botulinum toxin use in dermatology
DESCRIPTION
Botulinum toxinTRANSCRIPT
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