Islamabad Clinic Address:
House 25A, Street 52, Sector F6/4,
Super Market, Islamabad, Pakistan
Tel : 92 51 8733552
92 51 8733553

 

Botulinum Toxin

BOTULINUM TOXIN

What is botulinum toxin?
It is a natural purified protein.
What are the uses of botulinum toxin?
  • Wrinkles removal / reduction

There are 4 most commonly seen wrinkles on the face that are treated by botulinum toxin. These are:

 

  • Forehead Lines
  • Frown Lines or lines between the eye brows
  • Crow’s Feet or lines around the eyes
  • Bunny Lines or lines around the upper part of nose

 

  • Reduction of platysmal neck bands
  • Reduction of jowls or Nefertiti face lift
  • Axillary hyperhidrosis (Excessive sweating in underarms)
  • Palmar and plantar hyperhidrosis (Excessive sweating in palms and feet)
  • Face slimming or non surgical jaw reduction (Converting a square face into a slim oval shape)
  • Brow lifting
  • Nasal tip elevation
  • Improving gummy smile
  • Improving the marionette lines (folds running from the angles of mouth towards the jaw line)
  • Improving the depressed/droopy corners of mouth
In which conditions, botulinum toxin is not given?
  • Neuromuscular disease like myasthenia gravis
  • Co-administration of aminoglycoside antibiotics
  • Skin infection at the proposed site for injection
  • Pregnancy / Breast feeding
  • Individuals with allergy to eggs
Is it painful to undertake this procedure?
Most clients describe it as an ant-bite. Patient is asked to apply the topical anesthetic generously on the area to be treated about 15-20 minutes before the procedure starts. A polythene sheet should be applied on top of topical anesthetic to increase the efficacy of the anesthetic.
How much time does this procedure take?
It is known as lunch time procedure taking about 5 minutes.
How is Botox administered?
Botox is injected via a very small needle into the skin.
How does it work?
When small doses are given into the skin, botox blocks the actions of the nerve that supplies the muscles and the sweat glands. This prevents the glands from producing sweat and weakens the muscles so that they are not used over actively and hence the skin overlying these muscles relaxes and the lines & wrinkles smooth out . This not only gives an instant wrinkle reduction treatment but also acts as an antiaging treatment for future by slowing down the wear and tear in skin.
What To Expect after a Botox treatment?

Usually you will have a mosquito-bite looking area for 10-15 minutes which resolves without a trace. Very occasionally, bruising at areas of injection appear but resolve within a couple of days. Try not to fall asleep or relax in a recumbent position for at least 4 hours after a Botox procedure as this may rarely lead to some diffusion or spreading of the Botox to adjacent areas, causing problems.

Your regular skin care regimen can be resumed immediately following a treatment, and makeup may be applied if desired.
After having had Botox injections, exercise should be avoided for twenty four hours.

Try to avoid aspirin containing products or high-dosage vitamin E supplements for 48 hours before the Botox procedure unless medically necessary. Avoidance of these for 10 days prior to the procedure is recommended to avoid bruising.

Can all skin types be safely treated with Botox?

Yes, all skin types can be safely treated with Botox.

 

What are the alternative uses of Botox to treat medical and surgical conditions.

 

Botox is used to treat the following conditions:

  • Hemifacial spasm
  • Blepharospasm(Uncontrollable blinking)can result in the eyelids remaining completely closed all the time,causing functional blindness
  • Spasmodic torticollis( Twisted neck; a forceful turning of the head to one side,a painful condition)
  • Spasmodic Dysphonia(spasm of the vocal cords) resulting in interruption of speech
  • Relief of spastic conditions of the hands in children with Cerebral Palsy and in Stroke patients so as to aid personal grooming
  • Tremor of Parkinsons Disease and Multiple sclerosis
  • Incapacitating pain due to Chronic low Whiplash
  • Incapacitating pain due to back and neck pain
  • Myofascial pain syndrome(Fibromyalgia)
  • Chronic Tension headache
  • Overactive bladder which results in frequent urination ,inability to retain urine and thus frequent “leaks”
  • Clubfoot in babies a condition in which the heel and toes turn inward. Botox injections lengthens tendons by relaxing them,(previously treated by tendon lengthening surgery.) The club feet are then repositioned and stabilised in casts. This avoids the necessity of an operation to correct the defect.
  • Stops drooling by blocking the salivary glands in stroke patients
  • Relieves spasm of anal fissures, a painful condition
  • Helps relieve prostatism in men, a common condition of ageing
  • Relieves the spasm of Achalasia and osophageal sphincter problems that involve difficulty swallowing
  • Clinical trials are underway for treatment of Obesity which involve injecting the stomach muscles which result in distention of the stomach wall and satiety(feeling of fullness)

 

Uses of Botox

 

  1. Wrinkles/ Lines
  2. Nefertiti Face Lift
  3. Chemical Brow Lift
  4. Excessive Sweating
  5. Botox Jaw Reduction

 

  • Wrinkles/Lines

 

What kind of wrinkles does Botox treat?

To understand the various treatments of wrinkles, one must understand that there are different kinds of wrinkles, dynamic and static lines or wrinkles.
Dynamic lines or wrinkles are those wrinkles and lines that appear when your face is animated.
Static lines or wrinkles are those facial lines that are evident even when our face is at rest and are due to volume loss and are better treated with dermal fillers. These two types of wrinkles are what separate Botox from any of the injectable fillers.
Botox is for dynamic wrinkling. It is a muscle relaxing agent so it will soften the wrinkles and lines that occur from a dynamic facial movement, such as between the brows with frowning….or the crow’ s feet from smiling… or around the mouth from excessive pursing of the lips.. With ageing, this repetitive motion will stress out the skin and deep folds and tiny wrinkles start to develop. Botox will also help prevent a mouth frown by relaxing the muscles that exert a downward pull to the corners of mouth.

Why do we get Dynamic or Static lines or wrinkles?
When we were younger and our skin had abundant collagen, the only lines and wrinkles we had were dynamic. Our face was otherwise wrinkle-free when we weren’t animated. All dynamic wrinkles, with age, will eventually lead to static wrinkles as collagen is depleted and constant motion “cracks” the skin. Dynamic Wrinkles are caused by facial expressions and repetitive facial movements. Each time we use a facial muscle, a groove forms beneath the surface of the skin, which is why we see lines form with each facial expression. As skin ages and loses its elasticity, the skin stops springing back to its line-free state, and these grooves become permanently etched on the face as fine lines and wrinkles.
How does Botox help the ageing process?

Consumers are always interested in maintaining a youthful appearance, and as the global population’s median age increases, this market is increasingly expanding. When we are younger, the brow and jaw line elevators are more prominent and the face appears constantly elevated.
As we age, the dynamics change and the depressors take over and combined with gravity, a gradual sagging of our brow and jawline takes place. If we can keep the dynamics between elevators and depressors neutral with strategically placed Botox injections every 4 to 6 months, then the sagging that occurs with ageing will be reduced.
Multiple clinical studies have shown that a modest elevation occurs in the range of 1 to 3 mms which in the face can be a real observable difference. Once the Botox “kicks” in 10 days later, the face takes on a relaxed and refreshed look and one’s face appears to glow.
In other words, an anti ageing effect is achieved because Botox relaxes the downward pressure that the depressor muscles exert on the facial tissues. This results in the elevator muscles of the face becoming more dominant, raising the brow and jawline and preventing the downturned mouth or mouth frown.

Will the lines look worse if one chooses to discontinue the treatment?

No.

How can Botox injections influence how people perceive you?
You only have one opportunity to make an impression. First impressions are significantly influenced by facial expression. Research has revealed overwhelming data indicating that more attractive individuals receive better judgments and treatment from others. More recently, a US doctor has revealed from his research the positive impact Botox can have on first impressions.
When should one start using Botox cosmetic?
With the millions of Botox injections that are performed annually, evidence and experience have shown that prolonged use of Botox over a period of 10 years does slow down the ageing process .If we can relax these facial expressions with Botox, then we can prevent the breaks in the skin, commonly known as wrinkles. If the skin is continually relaxed, collagen can build up in the area that is treated and the wrinkle will improve. Repeated Botox injections (every 4 to 5 months) will ensure a superior long term result as collagen is not depleted by the constant motion of our muscles.
Are there any side effects of this procedure?

Botulinum toxin is US FDA approved for cosmetic use, declaring it a safe product. Minor side effects like bruising can occur which resolves in few days.

In hands of an amateur or an inexperienced injector, serious cosmetic disfiguring complications can arise

  • Eyelid/eye brow drooping/ptosis in case the botulinum is injected in wrong places.
  • Facial asymmetry in case of botox jaw slimming
  • Eye brow malpositioning—Either too high or zig zag
  • In the long run, if the patient is still in wrong hands, muscle atrophy can happen due to over dosage of botox especially in temporal area or around the eyes giving a hollow look at the temples and around the eyes. It is very important to know how much is being injected in you and how frequently you are getting it????
  • Body can stop responding to Botox by producing antibodies against it if cheap botulinum is used by the doctor. It is very important to know what is being injected in you???
Is Botox safe?

Botox facial injections have become an essential ingredient in facial wellness, erasing frown lines and relaxing worried brows. Botox Facial is safe and effective and has been approved for cosmetic use by the FDA. Botox has become the most commonly performed cosmetic procedure and has been used for more than 10 years in aesthetic practice and more than 20 years in neurology and ophthalmology. There are many publications supporting its use. It has a long and impressive safety record.
Botox should be injected at a physician’s office by an experienced and trained medical doctor with an intimate knowledge and understanding of the muscular anatomy of the face as well as the aesthetic implications of proper placement. The final outcome of a Botox procedure is very dependent on the experience of the injector. In addition Botox side effects will be minimized if done by a practitioner who has done thousands of procedures.

  • Botox has been proven safe if administered by a trained medical professional
  • Botox has been used worldwide in millions of patients since 1988
What are the alternative cosmetic uses of Botox?

Botox can decrease the secretion of sebum from the pilosebaceous unit, an important factor for acne conditions.
Another off label indication for Botox is for chronic migraine. Botox is injected into fixed-sites in varying locations, including the forehead, temples and potentially extending into the neck muscles. According to Allergan, the manufacturer of Botox, Phase III clinical trials showed a significantly greater decrease in headache among patients receiving Botox, compared with those receiving a placebo.

  • Nefertiti Face Lift


Named after the Egyptian queen, the Nefertiti Lift is the name for a cosmetic procedure that eliminates the jowls and restores the neatness of the jaw line using Botox injections.
As the skin sags with aging, one of the effects is the loss of a well defined jaw line and formation of jowls giving face a square look. There is a continuous sheet of muscle called platysma that extends from the cheek to the lower neck. Placing multiple small injections of Botox along the lower jaw line as well as down the side of the neck along the rear edge of the platysma muscle, jowls can be reduced and jaw line definition can be improved.
The Nefertiti Lift works by relaxing muscles beneath the jaw which contribute to a down ward pull along the jaw. Once these muscles are relaxed the net effect is an upward pull from facial muscles, creating a more defined looking jawline, neck and face.
However, if jowling is in advanced stages, then a surgical facelift is usually more effective.

 

  •  Chemical Brow Lift

 

If you’ve been considering brow lift surgery to rejuvenate your face and take a few years off your looks, going under the knife may not be your only option. Today’s advanced technologies in facial rejuvenation include skin tightening treatments and strategically-administered injectables such as Botox and Fillers.
In fact the ‘Botox brow lift’ is becoming a popular anti-aging procedure for men and women who have a mild to moderate heaviness in the brow area and don’t want to undergo surgery. Are you a good candidate for this innovative treatment? Here’s what you need to know about the Botox brow lift:

 

How the Botox Brow Lift Works

Botox is commonly used for smoothing out wrinkles and fine lines, particularly in the forehead area. Botulinum toxin acts as a ‘freezing’ agent to weaken the muscles and thereby prevents more wrinkles and lines from forming.

Botulinum creates a lifting effect by relaxing the muscles that pull down on the eyebrows. This not only raises the ends of the eyebrows into a more pleasing arch (correcting a downward slanting “sad eyes” appearance), but also opens the eyes, reducing the “hooded” appearance so common in middle aged eyes.

 

Benefits of the Botox Brow Lift

The Botox brow lift can be performed on all skin types, and may be particularly effective for people who have naturally-drooping eyelids and low-hanging eyebrows. The brow lift literally ‘lifts’ the skin tissues above and around the eyebrows so that the natural eyebrow arch is a few millimeters higher.

Touchup treatments are not required until 3 to 6 months after the initial treatment.

 

Drawbacks of the Botox Brow Lift

If botox is not injected by a trained professional, upper eye lid can droop further. This cannot happen if you are in hands of a professional.
Hence only a certified, licensed professional should administer your Botox injections, and must take the time to go over the potential risks associated with this type of procedure.

The Botox brow lift treatment is recommended for people who have mild brow drooping, and do not want to undergo major eyelift surgery or brow lift surgery to balance out their facial features.

The doctor administering the treatment will need to conduct a thorough facial analysis and consultation with the patient to determine if Botox alone can correct the problem, or facial fillers may need to be used in conjunction with Botox to achieve the full effects.

 

  •  Excessive Sweating

 

What is Underarm/ Axillary Hyperhydrosis?
Axillary Hyperhidrosis is the medical term for excessive sweating in the armpit of a person. This condition involves extreme dripping of sweat in the armpits, which is almost totally resistant to all the types of deodorants and other odour controlling medication.
What is Palmar hyperhidrosis?

Palmar Hyperhidrosis is the medical term for excessive sweating in the palms.

Sweating is necessary for our body as it maintains core body temperature .The human body has 4 million sweat glands distributed on all areas of the skin, with higher concentrations found on the palms, soles, axillae and face.
Sweating has both thermoregulatory and emotional variants.

What causes Hyperhidrosis?

Hyperhidrosis is a medical problem that involves more sweating than what is required by our body. Hyperhidrosis is caused by overactivity of the sweat glands and is present in 1 % of the population and a family history is present in 30 to 50 % of patients suggesting a genetic component.
Hyperhidrosis is triggered by

  • Exercise
  • Heat or cold
  • Alcohol, coffee, tea, smoking , hot or spicy food
  • Stress , anxiety, strong emotions
  • Certain times of the day

 

Social and functional working of the person is directly affected by hyperhidrosis and can create anxiety and depression in the person suffering from it. The condition generally starts in adolescence. Hyperhydrosis is divided into primary or secondary hyperhidrosis. Secondary hyperhydrosis is usually generalized and often has an underlying pathological etiology.

What are alternative treatments?

 

Deodorants and antiperspirants.

Aluminum chloride hexahydrate and salts are used in topical antiperspirant sticks, creams, lotions and solutions. These prevent sweating by clogging the sweat ducts in the skin. These products can be irritating with continued use and are largely ineffective in people with excessive sweating.

 

Anticholinergic drugs and tranquilizers.

Oral medications currently used often provide relief but can cause dry mouth and blurry vision. Tranquilizers may minimize one’s anxiety, but do little to diminish actual sweating.

 

Tap Water Iontophoresis

Battery-powered electrical devices that use water, consist of a moist pad and a prickly electrical current held against skin for several hours. Although they decrease sweating in some people, they are time consuming and they need to be repeated on a daily or a weekly basis. Iontophoresis is mildly effective for severe cases.

 

Surgery – ETS technique

Surgical alternatives include cutting the sweat glands from the skin of the underarms, therein leaving visible scars and permanent numbness of the skin for decreased sweating. Neurosurgeons now use a fiberoptic surgical tube, to cut nerves in the neck which lead to the axillary sweat glands, i.e. endoscopic sympathectomy.

 

Risk and side effects of ETS procedure:

Infection, bleeding, and damage to the nerves.

Compensatory sweating. When this occurs the body “makes up” for the decreased sweating in the treated area by producing more sweat in other areas of the body. Approximately 85% of patients will experience some degree of compensatory sweating. It is important to note that compensatory sweating does not improve with time and is the main cause of dissatisfaction with the procedure.

Gustatory Sweating: Increased sweating when patients eat.

Horner’s Syndrome: Presents with unilateral decreased facial sweating, drooping of the eyelid, and enlarged pupils.

Pneumothorax: Air or gas can collect in the chest cavity, which may cause the lung to collapse.

 

  • Botox Jaw Reduction

 

A New Technique For Facial Reshaping

While a strong, square jaw line can be distinctly masculine and desirable in male patients, many female patients are seeking softer more feminized shape to their face. Particularly in Asian females, changing the shape of the face from square to a more attractive oval shape can add a more gentle graceful appearance.

Jaw reduction surgery used to be the only option for many patients. However, patients had long recovery times, inconsistent and unnatural results. Now Botox has revolutionized facial reshaping. Botox allows for changing the shape of the face without a scalpel, pain, swelling and zero downtime.

Botox jaw reduction is a specialized technique to reduce the width of the jawline changing an overly square jawline to a more attractive oval or heart shaped face.In some patients, the the masseter muscle, a chewing muscle, is enlarged creating extra facial width. Botox selectively weakens this muscle over time leading to an overall reduction in the size of this muscle.

Dr. Abbasi’s special technique of injection makes this a pain free and bruise free experience. Many patients come on lunch breaks to have this procedure done and are able to return to the office immediately after. Patients typically notice softening of the masseter muscle at one week and softening of the jawline at 6 weeks.

Some researchers have noticed “permanent changes” to the jawline after 2-3 treatments. However, it is reasonable for patients to expect long term benefit but not permanent changes.

 

 

FAQs

What is Botox Jaw Reduction?
Botox jaw reduction is where botulinum is injected into the muscles of the jaw (called the masseter muscle) to reduce its size. In some ethnicities, patients have a tendency to develop overly square facial features. Botox can reduce the overall size of the masseter muscle, allowing for improved facial proportions in a noninvasive manner.
How does Botox Jaw Reduction vary from jaw reduction surgery?
Botox jaw reduction is a relatively painless, no downtime procedure which can be performed in an office setting. Jaw reduction surgery is an invasive surgical procedure involving either cutting or shaving of the mandible (jaw bone) to help reshape it.
What the benefits/drawbacks of one over the other?
Botox jaw reduction can create a natural, subtle improvement to the area without any downtime or potential complications. Jaw reduction surgery can cause sensation issues, dental alignment issues, and potential for pain along theTMJ area. Botox jaw reduction is actually one of the treatments for TMJ discomfort.
What can cause bulky jaw line?
Chewing on hard foods and jaw grinding can result in overdeveloped muscles in the jaw line. This is known as masseter hypertrophy or more commonly, square jaw, and concerns many cosmetically.
How is the procedure done?
Botulinum is placed in the muscles via tiny injections using a very fine needle.
How long does each treatment take?
It takes only 2 minutes.
Is the treatment painful?
No. The patient is asked to wear a numbing cream 10-15 minutes before procedure.
Is there a downtime?
There is no downtime for this treatment and you can resume your normal activities immediately.
How long will the results last?
The results will show after around 2- 3 weeks and will become clearer in 2-3 months. The result will last up to 18 months or over depending on the individual. You will be advised by the doctor to repeat treatment to gain the desired change in face shape.
Are there any side effects?
There could be mild bruising in rare cases resolving in 2-3 days.
Can you experience any pain initially when eating? Do you need to restrict your diet immediately after the treatment?

There is no pain with eating. Dr. Abbasi recommends the restriction of gum chewing, chewy candies, tougher meat products etc as they can promote masseter fullness
.

Initial phase consists of 2-3 treatments, how long does that last?
Dr. Abbasi recommends that patients are treated with a second treatment 4-6 months after the initial treatment. Most patients do not need a third treatment, however, for patients seeking further correction this can be redone.
How often does it need to be re-done?
After patients are injected with 2 treatments, most patients do not need additional treatments with botox. Those that seek in further contouring typically come for repeat injections every 12-24 months.

If I stop practicing some negative personal habits like chewing tougher meats or chewing gum, do I still need the botox jaw reduction?
Yes, since the muscle will not atrophy on its own. Botox will change the physical mass of the muscle and make it less prominent.
How many units of botox are used for jaw reduction?
This is no set number of units or dosage of botox used for treating the masseter hypertrophy. The average necessary for most patients is 25-40 units per side, with a great variation based on the size of the muscle.
Are the results of jaw reduction permanent?

Yes and no. Masseter reduction with botox is when the botox is injected directly into the muscle to reduce its size and force. As time goes on, the treated patient will be trained not to use the masseter muscle with as much force enjoying the results for 12-24months.
If a patient desires more bulk in the masseter area, they could chew gum, eat chewy foods, such as chewy candies or tough meats, or flex the muscle more often.
It is vital that an injector have a keen understanding of both the aesthetics of the face and a vast knowledge of facial anatomy.