Dear Dr. Dave and Dr. Dee,
I have deep wrinkles on my forehead, and my sister suggested that I get Botox injections. The idea of having a toxin in my skin worries me. Is it safe? What else can I do?
Dear Worry Wrinkles,
Small amounts of Botulinum toxin is used to block nerve impulses, causing temporary paralysis of the forehead muscles for 3 to 4 months. The U.S. Food and Drug Administration (FDA) has granted approval to botulinum toxin type A (Botox Cosmetic) specifically for use on the glabellar lines, the vertical lines between the eyebrows, for adults age 65 or younger.
The AAD (American Academy of Dermatology) considers Botox injections a safe procedure. Possible side effects are soreness or mild bruising around the injection site, temporary headache, temporary weakness of neighboring muscles, and a temporary droopy brow or eyelid. For more information on Botox, visit the AAD website at www.aad.org
Besides Botox, there are other treatments for removing wrinkles. In brief below are cosmetic procedures for skin rejuvenation to help diminish the signs of aging as described by the AAD.
11 AGING SKIN COSMETIC PROCEDURES (AAD, 2008)
1. BOTULINUM REJUVENATION
Reduces the appearance of lines and wrinkles by injecting small amounts of botulinum toxin into targeted muscles and blocks nerve signals to these muscles. The resulting nerve blockade of that muscle causes a local immobilization of muscle movement to prevent crinkling and wrinkle lines from forming when the patient frowns or squints. Results can be seen in 3 to 7 days and lasts 3 to 4 months.
2. CHEMICAL PEELING
To diminish fine lines and wrinkles, acne, skin discoloration, dull complexion, or rough skin. A chemical solution that may contain glycolic acid, salicylic acid, or trichloroacetic acid is applied to facial skin, causing the skin to blister and peel off, and new skin will appear over the next 1-14 days. The penetration deepness of the chemical peel determines the type of aging treated and length of healing. Penetration can be superficial, medium, or deep. The superficial peel (aka: lunchtime peel) only penetrates the outer skin layer to gently exfoliate and treats mild skin discoloration, smooth rough skin, and gives the skin a refreshed look. Deep reaches deep into the middle layer of skin to remove fine lines, age spots, slightly tighten skin and can make a person look years younger, but can be performed only once and only on the face. Results are not permanent as skin continues to age.
Used to diminish deep wrinkles above the lip, shallow scars, or get rid of a tattoo. This cosmetic procedure literally sands away several layers of damaged skin, causing a medium depth or deep wound, with new skin appearing within 10 days. Results might last 10 years. Dermabrasion is not used as much today because of advances in laser technology. A technique that removes less surface skin is called microdermabrasion; it is used most often for superficial skin defects (see below).
Fillers are used to plump lips, fill hollow cheeks, fill deep creases, diminish the appearance of scars, erase fine lines, lift brow or downturned mouth. Results can last months, years, or are permanent depending on the type of filler. For example, collagen lasts 3 to 6 months, hyaluronic acid gel 4 to 12 months, Poly-L-lactic acid and self-donated fat 1-3 years, and PMMA (polymethyl-methacrylate) is permanent.
5. HAIR RESTORATION
The most common hair restoration is hair transplantation where skin on the scalp that has good hair growth is removed and transplanted to areas that need hair. Other restoration techniques are scalp reduction to bring hair-bearing scalp closer together, scalp expansion to stretch hair-bearing areas, and scalp flaps where hair-bearing scalp section is moved to area where hair is needed. Hair restoration takes 1 to 3 treatment sessions with re-growth in 6 to 8 months, and hair growth can last for the person's lifetime.
6. LASER HAIR REMOVAL
Common areas for hair removal are back, bikini area, chest, face (upper lip and chin), neck and shoulders. Laser hair removal takes 1 to 6 sessions, each performed once every 4 to 6 weeks. Results can last several months to years.
7. LASER SKIN REJUVENATION
Lasers can diminish wrinkles and age spots, remove tattoos, warts, varicose veins, and unwanted hair, often in less than an hour, and depending on the type of laser used can have no downtime to several days or weeks of healing. Laser skin rejuvention takes 3 to 6 treatments, and improvement can be seen in several months. Some results could be permanent, but as the skin continues to age some signs of aging may reappear.
Wrinkles and age spots are visible effects of aging, and unwanted fat deposits are another. Despite diet and exercise undertaken to keep looking young and trim, small pockets of fat may remain on the face, chin, neck, breast, abdomen, hips, thighs, buttocks, knees and ankles. Liposuction results can be permanent if the patients maintains a healthy weight and exercises.
Gently exfoliates skin for smoother, brighter, and more even tone. Because microdermabrasion does not deeply penetrate the skin, results are modest, and a series of treatments are needed, perhaps 5 to 16. Results are not permanent as skin continues to age.
10. SKIN TIGHTENING
Non-invasive infrared laser, pulsed infrared light, or radiofrequency are used to firm forehead and cheeks, lift eyebrows, tighten jowls and neck, reduce wrinkles, diminish the appearance of cellulite, and tighten skin on the abdomen, buttock, arms, and thighs. These procedures cause the body to produce more collagen, which makes the skin thicker and firmer. A series of treatments are needed, but there is no downtime and results last about a year. Results from these non-invasive procedures will not be as dramatic to that of surgical lifting.
11. VEIN TREATMENTS
For spider and varicose veins, treatment options are sclerotherapy (solution injected to seal off vein), ambulatory phlebectomy (vein surgically removed), or laser therapy (radiofrequency where laser closes the vein). Vein treatments require several sessions and results are basically permanent.
Always consult with a dermatologist for best treatment options.
For more information, see the AAD article, "Cosmetic Procedures" at http://www.skincarephysicians.com/agingskinnet/cosmeticpro.html