About medical skills, about Dysport and about an individual approach

What do we know about botulinum toxin? This “mysterious molecule of the century” has long ceased to frighten people with its high toxicity and now it is of great interest for its wide possibilities of use in medical practice. The diversity of these possibilities is ensured not only by the fact that many botulinum toxin preparations have been developed today with their own characteristics of use, but also by the skill of doctors who offer new approaches and methods for working with such preparations.

Inna Vladimirovna Litus, doctor of the highest category, dermatologist, cosmetologist of the “Litus” clinic, answered the questions of Estet-portal.com about some features of working with botulinum toxin preparations.

 Inna Vladimirovna Litus,

Doctor of the highest category, dermatologist, cosmetologist at “Litus”clinic

On the basis of your clinic 15 years ago, the first official training course in Ukraine on the use of the botulinum toxin preparation Dysport was held. What were your impressions of getting acquainted with the drug? Has the attitude towards him changed since then?

- It was rather not an impression, but a normal working moment – the introduction of a new remedy, which doctors have known for a long time - how it works, what features it has, but before the official registration in Ukraine they were not able to use it in their practice. There was enough knowledge about Dysport, but there was no experience at that time, because, for example, I do not work with unregistered drugs, like most cosmetologists.

During the time that the drug is present on the Ukrainian market and used in the practice of doctors, of course, there have been many changes – methods of its application are changing and expanding, more and more new opportunities are opening up that can be realized with the help of Dysport.

But I am a conservative, and I am very careful about this drug. All doctors know that Dysport in its use, like any other botulinum toxin preparation, requires very precise adherence to the protocol for the procedure, observation and control of the patient. And if you need, say, a second injection, you need to resort to it on time, not ahead of schedule. That is, our task – Just the right time to do everything right. And in fact, we have not had any serious complications when working with this drug over these 15 years.

Are complications possible when working with botulinum toxin preparations and how to avoid them

Doctors know that when working with botulinum toxin preparations, complications occur – both local and general. And this is a known fact. But it is quite possible to prevent their development. To do this, you must strictly follow the protocol for the procedure and follow a few simple rules for working with such drugs.

Firstly, the drug must be certified. Unfortunately, it happens that funds from rejected batches or stored improperly come on sale. One of the simplest complications when working with botulinum toxins – when the drug doesn't work. That is, you inject – but it does not produce the effect that is expected from it. This may well happen if the drug turned out to be weakened due to improper storage or non-compliance with some manufacturing technologies, in connection with which it was subject to rejection, but then somehow still got on sale.

If you officially buy the drug , provided with proper certificates, which means that the company is responsible for its quality. That is, already at this stage I cut off complications.

The next important point, which helps to avoid complications, – this is the delivery protocol. That is – the drug should get to you from hand to hand, from a company representative.

Next comes our responsibility: how we diluted the drug, how we store it, how we inject it, whether there are indications to inject or not. Here there is a very important point in assessing the likelihood of complications: even when the patient wants to receive injections of botulinum toxin – be able to refuse him if this procedure, from the point of view of the doctor, does not give a positive result.

Yes, it happens that a person comes, makes an appointment and says – I want to get a Dysport injection. But you are a doctor, you evaluate his testimony and decide whether to inject here or not, and if not, you need to have the strength to refuse. Suppose the patient wants to remove the "crow's feet", but I see that in this case, injections of botulinum toxin can provoke swelling of the lower eyelid, cause even more wrinkles to appear elsewhere, because when one muscle relaxes, some other starts to work harder – for example, the back of the nose. As a result, the architecture of the face changes, and the patient must be informed about this. The muscle that forms the cheekbone will relax, and because of this, it will “float” a little. cheek, which means – the nasolabial fold will appear more actively hellip; That's all – also complications, because the patient is unlikely to be happy with such consequences of the injection. Therefore, even at the stage when the drug is diluted correctly, and the patient is ready for the – you need to be able to find strength in yourself and refuse in time.

Another important stage at which complications can occur – this is the period after the procedure, when the patient must follow the doctor's recommendations to prevent unwanted consequences.

Even if we carefully considered the choice of the manufacturer of Dysport and bought the drug directly from the representative of the company, even if we correctly assessed the indications, correctly diluted the drug, determined the dose, chose the locally correct points for injections – but the patient does not stand up, does not comply with the recommendations given to him, complications may arise. Recommendations to the patient include taking antibiotics, body position after injections, drinking alcohol, keeping the temperature of the skin, acceptable and undesirable cosmetic procedures.

The patient signs an agreement with you stating that he is aware of the need to comply with the recommendations, and you release him. After some time, he should come for a follow-up examination. As a rule, those who do not really like something and would like to correct the result return for examination. The protocol allows an additional small amount of the drug to be administered within two weeks after the injection of botulinum toxin. Therefore, it is always better not to finish a little, so that corrective procedures can be made without fear.

What can affect the duration of action of botulinum toxin injections? Under what conditions does the result of the procedure last longer or, on the contrary, disappear earlier than the patient would like?

Prolong the action actually by observing the conditions of the rehabilitation period, but there are individual characteristics of each organism. After all, with the introduction of botulinum toxin, we turn off the synapses, and then, after a certain time, they begin to appear again. Even at the stage before injections, there is such a subtlety: if a person does not have enough calcium in the body, then Dysport may have a weak effect. This is due to the active participation of calcium in the biochemical processes associated with the transmission of nerve impulses. But it rarely happens that a patient comes for a consultation, you recommend him to take calcium for two weeks and then come for injections, and he agrees to this – except that regular patients are ready to comply with these conditions.

Affects the action of botulinum toxin and the use of antibiotics, but here you need to be very careful – the effect of the drug may increase so that ptosis appears.

It also happens that after the procedure, no matter how the patient maintains his regimen, there is a very rapid recovery of motor activity of the muscles, new synapses quickly sprout.

A person may also have antibodies to botulinum toxin in the body. This phenomenon usually occurs in men, because they are more likely to experience some kind of acute poisoning, where the cause could be a small dose of botulinum toxin, especially if this poisoning was taken while taking large doses of alcohol, which, as you know, reduces the potency of botulinum toxin. Sometimes the cause of the production of antibodies could be some kind of vaccinations that military personnel receive.

And again, antibodies are produced if the drug is used irrationally. That is why it is necessary to adhere to the terms of injections determined by the protocol, and not to carry out procedures when the patient decides – today injections in the forehead, and a month later in the armpits. No, after the first injection, at least 4 months must pass (previously it was recommended at least six months) before the next injection can be given – global, large, with significant doses. Docols are almost not considered additional injections of the drug, but they too can tease the immune system, and therefore are undesirable. The correct dose must always be administered. That is, the most important – do not irritate the immune system so that it sleeps and does not produce antibodies against botulinum toxin.

Standards for the administration of botulinum toxin-containing products

Is Dysport used according to strictly established schemes and indications, or is the doctor entitled to apply his own technique as part of the procedure protocol? In what cases do you consider it justified to deviate from the established schemes?

The fact is that it's all very individual. Of course, there are rules, standards: for example, if the injection site – intramuscularly, the radius of influence of the drug is one, if the injection – intradermal, the impact radius is different, you need to take this into account. There are certain areas where injections are really undesirable because ptosis can occur. But inside this scheme, you have to keep within, using your own methodology. And such a technique is justified, since there are individual characteristics of the organism. After all, everyone knows how deceitful the way – treat the disease, not the person. So here. After all, we evaluate a person, and from an aesthetic point of view. And if for the first time a person comes for a consultation, and you understand that it is better for him not to inject than to agree with his wishes, or to carry out the procedure in a different way than the generally accepted scheme requires, you need to ask him a question – how much and what worries him. And from the needs to determine the methodology.

Some ethical issues are also important. For example, yes, the patient has problems, and they need to be addressed. But you understand that if a person comes to you all the time and receives injections of botulinum toxin, then soon he will go to a plastic surgeon. Well, it happens – if, say, tonic skin or a rather weak muscular frame. In this case, I tell the patient that this injection should be given, perhaps for the first and last time, that this injection should be used to stop facial expressions, to treat wrinkles during this time – Remove them as much as possible, fill something somewhere, and take advantage of the state of the real estate of the forehead - remember it, fix it. I recommend the patient not to think that in six months he will come again and will inject, and I show that there is, say, such complexity - if imperceptibly-imperceptibly the forehead after such injections will relax, and the eyebrows at the same time – lower, then soon the patient will go for blepharoplasty. Does he need it?

You can do anything with his forehead, but the main thing is to get a person out of a state where he is used to wrinkling it. Sometimes a person frowns so much that you give him an injection, and he shifts the drug with facial expressions. Therefore, it is necessary to fix this relaxed state of the forehead, treat wrinkles and then maintain the skin in this state using other methods. For example, in order to remove wrinkles, it is very good to perform resurfacing after an injection of botulinum toxin - it is just permissible. But I repeat – it's all calculated for each specific person.

It turns out that for each individual person there should be a separate rejuvenation program? And botulinum toxin acts as part of this program?

Absolutely correct. Botulinum toxin injections are part of a general complex to improve the patient's appearance. They can be combined with almost all procedures, except those that improve blood circulation.

Botulinum toxins are not used simultaneously with massage, with deep heating, they are not combined with deep ultrasound, with microcurrents, they are not combined with ozone therapy. Any procedure that improves blood circulation will shorten the time of action of botulinum toxin. And this is undesirable. Therefore, if a person wants to undergo some more procedures, he first does them, and then completes the care program, for example, with botulinum toxin injections.

What, in your opinion, are the prospects for botulinum toxin preparations in the practice of a cosmetologist? Are they sacrificing newer technologies and drugs?

The use of botulinum toxin is very individual – this is the first. And the individuality of its application, combined with the skill of the doctor in determining the indications, selecting the technique, the ability to explain to the patient the importance of following the recommendations, gives excellent results. you can just adjust facial expressions, make your face more natural.

Today, Dysport is needed in many areas. It is needed in neurology first of all, in ophthalmology, it is needed for children with cerebral palsy, it is used for vaginismus, for anal fissures, for sweating – he is a very good drug, and I think that this is a great find for doctors, and it's very cool.

Source estet-portal.com