By the doctor Frédéric Braccini
Botulinum toxin is celebrating its twentieth anniversary in aesthetic medicine and is still the number one rejuvenation treatment requested by patients. This fascinating product continues to be the subject of many clinical studies. New indications and techniques are now possible thanks to the research and work carried out by surgeons and doctors. Today, toxin can be used for “Full Face” treatments, combined with other procedures.
Precision and purity for millimetric distribution
Botulinum toxin can be used in a highly precise way in terms of the injection site and depth, in order to achieve very targeted “myo-modulatory” responses. The way it is used has evolved because we now better understand the 3D distribution of the facial muscles, which gives rise to a well thought-out “3D” treatment approach. Of the toxins on the market in France that are formulated to have a limited range of diffusion – in order to offer more accurate correction while avoiding a frozen appearance – I tend to use IncobotulinumA (Bocouture), which is described as “pure” by the pharmaceutical industry. In terms of physiochemistry, it does not contain any complexing proteins and therefore, in theory, nothing that might cause an autoimmune reaction and the production of antibodies by the body, which is good for people who do not respond to botulinum toxin with complexing proteins.
From a clinical point of view, this toxin is very precise in terms of its diffusion, and it seems to cause fewer immune responses. This is even more useful when we know more about the muscle layout and the neuromuscular junctions, where the nerve ends inside the muscle. The most important condition is knowing where to inject deeply and where to inject superficially, according to the main muscle attachments. This allows for great precision in terms of managing the product’s diffusion and action. The result achieved on a mobile face is more natural because it respects the facial dynamic and avoids a frozen appearance.
Expanding the treatment zones
Botulinum toxin and hyaluronic acid are very useful tools that allow us to correct any flaws and changes in the face visibly and naturally, as well as any negative expressions such as fatigue, anxiety, sadness or anger. With age, the muscle contractions alter the expressions and the patient projects emotional messages that do not match their personality or state of mind.
Forehead wrinkles react perfectly to injections into the frontalis muscle that lifts the eyebrows, as do glabellar lines (corrugator muscle) that make a person look unhappy or stern. In the crow’s feet, 2 to 3 injection points, depending on the case, will smooth the periorbital wrinkles (orbicularis oculi muscle) and lift the tail of the eyebrow, if required. In practice, toxin is sometimes used for other indications than those stated, for example in the middle of the face, level with the nose, as some people have an overactive depressor septinasi muscle, which, though small, pulls the tip of the nose downwards and accentuates any bumps on their profile. A small dose of toxin blocks this muscle and allows the tip to rotate upwards, which lessens the bump. We can also act upon the muscles that dilate the nostrils.
A gummy smile can be treated by relaxing the muscles that pull the lips upwards, allowing the gums to be covered when the patient smiles. This injection also smooths the naso-labial folds.
Severe expression lines are one of the most negative aspects of facial expression. Most of them are connected with hyperactivity in the muscle that pulls the corner of the mouth downwards, and relaxing this muscle repositions the folds. As for “barcode” lines on the upper lip, micro-injections can help, in combination with other techniques. In the lower third of the face, the powerful chewing muscles are responsible for a square jaw. Several sessions, carried out at regular intervals, can relax them, reduce their thickness and give the face a more feminine, triangular shape. These muscles’ hyperactivity is often combined with bruxism (teeth grinding), and therefore toxin has both an aesthetic and a functional role.
An orange-peel effect in the chin, due to the contraction of two small muscles, is easily treatable. Thin and spread out, the platysma muscle of the neck deteriorates as we age, creating a “bowstring” effect. These taut fibres can be relaxed by injecting along the length of the muscle, which in some cases improves the neck’s appearance.
By the Doctor Frédéric Braccini.
Surgeon of the face and neck, Nice. University hospital training in Marseille. Registrar then Associate Practitioner for the American Hospital in Paris. International expert in aesthetic surgery for the face. Co-founder and former president of the Advanced Society for Aesthetic and Plastic Medicine and Surgery (SAMCEP), active member of the European Academy of Facial Plastic Surgery and the Rhinoplasty Society of Europe.
More information on braccini.net
