Reviewing the role of non-surgical options as part of the management of the aging face would be incomplete without an introduction to facial wrinkles (clinically also known as rhytids). There are two types of facial wrinkles, dynamic and static.
Dynamic wrinkles are those lines of expression present only during animation (i.e. when the particular muscle group is active). Typically, these wrinkles are located in the upper third of the face and include the horizontal forehead wrinkles, the wrinkles between the eyebrows and those around the eyes. Dynamic wrinkles are best treated by agents that relax the muscle groups responsible for their activity. This can be accomplished with neuromodulators such as Botox™ or Dysport™ (both are commercial names for Botulinum toxin produced by two different companies). Neuromodulators act by relaxing the muscle groups into which they are delivered preventing the muscle overactivity generating the wrinkles. Occasionally Dr. Numa may use these for other purposes, including for example, modifying the height and orientation of the eyebrow, or the occasionally occurring downward slope of the corner of the mouth.
Static wrinkles, on the other hand are those caused by a combination of long periods of over expression and loss of skin elasticity. These lines of expression are present even in repose, in the absence of activity of the muscle group in question. Static wrinkles respond best to dermal filler products, or a combination of neuromodulators and fillers.
Botulinum toxin (Botox™) has been in use for clinical purposes for approximately twenty years, and it has proven to be an extremely safe product for both cosmetic and medical purposes. Botox™ is the commercial name of botulism toxin produced by Allergan. Dysport™ is the commercial name of botulism toxin produced by Medicis. Botox™ and Dysport™ are not substitutes for surgical procedures such as a facelifts, browlifts or eyelid surgery. In fact, the use of Botox™ as an adjunctive procedure following these surgical procedures will typically help enhance a patient's appearance, as these surgeries do not address the wrinkles susceptible to Botox® treatment.
Patients typically return to normal activity, such as work on the same day following an injection, and the effects of Botox™ start to become apparent in five to seven days after the session. A follow-up visit is typically scheduled two weeks after the initial injection, and when indicated a touch-up can be given at the time to refine the final appearance. Dr. Numa does not charge any additional fees for touch-ups at the follow-up visit.
Treatments with Botox® and Dysport® usually last about four to five months, and as patients continue their treatments, the time interval between treatments can sometimes increase.