Skin Wrinkles: An Overview Botox® and Fillers

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Skin Wrinkles: An Overview of Botox® and Fillers




Guest:  Dr. Krishna Patel – Otolaryngology/Head & Neck Surgery, MUSC

Host:  Dr. Linda Austin – Psychiatry, MUSC


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Krishna Patel, who is a facial plastic and reconstructive surgeon.  Dr. Patel, I know you’ve recently come to MUSC, welcome.  We’re so delighted to have you here.  Let’s start off, today, talking about something that many of us don’t even think of.  It isn’t truly surgery, but I bet you get a lot interest in this, which is Botox, and fillers.  Who is a good candidate for Botox?


Dr. Krishna Patel:  Botox is ideal for people who are starting to develop wrinkles on the face.  I’ve seen a trend of people, maybe in their late thirties, and up, liking the use of Botox.  When you inject a very small amount of Botox into a muscle, it relaxes the muscle.  The wrinkle is actually caused by the muscle working, and when you relax that muscle, it removes the wrinkle.


Dr. Linda Austin:  How long does it last?


Dr. Krishna Patel:  On average, it usually lasts about three months; however, every person’s different.  Some people have effects for as long as six months.  What I’ve seen in people who use it repetitively; they come back for injections every three to six months, the muscle begins to weaken.  They tend to be able to go longer periods between injections because the muscle isn’t as strong as it was at the time of their first injection, so it does tend to space out.


Dr. Linda Austin:  I’ve heard people say that it’s poison; Botulinum toxin.  Is there anything to be concerned about there, any potential adverse effects from Botox?


Dr. Krishna Patel:  That’s a very good question.  What I can tell you is that it is a toxin.  It’s purified from bacteria.  Its usefulness was discovered about forty years ago, in the 1070s, when eye doctors were using it for twitching around the eye.  They soon realized that it would also remove wrinkles.  That was really the first time Botox was used for clinical reasons.  Since then, it’s been used for many other things, including children who have cerebral palsy, with severe contractions of their muscles.  It helps to relax those muscles.


The amount of Botox we use on the face to remove wrinkles is miniscule compared to what children with cerebral palsy, for instance, are given to relax their muscles. When Botox is used in the face, in small amounts, we’ve seen no bad effects.  Sometimes, people get too relaxed of a muscle, which can cause their eyelid to droop.  That’s very rare.  We have learned, as surgeons, that we’re not to inject to prevent that. 


With respect to reported adverse effects, or bad effects, they’ve had some children, who were injected for muscle contractions due to cerebral palsy, whose respiratory muscles; breathing muscles, were affected, and they stopped breathing.  The doses for that, however, were massive.  And it’s almost impossible, I think, given the amounts we use on the face, to ever have that bad of an effect.


One thing I can say about pregnancy is that there have never been trials for Botox in pregnant women, and whether that is a risk.  As a general rule, I do not give Botox injections to pregnant women.  There was, recently, in the news, another Botox equivalent, called Dysport, and there was some report that it may cause birth defects, but it was unfounded.  This happened in one person, and it wasn’t any type of controlled study.  So, my personal opinion is that there’s very little risk involving Botox use.


Dr. Linda Austin:  What percentage of your patients, now, are men requesting Botox?


Dr. Krishna Patel:  That has actually been an increasing trend.  I would say, though, that it’s still much lower as compared to women.  The ratio, now, is probably one male to every five females.  But the trend is definitely changing.  For people who start Botox at a younger age, when they’re regular users, it really does give a longer lasting more youthful result, and I think men are starting to realize that; the men coming into my office tend to be younger.


Dr. Linda Austin:  Let’s talk, now, about fillers.  Restylane, I guess, is the new kid on the block, as far as fillers go.  How are fillers used?


Dr. Krishna Patel:  This is something, I think, people often get mixed up.  They think Botox and fillers are the same, when they’re not.  Sometimes the effect can be similar.  Botox, essentially, paralyzes muscles temporarily.  Fillers don’t.  They’re made up of a substance that can be injected into a wrinkle to remove the crease.  Restylane is, by far, my favorite because it’s very safe and the body accepts it; does not reject it or create any kind of reaction to it.  It’s made up of what is called hyaluronic acid, which is a natural product that it’s in our bodies. 


I like Restylane because it can be used in very fine wrinkles, as well as deep wrinkles.  That’s something that’s very important to know.  Right now, in Europe, there are probably 200, or more, different products of fillers.  In America, which is much more regulated, there are still, probably, about 10, or so, products out there that are used.  Some of them, however, are not quite as benign, or safe, as Restylane.  I would caution people to know exactly what is being injected, if they do go with a filler.  I have found Restylane to be very safe, and work well.


Dr. Linda Austin:  What are the sites where you inject Restylane?


Dr. Krishna Patel:  The most popular site is probably the nasolabial crease, which is, essentially, the line that goes from your nose to your mouth.  You notice it the most when you’re smiling or talking.  That is the most common injection site.  Another area is around the mouth, where you have the very fine wrinkles around the upper and lower lips.  A site that’s becoming more popular is the cheek.  As we age, the fat in our cheeks tends to drop a little, so it flattens our cheek bones.  People are, then, getting Restylane placed a little deeper in the cheek.  And that gives a nice rejuvenated, youthful look. 


As a side note, Botox, all those areas I just discussed, are places where I tend not to put Botox.  If you do, you have to be extremely careful to inject around the mouth, as you don’t want someone to lose their ability to smile, and be animated.  Botox tends to be more popular around the eyes and forehead, and between the eyebrows, whereas Restylane, and the different fillers, tend to be used more in the lower part of the face. 


Dr. Linda Austin:  How long does Restylane last?


Dr. Krishna Patel:  It usually lasts about three months as well; sometimes, six months.  I think it’s advertised as being closer to six months.  And, again, like Botox, when you use it repetitively, you tend to have some residual product left.  So you tend to not need as much when you come back for repeat injections.  It does tend to space out the length of time you can go between injections. 


Both Botox and Restylane, and most fillers, are reversible.  Meaning, they’ll last for three months, but then they should go away.  When you’re using fillers, there are some that are advertised as being permanent, and it’s very important to know, exactly, what is in those products.  They may be permanent, but they may also cause a reaction that’s undesirable.


Dr. Linda Austin:  Dr. Patel, thank you so much for talking with us today.


Dr. Krishna Patel:  Thank you.


If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at:  (843) 792-1414.

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