DR Andrew j. HAYDUKE
Botulinum toxin injections (brand names Botox, Dysport, Xeomin, Jeuveau and Daxxify) remain one of the most frequently performed non-invasive cosmetic procedures in the United States. The injection of botulinum toxin is a simple, nonsurgical treatment that has been used for decades to temporarily smooth out moderate to severe “dynamic” facial wrinkles. Dynamic facial wrinkles are facial wrinkles that are formed during facial movements (facial expressions), such as during smiling, frowning, raising your eyebrows, squinting or while furrowing your brow. As we age, most of us do not realize how many facial wrinkles form while we are making normal daily facial expressions. Unfortunately, the older we get the more severe these facial wrinkles become. When botulinum toxin is injected into the proper facial muscles, clients enjoy several months of a smoother (more youthful) look to their face during facial expressions since less wrinkles form during animation. In addition, if botulinum toxin injections are maintained on a regular basis without interruption, the facial skin is less likely to form permanent “static” facial wrinkles in the treated area.
Facial wrinkles that exist when no facial movement is occurring are called static wrinkles. Static wrinkles are associated with aging. Static wrinkles will not be improved by botulinum toxin injection since they already exist without any facial muscle motion. Static facial wrinkles are usually seen from about age 45 and beyond (sometimes earlier). Laser skin resurfacing with a carbon dioxide (CO2) laser would be the appropriate choice for static facial wrinkles. Most patients over age 45 have a combination of dynamic and static wrinkles scattered throughout their face. For this reason, a combination of botulinum toxin injection and CO2 laser skin resurfacing would be the ultimate treatment for facial wrinkles for those over age 45.
Botox (OnabotulinumtoxinA) has been around since about 1991 and is the most famous of all the botulinum toxin formulations used in the cosmetics industry. Other commercially available formulations of botulinum toxin (type A) used in the United States to improve dynamic facial wrinkles include Dysport (AbobotulinumtoxinA), Xeomin (IncobotulinumtoxinA), Jeuveau (PrabotulinumtoxinA) and Daxxify (daxibotulinumtoxinA).
Botox has been approved by the FDA for frown lines between the eyebrows (glabellar lines) and crow’s feet. Dysport, Xeomin, Jeuveau and Daxxify are FDA approved for frown lines between the eyebrows (glabellar lines) only. All other uses of botulinum toxin are considered “off label” unapproved uses by the FDA.
Botulinum toxin is a purified biological substance that is derived from bacteria. It is a safe naturally occurring protein. It does not contain live bacteria. Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum. Botulinum toxin interferes with nerve transmission by blocking the release of acetylcholine, the principal neurotransmitter at the neuromuscular junction, causing temporary muscle paralysis. The muscle weakness (paralysis) induced by injection with botulinum toxin (type A) usually lasts about three to four months. During this time, your dynamic facial wrinkles smooth out and your skin appears more youthful during facial expressions. Currently available botulinum toxin (type A) formulations in the United States include Botox, Dysport, Xeomin, Jeuveau and Daxxify.
Botulinum toxin works beneath the skin’s surface and blocks muscular nerve signals, which then temporarily weakens the muscle. Once the affected muscle is relaxed, its overlying skin is no longer being stressed by the muscle motions. The end result is diminished unwanted facial wrinkles of the forehead and eyes (crow’s feet) during facial expressions. This imparts a more youthful appearance to your entire face.
Wrinkles result from a combination of many factors. When you frown or concentrate, the muscles between your brows contract, causing your skin to furrow and fold between your eyebrows. This usually creates two vertical wrinkles (creases) between your eyebrows when you are frowning. Squinting your eyes cause the muscles around your eyes to contract and this creates crow’s feet. Crow’s feet tend to be most obvious during smiling. When you raise your eyebrows and look surprised, horizontal lines tend to deepen and become more obvious in your forehead. Botulinum toxin works on all these facial areas to lessen the wrinkles during facial motion. Less wrinkling in your face during facial expressions makes you look younger.
Dr. Andrew Hayduke will address your medical history and concerns. He will discuss with you the best application of botulinum toxin based on your cosmetic goals. Botulinum toxin is injected with a very small needle directly underneath your skin. The results are not immediately effective, but will become apparent after about five days. In some cases, it may take as long as ten to fourteen days to see the true final result. Bruising rarely occurs and tends to fade quickly. Overall, Dr. Hayduke’s botulinum toxin injection patients are extremely satisfied with the results.
Botulinum toxin products (brand names Botox® Cosmetic, Dysport, Xeomin, Jeuveau and Daxxify) are prescription biological products that work by blocking nerve impulses and reducing movement of the muscles around the eye area, in between the eyebrows, and in the forehead. The decreased muscle activity helps temporarily reduce the appearance of moderate to severe crow’s feet lines, forehead lines and glabellar lines that are formed during facial movements (during facial expressions). The results do not radically change your facial appearance but generally make you look younger while you are making a facial expression. When administered by a properly trained physician, botulinum toxin delivers noticeable, yet subtle results. As opposed to other plastic surgery practices, Dr. Hayduke personally injects the Botox or other botulinum toxin products himself. He does not delegate this task to a physician assistant or nurse. Treatment results are temporary. Patients should work together with Dr. Hayduke to develop a treatment plan that is right for them.
There are risks involved with all types of botulinum toxin injections, so Dr. Hayduke believes his patients deserve to have their injection performed by a board certified plastic surgeon. You cannot compare the detailed knowledge of facial muscle anatomy that a board certified plastic surgeon possesses with the knowledge that a physician assistant, nurse or other physician in an unrelated specialty possesses. Detailed knowledge of facial muscle anatomy is essential for the botulinum toxin to be injected into the proper facial muscles and for the botulinum toxin to have the longest duration of effect. There are 43 small muscles in the human face. Human facial muscle anatomy is quite complex and targeting the proper facial muscle during injections requires true expertise in facial anatomy.
You can easily check the credentials of your prospective physician by visiting certificationmatters.org and verifying yourself if your physician truly possesses board certification in plastic surgery. I recommend that you specifically look for a physician who is board certification by The American Board of Plastic Surgery, rather than a random board unrelated to the specialty of plastic surgery.
Please also read Dr. Hayduke’s blog post on Fake vs Real Botox and watch Dr. Hayduke’s Instagram video on fake Botox.