Botulinum Toxin Injection for Facial Wrinkles

Botulinum toxin injections for the treatment of facial wrinkles are the most commonly performed cosmetic procedures and one of the most common introductory procedures for clinicians seeking to incorporate cosmetic treatments into their practice. Treatment of frown lines and crow's feet (FDA-approved cosmetic indications) and horizontal forehead lines provides predictable results with few side effects and is associated with high patient satisfaction. Wrinkles are formed by atrophy of the dermis and repeated contractions of the underlying facial musculature. Botulinum toxin is a potent neurotoxin that inhibits the release of acetylcholine at the neuromuscular junction. Injecting a small amount of Botox into specific overactive muscles can cause localized muscle relaxation, thereby smoothing overlying skin and reducing wrinkles. The effects of Botox take about two weeks to develop fully and last for three to four months. Dynamic wrinkles seen during muscle contraction have a more pronounced effect than static wrinkles seen at rest. Botulinum toxin injections are contraindicated in people with keloids, neuromuscular disorders such as myasthenia gravis, allergies to the ingredients of botulinum toxin products, and body dysmorphic disorders. Minor bruising may occur from Botox injections. Temporary ptosis and brow ptosis are rare complications that are technique-dependent; the incidence declines as injector skill improves.