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Using botulinum toxin to relax the muscles and reduce the appearance of wrinkles was a serendipitous discovery found while treating strabismus, an eye condition that causes abnormal alignment of the eyes. Over time, the mystique and trepidation of using it for cosmetic purposes has gradually diminished. Many millions have now incorporated it as a way of maintaining a refreshed and youthful appearance. But there are many additional benefits that botulinum toxin injections can have for patients with distressing symptoms or conditions. These treatments should be performed by medical specialists who routinely see patients for these conditions such as neurologists who use it for the treatment of headaches and urologists who use it for the treatment of bladder spasm. In my practice, in addition to cosmetic uses to soften lines around the face and neck and lift facial areas, we also use it for three additional purposes.

  1. Rosacea and flushing. Redness and flushing can be improved, especially in conjunction with lasers that reduce the amount of vasculature in the face. After laser treatment, small amounts of toxin on injected in the upper most layers of the skin. This maintains the results of the treatment for longer, reduces often uncomfortable or embarrassing flushing and decreases burning or heat sensations that can occur with facial flushing. It works by blocking the release of acetylcholine from the autonomic nerves that allow the vessels in our peripheral nervous system. It also decreases inflammatory mediators like substance P and calcitonin gene-related peptide that can cause blood vessels to dilate.

  2. Botulinum toxin is used prior to laser treatment with CO2 or non-ablative fractional lasers. Scars, including acne scars and some deep wrinkles are tethered and constrained under the skin. Before using laser treatments to help remodel the skin, a small amount of toxin is injected to relax the tissue and allows the skin to remodel and soften without being pulled tightly, increasing the efficacy of the laser treatment.

  3. Excessive sweating in the underarms, palms or soles can be very troublesome for patients. Neurotoxin works around the sweat glands by blocking the release of the neurotransmitter acetylcholine, not necessarily by relaxing the muscle fibers but by making the sweat gland less responsive or functional. Once the right dosing is achieved results can last six to nine months and over time in some cases even longer.

So beyond getting rid of frown lines, botulinum toxin has many different ways of helping patients put a smile on their faces.