Botulinum therapy is one of the most popular injectable anti-age procedures, the main purpose of which is to smooth mimic wrinkles. The list of botulinum toxin preparations, indications for their use and administration techniques is expanding every year, therefore it is very important for a practitioner to constantly improve their knowledge and skills, the patient's safety and the effectiveness of the procedure directly depend on this. Dr. Alessio Redaelli, in an interview for estet-portal.com, shared important information about botulinum therapy: new indications, causes of complications, popular techniques for correcting botulinum toxin preparations and the appropriateness of their use in various situations.
Alessio Redaelli MD (M.D.), professor, vascular surgeon, phlebologist, specialist in Aesthetic Medicine, Professor of the Milan Aesthetic School Agora and the International Academic School of Practical Medicine (ASPEM). One of the best European specialists in botulinum therapy and injection techniques, author of books for professionals. Milan, Italy.
In what cases do complications most often occur after botulinum toxin therapy?
A few months ago, an article was published on the complications after the introduction of botulinum toxin, which is very popular. 5000 patients underwent botulinum therapy, i.e. 5000 injections were performed, after which about 300 - 400 cases of complications were recorded. At the same time, the drugs did not cause any of them, that is, in 100% of cases, complications arose due to improper injection of botulinum toxin. Thus, it can be concluded that all complications of botulinum toxin therapy are the result of incorrect drug administration technique.
I believe that in this case one cannot speak of bad luck: insufficient training is to blame, the introduction of too much drug to obtain a result where a significantly lower dosage is indicated to achieve it.
Correction with botulinum toxin preparations – excellent procedure, which I have been doing for 15 years, and in all the time I have not encountered complications. Therefore, I believe that we should be more rational and approach botulinum toxin therapy wisely, since many doctors, especially in post-Soviet countries, perform this procedure too aggressively.
Almost all complications of botulinum toxin therapy are the result of incorrect injection technique.
Are there any new indications for botulinum therapy?
One of the most interesting, in my opinion, evidence is devoted to my work, available on the site Pubmed. We are talking about the correction of the oval of the face by introducing botulinum toxin into the masticatory muscle. This procedure opens up excellent opportunities for doctors in the case of hypertrophy of the masseter muscle in a patient. At the same time, it is important to understand that botulinum toxin therapy is effective precisely in the presence of muscle hypertrophy, but will not work if the cause of the deformation of the oval is a wide jawbone.
Another interesting technique is mesobotulinum toxin, or mesobotulinum toxin (because in practice I almost always use abobotulinumtoxin). This procedure provides very good results, especially in the correction of complex mimic wrinkles, including in the neck area, as well as in the treatment of hyperhidrosis of the palms and armpits. For its implementation, botulinum toxin diluted in a certain way is used, which is injected very superficially, since with deeper injection there is a risk of asymmetry, in which case the procedure becomes dangerous. Therefore, it is very important to pay special attention to the insertion technique.
You say that the patient pays you not for the injection, but for the work on the face as a whole. What is important to pay attention to?
Indeed, I never ask patients to pay for the amount of drug they inject. However, my services cost a lot, and I always tell patients that they pay for my skill. For example, the cost of correction of brow wrinkles, which is 2 units of the drug, is equal to the cost of working with the entire face – that is my principle. I believe that the patient pays for the fact that the doctor carefully analyzes the features of his face and makes the necessary adjustments to obtain a natural and harmonious result: evaluates movements, creates ideal muscle balance, provides an optimal eyebrow lift, a beautiful smile – all these nuances the practitioner takes into account, based on his experience with patients.
When is the combined use of botulinum toxin and hyaluronic acid appropriate?
There is a very simple technique for the combined use of hyaluronic acid and botulinum toxin, provided there are indications for their use: for example, if the patient simultaneously has a decrease in hydration and the presence of dynamic, that is, mobile wrinkles. In such cases, a mixture of a good, very soft filler and a certain amount of abobotulinum toxin type A (10-15 units to correct one side of the face) can be the solution to both problems. Thus, you improve hydration and reduce the appearance of wrinkles.
I use mesodysport (mesoabobotulinum toxin) to correct areas where traditional botulinum toxin therapy is usually not performed: in the cheeks, marionette wrinkles, neck and décolleté. But the best results with this technique can be obtained precisely in the lateral region of the cheeks
Important! Do not confuse 10-15 units of onabotulinum toxin type A (that's a huge dose!) With a similar amount of abobotulinumtoxin in question. I use about 10 units of abobotulinum toxin on one cheek and 10 units on the other. For injection, I use a 0.5 ml insulin syringe, with which I can inject very small amounts of the drug.
What areas do you most often use mesobotulinum toxin to correct?
I use mesodysport (mesoabobotulinum toxin) to correct areas that are usually not treated with traditional botulinum toxin therapy. That is, I use the traditional technique to correct brow wrinkles, forehead wrinkles (although in rare cases I use mesodisport to reduce sweating in the forehead) and crow's feet. I mainly use the mesodysport technique in the cheek area when I make final adjustments to the face. For example, if wrinkles are smoothed out in the forehead and eyes, but at the same time they are quite pronounced on the cheeks, this is an excellent indication for mesodysport. Puppet wrinkles, neck and décolleté area – these areas can also be corrected using this technique, although it provides the best results with it in the lateral region of the cheeks.
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