Demand for injectable procedures continues to grow. Despite forecasts that cosmetic procedures may face a decline in demand due to economic problems, the volume of minimally invasive procedures, including neurotoxin injections, has increased by 123% since 2000, while the volume of traditional surgical procedures has decreased. by 17% over the last decade. Such demand for botulinum toxin injections is due to the simplicity of the procedure, which can give the face a more youthful appearance, and complications after botulinum toxin injections are minimal with appropriate training of the doctor.
Various preparations of botulinum toxin, derived from individual botulinum bacteria, cause muscle paralysis by inhibiting the release of acetylcholine at the neuromuscular junction. Each of the available neurotoxin preparations has a specific mechanism that causes muscle paralysis, which is necessary to achieve the desired cosmetic and / or therapeutic effect. Numerous studies have documented the efficacy and safety of neurotoxins for aesthetic purposes, in particular for the correction of the glabella, forehead, periocular and perioral lines.
There were no serious side effects from the use of botulinum toxin for therapeutic and cosmetic purposes, according to a review submitted by the FDA over a period of 1 year. There have been no reports of death from cosmetic use of botulinum toxin, and reactions unrelated to drug therapy were recognized as possible complications - no effect, reaction at the injection site and ptosis.
Complications of botclotoxin injections and their manifestations
More commonly, complications from a botulinum toxin injection include local reactions such as bleeding, pain, swelling, erythema, and bruising at the injection site. All of these complications can be greatly reduced by proper technique, knowledge of the anatomy of the face, advanced training & nbsp; and education of physicians. It is important to inform each patient that despite good injection technique, most patients will have bruising due to individual wound healing.
Pain at the injection site is also highly variable and dependent on individual sensitivity, but can be minimized by using fine needles (eg, 30 or 32), inserting the needle through the pilosebate, and pinching the skin prior to injection. This gives a good effect – if you vibrate without injection with your hand / index finger on the patient's skin, near the injection site, in order to "trick" him & nbsp; into feeling the vibration, not the injection. Pre-treatment with a local anesthetic (eg, 2.5%/2.5% lidocaine/prilocaine or 30% lidocaine) and application of ice or cold gauze to the skin before and after injection may be used in more anxious patients and markedly reduce injection pain .
Bruising occurs in less than 1% of all botulinum toxin injections and can be reduced by not taking medications that have anticoagulant properties (eg, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), herbal supplements (eg, vitamin E, gingko), and also smoking and alcohol for 7-10 days prior to the procedure.Cold compresses and direct pressure on the puncture site immediately after the injection can also reduce the risk of bruising after the injection.Even with the correct technique and careful patient selection, the periocular, perioral areas, consisting of thin skin with superficial vessels, very prone to bruising.
Common reactions including nausea, malaise, flu-like symptoms, and skin rashes may result from diffusion of the neurotoxin into the systemic circulation. Systemic reactions are considered as hypersensitivity to botulinum toxin or one of the components of the drug (i.e. albumin or lactose) in suspension. Allergies are rare, but cases of sarcoid nodules due to antigenic stimulation following botulinum toxin injection have been reported. There are no reported cases of anaphylaxis after cosmetic use of botulinum toxin.
Headaches were the most frequently reported adverse event after treatment with botulinum toxin glabellar lines, but were most likely the result of the injection technique rather than a reaction to the drug itself. Fortunately, headaches are usually mild and do not require special treatment.
Muscle paralysis is the ultimate goal of cosmetic use of botulinum toxin, but inadvertent transfer of effect to neighboring muscles can also occur due to local diffusion of the drug into a space up to 3 cm in diameter from the injection point, causing ptosis and diplopia. Unwanted paralysis/weakness of adjacent muscles after botulinum toxin injections can lead to blepharoptosis.
When botulinum toxin is injected around the lips, there is a high chance of lip ptosis because many facial muscles are involved in the movement and shaping of the lips. When injected into the mentalis, depressor anguli Oris or Oris circular, undesirable spread of the drug may occur, which & nbsp; will cause an asymmetrical smile and/or difficulty eating.
Reducing the unwanted risks of paralysis can be achieved with proper injection techniques. Applying pressure immediately after injection, using lower dilutions with higher concentrations (lower injection volumes) should help to limit unwanted diffusion.
Hyperhidrosis injections into the palms and soles of the hands may cause temporary weakness of the hands and reduced fine motor skills that can last for several weeks.
Thus, botulinum toxin injections must be administered appropriately, and full disclosure of the possible complications of cosmetic use of neurotoxin requires further research.
According to Journal of Cutaneous and Aesthetic Surgery
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