Aesthetic Plast. Surg.

Some Special Indications and Results of Botulinum Toxin Therapy

Based on the 5 Years’ Experience of Professio Clinic in Hungary

György Ivanics, MD Budapest, Hungary

Abstract. We published our experience with the botulinum toxin anti wrinkle therapy in Hungary several times, but now we want to publish the special treatments and their special indications. At Professio Clinic we use the products BOTOX and Dysport, thus we can compare them. We have some exclusive experience concerning the botulinum toxin the­rapy.

Key words: Botulinum Toxin Therapy— BTX. —Special indications of botulinum toxin therapy— Special experience with botulinum toxin therapy— BOTOX— Dysport

Introduction

At Professio Clinic we have been using botulinum toxin therapy for more than 5 years, and made more than 1000 botulinum toxin treatments. In the past two years we treated more patients than before, due the publication of a lot of news about botulinum toxin treatment in Hungarian newspapers.

We read a lot of information about botulinum toxin therapy in the literature. [1-4] Now we want to publish the special experience we made at our clinic.

Agents and Standard Methods

We use the products “BOTOX” and “Dysport”, (with “CE” licence) and the name “Botulinum Toxin Therapy”, “BTX therapy” or “Botox Therapy” because patients know this name from the news. Our experience may be of interest for American plastic surgeons, because they cannot use Dysport (wich does not have an “FDA” licence yet).

First we use BOTOX and now we use both BOTOX and Dysport.

__________

Correspondence to Gy. Ivanics M.D.;

Professio Clinic,

Krisztina krt. 79, Budapest, Hungary;

E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Dysport is easier to use than BOTOX as the latter has to be transported and stored at –4Cº, while in the case of Dysport 2-8Cº is allowed, which can be an important safety criterion (inactivisation). [5,6]

At Professio clinic we use the rate 1:4 BOTOX-Dysport for many places on the face and neck for anti wrinkle and anti lines therapy. A Dysport vial contains 25% more usable product than one Allaergan vial. [9]

We published our first experience concerning Botulinum toxin therapy in Hungary in our Aesthetic Plastic Surgery book. This contains a table about the Inverse Safety Rules that can be applied to the Glabellar botulinum toxin therapy. [8,9]

Safety Rules

Table 1. Inverse Safety Rules of the Glabellar Botulinum Toxin Therapy by Ivanics. [8]

New Special Indications [10-12] 

1. Headache

Many women suffer from headache. We can read about headache after botulinum toxin therapy in the literature. It is true, because every injection (stress) can provoke headache. In our practice there are a lot of patients who want botulinum toxin, because after the (anti wrinkles) botulinum toxin therapy the headache disappears.

2. Twitching (Tic)

Some patient suffers from tic. It is a very discomforting feeling. The situation is the same as with headache: after the (anti wrinkles) botulinum toxin therapy the problem disappears, (if the problem was at the same place as the wrinkles, we can treat both at the same time).

3. Mimic deformation after trauma (or operation)

If a trauma caused mimic lesion we can see a deformation when the muscle moves. We can help by blocking the muscle function on both sides.

4. Asymmetric mimic muscle function

Many people have asymmetric mimic muscle function, which is normal but sometimes the asymmetry is extreme, and this causes big problems for the patient. (For example s/he is a model, or artist.) We can use the same method as in the case of mimic deformation.

5. Aesthetic mimic correction

A lot of patients do not have wrinkles normally. For some (artist) men or women however it is a big problem that if they go somewhere where there is strong light or hard sunlight they get wrinkles on the face and look “angry”.

6. Supports soft tissue augmentation

In the case of soft tissue augmentation the injectable implant often moves from the place of injection due to mimic muscle function. If we use botulinum toxin therapy first, this problem will cease to exist.

7. Helps the operation result

The operation (facelift, blepharoplasty) result is better if used in combination with botulinum toxin therapy.

8. Facial contouring and sculpting

• Eyebrow lift
• Open Palpebral Aperture (Asian patients)
• Round eye repair
• „Bunny Lines” correction
• Nasal Flare correction
• Upper gun show correction
• Lip forming
• „Mouth Frown” correction
• Peau D’Orange Chin correction
• Mental Crease correction

9. Treatment of Hyperhydrosis [13]

It’s a new special treatment with botulinum toxin. We used the Bo-tox before on head and neck on now we can use on other parts of body

Contraindications

We know the contraindications from the product information brochure.

• Neuromuscular illnesses (myasthenia gravis)
• Aminoglikoside or neuromuscular transmission blocking drugs
• Botulinum A toxin hypersensibility (but we never observed this problem)
• Pregnancy, nursing
• Ectopia
• Other serious illnesses

Special Experience

“Bulldog” Forehead

We can help a lot of young and old patients, but we cannot help in the case of some special situations. The “bulldog” forehead is one of them, because normally the forehead skin is not large, but in the case of bulldog forehead the skin is too large.

Axillary Hyperhidrosis

In the literature of botulinum toxin therapy axillary hyperhidrosis is often mentioned, too. We apply this treatment, but there is an old (surgery) treatment against axillary hyperhidrosis. The surgeons cut the skin together with the sweat glands. One of our patients thought that the botulinum toxin therapy was all right, but very expensive, so she went to another surgeon for the operation. After the operation she visited our clinic, and told us that the operation scar was terrible. Her conclusion was that the aesthetic aspect is very important for her. The scar turned out to be a bigger problem than the axillary hyperhidrosis. She wanted botulinum toxin therapy. (After the operation always sweating remained a permanent problem, because the glands could not be totally excised.)

Discussion

The medical literature on the use of botulinum toxin in plastic surgery practice is growing. A new age has arrived. We need to know and use new words: botulinum toxin surgeon, Botoxology, BTX doctor, etc. We use botulinum toxin therapy for the hyperfuctional facial lines and wrinkles, but it is also very interesting for other indications. Botulinum toxin therapy is an easy routine for plastic surgeons, it is well tolerated by patients and is extremely safe, if we apply it carefully and use the safety rules. In Europe we can use both BOTOX & Dysport, they provide us with the same result, thus our experience may be of interest for American plastic surgery.