Botulinum toxin use in dermatology

Botulinum Toxin

Dr. Sanjay SinghAIIMS, Dermatology

Introduction

Product of clostridium botulinum

Bacteria and their spores are ubiquitous

Found in soil and marine segments

Spores detected in vegetables, fruits and sea foods

Growing bacteria produces neuron toxin, botulinum

toxin, the most poisonous substance

Toxin inhibits the release of acetylcholine

Results in flaccid paralysis

Seven serologically distinct types exist

Type A ( Allergan)

Type B (Myobloc)

All seven types are distinct in their molecular weight

Botax is indicated in wrinkles caused by muscular contraction and not by solar exposure

Indications

Frown lines between the eyebrows ( glabellar lines)

Strabismus and blepharospasm associated with dystonia

Cervical dystonia

Transverse forehead lines

Lateral canthal wrinkles (crow’s feet)

Medial and lateral brow lifts

Wrinkles on the upper lips

Nasal scrunching and flaring

Marionette lines

Necklines

Platysmal bands

Mental creases and dimpling of chin

Palmo plantar hyper hidrosis

Relevant anatomy

Vertical rhytides- Corrugator supercilii muscle

Horizontal rhytides- Procerus muscle

Horizontal frown lines – Frontal muscle

Crow’s feet – Orbicularis oculi muscle

Excessive lip pursing – Orbicularis oris and

mentalis muscle

Platysmal bands- Platysma

Dosing of Botox

Contraindications

Wrinkles not caused by muscular contractions

Neuromuscular disorders

Hypersensitivity to any ingredient in formulation

Pregnancy or breast feeding

Unrealistic expectations

Possible interference with the patients’ work

or daily activities due to changed

expressions

Workup

EMG

Starch iodine test

Treatment

Preoperative details

Patient counseling

Pre and post photographs

Remove makeup's

Patient should lie on back propped up position

After injection do not massage the injection site

Avoid exertion on the day of treatment

Complications

Local effects: Drooling, pain, bruising, infection

Weakness of muscles

Ptosis

Delayed eye closure

Headache