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Botulinum Toxin


What is the Treatment with Botox Cosmetic ®?

   The expression marks appear in the face as furrows or wrinkles. They are caused by the action of expression muscles. The use of these muscles varies from a person to another. Some people use these muscles much more and others less. What happens along the time is: the muscles are contracted in so many repeated times so they are hypertrophied and the tonicity increases (Tonus is the contraction degree that stays even when the muscle is resting). It happens as if the muscle of the expression were submitted to a fitness program. This hypertrophy forms furrows and wrinkles that appear in a very marked way in the moment of the expression and it stays, a little less marked, even when we are not contracting the muscle. Those furrows and wrinkles stay exactly by the effect of the muscle hypertrophy and tonus.

            As long as the time and the aging process pass by, the skin can break and the wrinkles can be more accentuated and marked. The action of the sunlight causes the photoaging and it removes the elasticity of the skin and the whole process increases giving to the face skin an aged aspect.

    The Botulinum Toxin(Botox Cosmetic ®) that is a substance produced by the bacterium Clostridium Botulinum, has a potent action, but if it is used in small doses, it doesn't make any badly effect, and it can improve the aspects of facial aging. The dose used for aesthetic purpose is from 25 to 50 units. Three hundred units surely are able to cause problems to human being. The small amount used with aesthetic purposes obtains the effects without damaging the human health.

            Botox Cosmetic ® is used to correct the expression wrinkles. The forehead wrinkles, the furrow between the brows and the famous Crow’s feet can be removed with this method. Other areas can also be treated. Lifting with Botox Cosmetic ®, is a technique that elevates the corner of the brows and opens the eyes, with a very interesting effect. The technique consists in injecting the substance in the muscle in which hypertrophy and tonus cause the emergence of wrinkles. Then, it is obtained a temporary paralysis (obviously in the unnecessary muscles), exterminating the lightest wrinkles and reducing the deepest ones.

            Botox Cosmetic ® performed with efficiency, brings great results. These results are the responsible for the explosion of its use. The patient, his family, his circle of friends and coworkers will notice the improvement, but this improvement should be natural, and it is desirable that he doesn’t realize that Botox Cosmetic ® was applied. The objective is when the people say to the patient that he is well, with a good aspect and with better appearance. The exaggerated use of Botox Cosmetic ® presents little natural results; it should not be the objective of the treatment. At the Naturale Clinic, we prefer Botox Cosmetic ® for the Crow’s feet, for the wrinkles of the forehead and for the reduction of wrinkles of glabela. We treat wrinkles and furrows from other locations with other techniques, and then, this way, we maintain the natural results.

            The duration of effects is about 6 months, and later it disappears. What happens is that the muscle is forced to rest by Botox Cosmetic ®, so it keeps a little weaker and when the contraction action returns, it takes some time to the muscular activity effect cause hypertrophy and the return of the muscular tonus like before the treatment.

            Botox Cosmetic’s ® application can be then repeated. The muscular activity returns as it was before at about the fifth month of the application, but the wrinkles only return around 6 months, that it is when Botox Cosmetic ® should be reapplied. The return of the movement doesn't mean that Botox Cosmetic ® should be reapplied immediately, because the muscle has caused the wrinkles and it is still weak and it should only be treated when it recovers the normal tonus. It normally happens between 5 or 6 months in the first applications and between 6 or 8 months in patients that do the regularly treatment.

            With the lack of muscle’s temporary function, the habit conditioned that forms expression wrinkles decreases. As a result, the speed of emergence of new wrinkles is smaller. Then, even stopping the use, a beneficial effect keeps for a certain time. But with the repeated applications, in the right time, about 6 months, there is a trend to an effective effect.

            Some people however can present a “vaccine effect” and the toxin isn’t so efficient, but it happens in a small percentage of cases. When some patients can develop immunological defense to Botulinum toxin and it is as if he was vaccinated, so the “vaccine effect” can happen and the toxin is not more efficient. This case rarely happens. It happens in a small quantity of patients and now it is already available the Type B Toxin - Myobloc®, to be used in possible resistant patients. This toxin B was developed with a different group of clostridium, and therefore, it has different properties. If a patient has the lack of lucky for being resistant to one type of toxin she can have a great possibility to answer to others types, like the Myobloc®.

            In some cases, what is not so rare, a patient that answers correctly to Botulinum Toxin’s use, in a certain application, obtains a smaller answer in another one. It can happen because of the “vaccine effect”, as we already said, but it can also happen because of some other technique cause, as an inadvertent inactivation of the Toxin. The toxin is very labile and it can be inactivated easily, the simple placement in the syringe, if it is not careful, can inactive the product. The transport, storage and dilution can also disable the Toxin. Then, if the toxin was not efficient in an application, it should be repeated and only then, if it is inefficient over again, you can attribute the fact to the "vaccine effect ".

            The Toxin is liberated by FDA (American medicines control), and by ANVISA, the Brazilian Health Authority as muscle blocking and correctly performed by trained doctors, it doesn't present serious complications. It can be used with others techniques.

            It is important to choose some well trained doctors to the Cosmetic ® application technique. Naturale Clinic was one of the first clinics to use the Botulinum Toxin in Brazil and it is already performed in hundreds of treatments. Their doctors develop researches and they perform some lectures and conferences on the subject.

Where the Botulinum Toxin can be applied?

            The Toxin presents better results in the superior part of the face. It can be applied to the forehead wrinkles, glabellas wrinkles (between the brows) and around the eyes (Crow’s feet). In these areas the toxin presents the best results and is considered one of the best treatments, for these cases of aging and of expression wrinkles.




Another great application of Botox Cosmetic ® is Lifting with Botox Cosmetic ®, the elevation of the corner of the brows and the increase of the aperture of the eyes.

            Botox Cosmetic ® can be applied in other places as the inferior eyelid and in the lip corner depression and it has also been applied in other locations, but the wrinkles of the forehead, the Crow’s feet and the glabellas wrinkles are the best indication.

            A small dose of Botox Cosmetic ® in the inferior eyelid helps to minimize the eyelids wrinkles. Controlled doses of Botox Cosmetic ® in the mouth area help to reduce the wrinkles around of the smokers’ mouth; however the Fillers have better results in this location. An application of Botox Cosmetic ® in the infralabial muscles elevates the corner of the mouth, leaving a more pleasant expression.

            The application with special techniques of Botox Cosmetic ® in the front area elevates the corner of the brow, performing a true brow lifting, without surgery. Platisma, the muscle of the neck, can suffer a contraction sensation attenuated with Botox Cosmetic ®, with interesting results.


How the Botulinum Toxin is applied?

            In the initial consultation, Naturale Clinic's doctor explain to the patient the indications, and the expected results of the skin treatment, in an individualized detailed way .He presents all  options, and decides with the patient what is  the most appropriate techniques for the case. Botox Cosmetic ® is frequently used.

            The patient comes to the clinic and at the scheduled time performs the application. On this day, the patient should not use any medicine, cosmetic or make-up in the face. When the patient arrives to the Clinic is applied an anesthetic ointment on the area that will be treated. This ointment keeps some minutes in contact with the skin, when it is obtained a transient anesthetic numbness of the skin. The patient is ready to receive Botox Cosmetic ®.

            Asepsis of the skin is performed with medicinal antiseptic; a demarcation of the applications points with paint is proceeded. This demarcation is based on study that the doctor performs for each patient's muscular movements and it serves as orientation for the application. Some patients possess the muscles of the face contracting in a same way, in this case the application points are drawn in a symmetrical pattern, other patients possess the muscles asymmetries, and in this case Botox Cosmetic ® should also be applied asymmetric, trying this way, to correct the muscular difference. The demarcation also allows to the Lifting Effect program being natural, without altering, negatively, the expression.

            Botox Cosmetic ® is applied with micro needles, very thin, imported from Europe, and it has a layer of protecting silicone that allows the puncture to be very easy, and with low pain. After the application that lasts about 10 minutes, the patient receives a protection of ant allergic adhesive plasters, that  maintains Botox Cosmetic ® in the points where  was applied.

            The patient can return the normal activities immediately, if she wants to remove the adhesive plasters, it can be done two hours later. The home recommendation is not to lie down for 4 hours, but to avoid heavy gymnastics in the day of the application, and not to massage the area in the day of the application. The following day, the activities are totally regular.

            The results appear in 2 or 3 days, and they are stabilized in 10 or 14 days.

Botox Cosmetic ® is so much used and it is frequently associated to Fillers and Bioplasty in our clinic.


Treatment of wrinkles on other locations with Botox Cosmetic ® or Dysport ®

Botox Cosmetic ® that is already very known and certain to correct and to control the wrinkles in the superior part of the face has been applied in other locations. A small dose of Botox Cosmetic ® in the inferior eyelid helps to minimize the palpebral wrinkles. Controlled doses of Botox Cosmetic ® in the perilabial area helps to reduce the wrinkles around the mouth and the smokers’ mouth as well.  An application of Botox Cosmetic ® in the infralabial muscles elevates the corner of the mouth, attributing a more pleasant expression. The application with special techniques of Botox Cosmetic ® on the front area elevates the corner of the brow, performing a true lifting without surgery. The Platisma, the muscle of the neck, can have a contraction state attenuated with Botox Cosmetic ®, with interesting results. Although Botox has all these applications, at Naturale Clinic we applied on the area of the forehead, on the Crow’ s feet, and on the glabellas wrinkles, and we performed the lifting frequently with Botox Cosmetic ®. For the problems of aging in others locations, we preferred others techniques, like Fillers and Bioplasty.


Myobloc® - Type B Toxin

            There are several types of Botulinum Toxin:  Botox Cosmetic ® and Dysport ® are  the type A. Myobloc® is the type B. the toxin type B has similar effects, but  we can  use  in a few patients who present resistance to the type A , or those ones that  receive the application but with small effects or a small duration of the effects. In these cases the type B Botulinum Toxin, Myobloc® can be used. Myobloc® has already been licensed and it has been used in the USA , however, it was still not regulated by the Health Brazilian Authorities and it is not available for this use.

Botulinum Toxin History

            It was a German poet who was also a physician and scientist who explained the illness called botulism. Dr. Justinus Kerner of Wurttemberg, from 1817 to 1822 published the first studies of that illness.

            Dr. Kerner, a representative of the German romantic poetic movement had their poetries turned in music by Schumann. But in other areas, with their first studies of the botulism, Dr. Kerner had already imagined that the toxin that caused such serious illness could be used to treat illnesses as the muscular spasms and hyper movement alterations. What a great poet! What a great doctor!  What a magnificent scientist! That amazing human who always stood out in all areas could not glimpse that this toxin would be one day used to treat the people's appearance and that, certainly, would make him happier.

            In 1978, the toxin was applied in humans, as treatment, by Scott, and surprisingly we find a safe drug, which would be used in many other medical indications, even on the aesthetics. Jean Carrhuthers worked with Scott applying the toxin for strabismus treatment. A strabismus patient treated by Carrhuthers told that their wrinkles got better a lot when the toxin was applied. With her husband, Jean Carrhuthers started using the Botulinum Toxin to cosmetic purposes beginning the revolution that we observed in the treatment of the wrinkles and the aging.

            The use of toxins as medicine are part of the history of the medicine, it was this way with the penicillin produced by a fungus, and with the captopril, a drug so widely used  for hypertension, derived from the jararaca snake's poison and many other.

            The doses used for the wrinkles treatment with the toxin are about 30 times less then the ones that would be capable to cause complications, similar to the illnesses. It offers a great safety.

            The doctor- poet and scientist Kerner would be satisfied in seeing such dangerous toxin to be domesticated and utilized to the happiness and the quality of the people's life.

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