eye can change the shape of the eyebrows. Sometimes it is possible to lift the outside of the eyebrows slightly upwards by Botox injection to the oculi anterior muscle beneath the outside of the eyebrows (it is not a method that everyone can do).

Wrinkles in the upper lip: Longitudinal wrinkles occurring in the upper lip are common in women over the age of 60, but this is caused by the action of the orbicularis muscles surrounding the mouth. This phenomenon is not seen much in men because there is a beard in this part.

When treating, have the patient pucker the mouth, especially marking the vertical wrinkle which occurs strongly with a pen, then inject 10 to 15 units into 4-5 places. Being careful with Botox’s injection to the lips, when the balance between the left and right collapses, the shape of the lips may change or it may be difficult to pronounce correctly.

Injection to other facial sites: Botox is also used for treating temporomandibular disorder by thinning the face line by injection into the muscle of jawline on the face. In addition, Botox’s injection may show a remarkable effect in the uneven surface like the oranges that can be made to the chin. On the other hand, Botox has no effect on the nasolabial lines or Marionette lines (wrinkles extending obliquely downward from the outside of the mouth). Hyaluronic acid injection is recommended for these sites.

“Side effects and failure cases in Botox wrinkle treatment”
Side effects: Although side effects related to Botox treatment are extremely rare, as a example, the eyelid becomes difficult to open (eyelid ptosis is seen less frequently than 1%. It is a complication especially seen in treatment to the frown lines. Even if this condition happens, it will return to its original state naturally in about 3-6 weeks. However, once this condition has occurred, there is a tendency for the situation to become the same again. The next time to be seen is in the treatment section, but the shape of the eyebrows may change or drop down when treating the forehead.

Those who are taking fish oil, DHA, EPA, aspirin or a pain killer tend to have a bruising tendency. In addition to the above, it is not recommended to egg allergy, those who have suffered facial paralysis in the past, those who are pregnant, breastfeeding, those who are planning to become pregnant within the next 3 months. Botox is also used for the treatment of migraine, but as a very rare complication, it may cause a headache to a healthy person. Also, when you have a cold, you may not be able to treat because your condition may get worse when you do not have physical fitness. Even those who are taking some antibiotics are considered to be cautioned.

Failure cases: Extreme failure example does not occur easily, but as we have mentioned, treatment of facial wrinkles using Botox has been used to paralyze muscle groups called facial muscles to make it more attractive. It is a treatment that expects a good effect, so it would be difficult to produce results that you expect to not understand facial muscles and nerve anatomy well. In the United States, Botox’s treatment is usually performed only by a doctor who has received proper training from a plastic surgeon or a dermatologist.

Tummy tuck combined with other procedures

Surgery called Tummy tuck is a surgery to correct sagging of the abdominal skin and subcutaneous tissue, which is associated with extreme weight loss from postpartum and obesity. Because it is a relatively large-scale operation, it is a treatment to be done after hospitalized.

At the same time as the tummy tuck, there are occasionally those who wish to perform liposuction surgery in the abdomen or correct the drooping of the breasts. However, we do not recommend doing two or more such operations together (compound surgery). The reason is that the risk of complications increases significantly.

It has been reported in the United States that necrosis of the tissues of the abdominal wall is likely to occur when Tummy tuck and liposuction are performed at the same time. In addition, when Tummy tuck and breast surgery are performed together, the operation time also becomes longer, the rate of causing deep vein thrombosis increases, water accumulates subcutaneously also in the site of tummy tuck (seroma), the healing of wounds said to be poor.

If you wish to do some of these surgeries, we recommend that you consider the next operation after a period of recovery from each surgery for safety.

plastic surgery and systemic management

Many of the surgery in the field of cosmetic plastic surgery are day trips and I think that there are many relatively small scale cases of 1-2 hours. However, sometimes there are cases where you need to be systematically monitered after being hospitalized, with breast reconstruction, massive liposuction, or surgery using free tissue.

As mentioned in this blog before, patients need to stay away from blood thinning agents such as Vitamin E, fish oil, aspirin, etc., and during the surgery we use devices to prevent deep venous thrombosis by intermittently massaging instruments in the lower limbs.

When considering the risk factor of the patient side, factors such as age (65 years old and over), obesity index (30 or more), presence of smoking, presence of other basic diseases (diabetes etc.), etc. become a problem.

In addition, in case of surgical procedures for cosmetic purposes, when considering the balance between risk and benefit, it is required that the risk be lower than when treating disease.

Those things are difficult to understand for the general public, but since it is important to life, if you are planning for big surgery, please consult with your plastic surgeon once again.

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