Botulinum toxin type A (Azzalure)

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  1. Clostridium botulinum toxin type A has been used in clinical medicine since the late 1940’s and for the successful cosmetic treatment of wrinkles since the early 1990’s
  2. Botulinum toxin works by blocking the signal between the nerves and the muscles (neuromuscular junction) and therefore stops the muscle contracting
  3. Botulinum toxin is not only used for treating unwanted wrinkles, it is also used for
    Treating facial asymmetry
    Unwanted facial muscle activity, blepharospasm and hemifacial spasm
    Migraine
    Spasticity
    Ceribral Palsy
    Hyperhydrosis (sweaty armpits)
  4. Careful assessment of the face is required and therefore for maximum benefit no makeup should be worn
  5. Careful placement of the Botulinum toxin is used to paralyse the muscles that cause wrinkles and also rebalance the muscle actions resulting in the elevation of specific areas of the face such as the brow
  6. Botulinum toxin starts to work 6-36 hours after injection and maximum effect will be achieved after 7-14 days
  7. The effect will last between 2 to 4 months before you will start to notice the muscles working and the wrinkles reappearing
    If the patient likes the effect you will require injections around 4 times a year
    If the patient does not like the effect it will wear off between 2 to 4 months
  8. We aim to achieve the desired effect after the first treatment but it may require one or two treatments to decide exactly what the patient prefers in order to gain the optimal effect
  9. Repeated treatments may give a quicker result that lasts longer and therefore increases the time interval between appointments
  10. Areas that can be treated using Botulinum toxin
    Horizontal forehead lines (lifting the eye brows)
    Glabellar complex, vertical or transverse frown lines between the eye brows and above the nose
    Bunny lines (side of the nose)
    Crows feet (to the side of the eyes especially when smiling)
    Upper third of the nasolabial fold
    Upper lip
    Marionette groove
    Chin
    Neck webs and chords

Contraindications for Botulinum toxin use

  1. Pregnancy
  2. Breast Feeding
  3. Patients trying to get pregnant
  4. Previous anaphylaxis (allergic reaction) to Botulinum toxin and other ingredients (albumin, sodium chloride)
  5. Neuromuscular disease (myasthenia gravis, Eaton-Lambert syndrome, motor neurone disease)

Cautions for Botulinum toxin use

  1. Tendency to excessive bleeding
  2. Thrombocytopaenia (low platelets)
  3. Haemophilia
  4. Anticoagulation therapy
  5. Aspirin

Administration of Botulinum toxin

  1. Careful assessment and planning by a Consultant Plastic and Reconstructive Surgeon
  2. A calm and relaxed patient laying comfortably
  3. Targeted areas are injected when the face is relaxed
  4. Combination treatment may be required eg Cosmetic Fillers
  5. Gentle pressure may be required

Post treatment care

  1. Patients encouraged to move the muscles that are injected
  2. Avoid lifting bending or staining for 3-4 hours
  3. Unrestricted activities after 4 hours
  4. Flying and heat is not thought to have an adverse impact
  5. The first effect may be as early as 6 hours and maximal effect is at 14 days

Botulinum toxin injections result in some sequelae (consequences) that are temporary

  1. Discomfort during injection
  2. Needle marks
  3. Slight swelling
  4. Bruising
  5. Mild erythema (redness)
  6. Some areas may be affected earlier than others in that 6-hour to 14-day onset period

Risks and complications

  1. Local (Normally these are temporary)
    Pain
    Tenderness
    Swelling/oedema
    Erythema (redness)
    Bruising (this can usually be covered up by makeup)
    Headache ( do not take aspirin)
  2. Regional complications due to the unwanted effect of Botulinum toxin on adjacent muscles. These are self-limiting and wear off in 2-4 months
  3. Systemic effects are rare in cosmetic usage
  4. Anaphylaxis to Botulinum toxin, albumin or normal saline is very rare.
  5. Therapeutic failure or non response can only be truly assessed after 14 days and before 4-6 weeks and may be due to
    Persistent muscle activity
    Surrounding muscle action
    Static lines will not be affected
    Persistent wrinkle due to dermal atrophy (thinning of the deep layers of the skin)

Our Aim

All patients will be assessed and treated to achieve the desired cosmetic result and minimise complications to ensure complete patient satisfaction

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