Botulinum Toxin

Dr Apratim Goel received her MD, DNB Dermatology from Kasturba Medical College, Manipal in 2000. She is on the scientific panel of various national and international professional organisations, and is a trainer as well as a pioneer in various lasers, dermaroller, botulinum and fillers. Dr Goel runs a chain of aesthetic clinics in Mumbai and has special interest in medispa, infusion therapy, lasers and practice management. She is also keen on training the upcoming doctors in aesthetic procedures, and conducts her own training courses.

Know more from Dr Goel on botulinum toxin:

Who is a good candidate for the botulinum toxin treatment? How do you approach your patient to determine if this is the ideal treatment?

To determine a good candidate, the following points can be considered:

•He person should be looking at enhancing his/her looks.

•He/she should be looking for anti-ageing treatments.

•Someone with a clinical condition such as migraine or hyperhidrosis can be treated with botulinum toxin.

• He/she should hose who are specifically looking at getting rid of lines and wrinkles, or slimming the face can be considered.

•Certainly, the person should not have any contraindications to botulinum toxin. 

•One with realistic goals and who understands treatment details.

If botulinum toxin is the ideal treatment for my patient and the patient has visited for some other complaint or has not done botulinum toxin before, I first inform them what we could achieve by injecting the toxin. It is important to explain the mechanism of action in a simple way, and break the negative myths that they have in their mind about the treatment. I also show them some before and after pictures of other patients, and inform them about my practice and that I have been doing toxin injections for more than 15 years. This gives them more confidence in opting for the procedure.

Having understood the effects and benefits of botulinum toxin, the patient mostly decides to go ahead with the treatment if not immediately, than at a later date.

How can best results be derived from this treatment and within what timeframe? Tell us about the technique and the number of sittings required?

Performing the procedure takes only a few minutes. It is important to understand the anatomy and different anatomical variations correctly before injecting botulinum toxin. Usually, anesthesia is not required, but if the patient is sensitive to pain, a topical anesthetic can be applied for 20 minutes before injecting or icing or vibration technique is used. It is mandatory to take pictures and get a consent form signed before injecting. Once the patient is ready for the injections, marking is done on the areas and calculated doses are injected to get optimal results. Results start showing in three to four days, and complete results are obtained in a week, which last for four to six months.

Usually, only one sitting is required, however you may call the patient back after one week to check for the results and if any touch up is required.

What is the recovery time for a patient who undergoes this treatment? What is the post-treatment care involved?

Botulinum toxin is a lunch-time procedure. Besides a few bumps on injection points that stay for a few minutes, there is no recovery time. In a rare situation, some people may get bruising, which can take up to a week to settle. Some patients may also experience headaches for the first few days. However, these are all transient effects and do not hamper the daily functioning of the patient.

The only post care instructions given to patients are: 

•Do not rub or massage the treated area for four hours post treatment.

•Avoid strenuous exercises for 24 hours post treatment. Light exercises such as walking and jogging can be done after four hours. However, it is advisable to wait for 24 hours before doing any strenuous exercise. 

•Patients are also instructed to not lie down flat for the next four hours to prevent diffusion of toxin.

It is important to understand the anatomy and different anatomical variations correctly before injecting botulinum toxin.

Any contraindications involved that one should be aware off? Also, is there anything the patient must not do after wthe treatment?

Botulinum toxin is contraindicated in patients with keloidal tendency, neuromuscular disorders (myasthenia gravis), allergies to botulinum toxin, and body dysmorphic syndrome. However, patients on blood thinners and painkillers may have bruising, but that is temporary and settles in few days.

Tell us about one of the most challenging case studies that you have dealt with for this treatment, and why?

Botulinum toxin is a relatively simple treatment and results are guaranteed as expected. However, I distinctly remember a young patient, about 30-year-old, who came to me for facial asymmetry. When she would speak, her mouth would deviate to one side. I understood that it is due to an imbalance of the muscles of face and neck, and that she will need botulinum toxin, but due to excess facial fat, the surface anatomy of muscles was difficult to locate. She had visited several dermatologists before me, but was not content with her experience. This made my job even more challenging. The complexity of muscles in the lower face made the treatment even more challenging. I split her treatment in to three parts, and injected muscle by muscle. She was happy with the results after six weeks.