“As a plastic surgeon, I used to “resist” botulinum toxin treatment for a long time” says MUDr. Lucák. Not for serious reasons. “I was just convinced that my task was to correct cosmetic imperfections surgically and everything else was up to a doctor of other specialization. Now, after I have been making use of excellent botulinum toxin effects for many years, I must admit I was wrong! What good is it having beautifully operated eyelids if the impression is spoilt with crow’s feet? What good is a facelift if the effect is not complete because of the lines between eyebrows? Not mentioning the fact that botulinum toxin acts preventively against wrinkle formation! If you asked me today: “Would you recommend botulinum toxin treatment for wrinkles and possibly even perspiration?” My answer would be clear: “Definitely”.
Wrinkles, laser
Injection correction, fractional laser...Injectable wrinkle treatments
What are the injectable wrinkle treatment options?
There are basically two types of injectable wrinkle correction procedures:
- Injectable wrinkle fillers – the application of a wrinkle filling substance (Collagen, Hylaform, Dermalive, Restylane, Artecoll, Bio-Alcamid, your own body fat, Estelis, Fortelis, Remake etc.)
- Using botulinum toxin (Botox) for paralyzing mimetic muscles
1. Injectable wrinkle fillers
Injectable wrinkle fillers are used both for mimic wrinkles (caused by the movement of mimetic muscles) and for dynamic wrinkles (caused by the drooping of facial tissues). From all available methods (fruit acids, laser treatment, facelift, wrinkle filling procedures), injections are surely the easiest procedure. They can be basically divided into two groups: with temporary and long-lasting (permanent) effect. Injections with a temporary effect include e.g. Collagen, Hylaform, Restylane, Dermalive, Artecoll, Estelis, Fortelis, Remake. Permanent effect is produced by e.g. Bio-Alcamid. Irrespective of the above-mentioned division, there are products within each group which differ according to the length of the effect (e.g. a temporary effect from 3 up to 6 months, from 6 months up to 1 or 1,5 years, or with an effect lasting from 1 to 3 years) and also the products can vary according to the degree of likelihood of developing allergies, granulomas and the necessity for skin pre-testing (Collagen).
Collagen
Collagen is easily injected with a thin needle just under the skin surface, without the need of a local anaesthetic. Performing the procedure under local anaesthesia however increases the patient’s comfort during the treatment. Collagen is most commonly applied into the superficial layers of skin. In case of fine wrinkles the results are usually immediate, with deeper wrinkles the effect comes within 14 days and despite some minor swelling or little potential bruise the patient can in fact perform his or her social duties even that very night and will look great. In case a greater amount of collagen was used, the swelling lasts roughly 1-2 days. Collagen injections nevertheless are not permanent. As the composition of collagen is similar to your own skin, it gradually decomposes and is naturally absorbed by the body in 3-5 months. This period, however, varies among individuals. In order to regain the appearance, the collagen injections must be repeated or refilled after this period. But there is one disadvantage of collagen – there are some people who are allergic to collagen itself. Therefore it is absolutely necessary to carry out a tolerance test at least 28 days prior to the treatment itself.
Effect:Temporary
Collagen
Collagen is easily injected with a thin needle just under the skin surface, without the need of a local anaesthetic. Performing the procedure under local anaesthesia however increases the patient’s comfort during the treatment. Collagen is most commonly applied into the superficial layers of skin. In case of fine wrinkles the results are usually immediate, with deeper wrinkles the effect comes within 14 days and despite some minor swelling or little potential bruise the patient can in fact perform his or her social duties even that very night and will look great. In case a greater amount of collagen was used, the swelling lasts roughly 1-2 days. Collagen injections nevertheless are not permanent. As the composition of collagen is similar to your own skin, it gradually decomposes and is naturally absorbed by the body in 3-5 months. This period, however, varies among individuals. In order to regain the appearance, the collagen injections must be repeated or refilled after this period. But there is one disadvantage of collagen – there are some people who are allergic to collagen itself. Therefore it is absolutely necessary to carry out a tolerance test at least 28 days prior to the treatment itself.
Effect:Temporary
Hylaform
Hylaform is a viscoelastic gel and is made from a natural material (hyalunoran) that provides the skin with support and volume (elastic cushioning). Injection is similar to collagen injection but no skin test is necessary and therefore can be performed instantly. The lifespan is also similar to collagen – that is about 6 months on average.
Effect:Temporary – 6 months on average.
Restylane
Is a non-animal stabilized hyaluronic acid. It consists of complex sugar chains that have been stabilized for a longer lasting effect on the skin. The production of Restylane is similar to the manufacturing process of insulin and antibiotics. When combined with the body’s own hyaluronic acid, it creates (increases) volume for the lip treatment and also for filling deeper wrinkles. It is not suitable for correcting very fine wrinkles because if Restylane is injected into the skin very superficially, it leaves visible bluish traces in the skin. There is no need for pre-testing and the injection is done in the same way as with collagen. It has reportedly a longer lasting effect than collagen or Hylaform.
Effect:Temporary – 6 months on average
Estelis / Fortelis
A modern verified form of injectable filler based on hyaluronic acid. Despite being an absorbable material (due to hyaluronic acid), after several years of experience it has shown perhaps all achievable benefits. It has excellent application, which can be made both right under the skin, deep into the skin and also entirely superficially. It does not cause any irregularities, granulomas, its tolerance is excellent, there are no allergic reactions reported. And what it more – the effect is one to one and a half years unlike other products based on hyaluronic acid. It is highly recommended.
Effect:Temporary – about one to one and a half years
Artecoll
Is a solution containing polymethylmethacrylate microparticles. This solution must not be injected right into the skin, but underneath. It is therefore suitable for correcting deep dynamic wrinkles, not mimic wrinkles, which are superficial. After the solution has been injected underneath the skin, the microparticles are encapsulated (enclosed) by the body’s collagen fibres, making the skin lift and strengthen. Due to this, the effect is longer than with the above mentioned injection materials. No pre-testing is required, but in more pain-sensitive patients it may be necessary to use a local anaesthetic.
Effect:Temporary but very long lasting
Bio-Alcamid
It is an alcamid water solution. This substance cannot be injected into the skin. That is why it is not designed for filling superficial wrinkles, but for filling deep wrinkles – especially nosolabial folds. It is also used for lip augmentation – the results are natural and the lips soft, Bio-Alcamid is not palpable in them. In a very small portion of patients it can however cause the lips’ painful swelling and a leakage of the polluted contents. On the other hand, in case of complications it is possible to drain with an injection needle. Bio-Alcamid does not form classic granulomas. It is one of the few permanent preparations which can be used for permanent lip enlargement with a very low percentage of above described complications. It can also be successfully used for correcting deeper depressions – post injury and postoperative scars as well as for some cosmetic nose reshaping procedures. The injection of Bio-Alcamid is uncomplicated due to its suitable consistency. No classic allergic reactions to Bio-Alcamid have been reported. After being injected into the region between the lip’s surface and muscle or beneath the skin, the alcamid solution is not absorbed by the body, because thanks to its properties it is wrapped by a membrane, forming a small soft permanent blister. The effect of Bio-Alcamid is therefore permanent! Another advantage of Bio-Alcamid unlike other permanent substances is that, in case of unwanted irregularity after application, there is a chance to remove a portion of Bio-Alcamid. Prior to the application it is advisable to numb the area with local anaesthesia.
Effect:Permanent
Patient’s own body fat
Fat injection/transfer is associated with various degrees of its constancy. Generally it is however considered rather unpredictable and therefore tends to be classified as a substance with a temporary effect.
Fat is obtained from different parts of the body, most commonly from the abdomen, hips or outer thighs, by microliposuction using a syringe. Firstly, the area the fat will be taken from is numbed and then fat is sucked with a cannulae, washed and filtered. The filtered fat is then injected into the area – but not into skin. That is why it is suitable for filling dynamic wrinkles, not mimic (where the skin is broken). Although theoretically, from all filling materials the body’s own, human, live fat cells should “take” the best in the area of application, there are several factors that complicate this premise. An important factor is movement. The more movement in the injected area, the shorter time fat cells survive. Thus, in very mobile areas like the mouth and areas of mimic wrinkles, the take is only about 15-20% at the very most! Therefore it is necessary to undergo multiple fat injections with intervals in order to achieve a good result. In other words, one visit is not enough as with other preparations, but you have to come repeatedly. Every time you should expect swelling and local redness, possibly a little bruise. A recommended injection interval for the fat transfer is 8 weeks. This must be considered already during the fat taking, that is more fat must be taken and the excess is stored in syringes under sterile conditions in a fridge until next application. Since the patient’s own fat is used, there is no overall risk of an allergic reaction. After the injection there is temporary greater swelling, soreness, and bruising. Patients can usually return to normal activities the day of treatment, even though strenuous activities and important social duties should be avoided for a week and the treated area must not be pressed during this period either.
Effect:Individual – but always temporary. The length of effect is markedly individual – sometimes 3 to 6 months, sometimes 6 to 12 months, in some patients remaining fat was observed even after a long time.
2. Using botulinum toxin (Botox) for paralyzing mimetic muscles
Botulinum toxin is designed purely for correcting mimetic muscles, that is wrinkles caused by a constant movement of mimetic muscles, which gradually cause “breaking” of the skin where it folds in always the same place. The principle of botulinum toxin is not filling the wrinkle as was the case with injectable wrinkle fillers (point one in this section), but rather it is paralyzing the movement of mimetic muscles. This will make the skin stop folding in the particular place and, what is more, the muscle will release its natural continuous contraction (muscle tension) and thus the treated skin will be partly lifted.
Dynamic wrinkles are caused by drooping facial tissues and mimic wrinkles are caused by contractions of mimetic muscles. The more and longer emotions we express, the deeper these lines and wrinkles will be. When we are young, the facial skin gets completely smooth after finishing the facial gestures. In addition, the skin elasticity prevents the skin from breaking into classic wrinkles. This starts to be seen after 35 years of age. Nevertheless even in this period wrinkles disappear as we stop showing expressions. At this moment it is the right time to apply botulinum toxin preventatively. The principle is very simple: botulinum toxin blocks the muscle movement and the skin above stops bending and breaking. As long as botulinum toxin operates - a wrinkle is not formed!!! The situation is more complicated in people over the age of 40-45 whose wrinkles are permanent irrespective of the presence of facial gestures. Here a good effect can be expected only after a number of successive Botox injections and in the case of very deep wrinkles an injectable wrinkle filler is necessary to fill the deep wrinkle completely (see point one of this section). In any case it is true for all of us that sooner or later the persistent or even unceasing contraction of these muscles leads to the development of permanent creases and wrinkles. These traces of running time – sometimes laughter, sometimes worries – are unavoidable and they are signs of the ageing process, of course. That is why the idea of these permanent lines “decorating” our face, forehead and neck is not appealing to all of us. With the coming of Botox, dynamic lines and wrinkles can be removed for the time of application and the formation of new ones can be delayed! The procedure, which takes advantage of a purified toxin produced by the bacterium Clostridium botulinum is also called cosmetic denervation. Although this toxin is the same as the one that causes a serious form of food poisoning (Botulism), the amount used in cosmetic surgery is so small that general reaction cannot develop, not even theoretically.
Botulinum toxin has been used very safely and successfully since 1982 by ophthalmologists for treating twitching of the eyelid and lazy eye. In fact, every year thousands of patients receive botulinum toxin treatment for a number of other medical conditions but over the last 15 years it has become extremely popular for suppressing the visible signs of ageing. Even though among patients and in the media it is being celebrated as a wrinkle remover, botulinum toxin has been recently used successfully for cosmetic indications to fight excessive sweating in armpits, palms and even soles.
How does botulinum toxin work?
When injected into the treated area, botulinum toxin type A reversibly blocks impulses from the nerves to the tiny facial muscles that are fixed to expression lines. Due to this, the muscles cannot contract and therefore tend to release. When muscles are relaxed, the overlying skin remains smooth and wrinkle-free, whereas the untreated facial muscles contract normally and common facial expression except for the treated areas is not affected.
What areas can be treated?
Botulinum toxin is most frequently applied in the upper face region. Specifically, botulinum toxin can correct forehead wrinkles, lines between eyebrows and crow’s feet. These are the most commonly treated areas. There are however many more areas suitable for Botox treatment – the front part of the neck, cleavage, sagging corners of the mouth etc. Here it rather depends on your wishes and your surgeon’s experience. The treatment of wrinkles around the mouth and chin is unusual so as to avoid weakening of the lip function. These lines are preferably treated with laser or by filling with collagen, hyaluronic acid, Bio-Alcamid, fat or inserting one’s own skin.
How is botulinum toxin application done?
The procedure itself is simple and safe. Botulinum toxin is injected with the thinnest needle possible – insulin needle – into the desired area. Depending on the treated areas it is necessary to expect several injections: forehead – 7 injections, between eyebrows – 4 injections, outer eye “crow’s feet” – 8 injections. As the needle is very fine and only a small amount of liquid is used, most patients consider the treatment not very pleasant rather than painful. As soon as the treatment is over, usually no discomfort is experienced. No sedation or local anaesthetic is required and you can immediately resume your normal activities. You can even drive home or back to your office. Very occasionally a minor bruising may appear as a result of piercing a tiny blood vessel. Redness at the injection site is only very temporary and can be easily concealed with make-up.
How long will the effects of the treatment last?
The effect will be noticeable only after 3-5 days following the treatment. This can show as a full or sometimes only partial reduction of facial gestures in the treated area. It depends largely on the strength of muscles and how deep the wrinkles are. As mentioned above, the effects of botulinum toxin treatment are temporary since the toxin is gradually metabolized by the body. Practical experience shows that after the first application you can expect a two and a half to three month effect. If you, however, have other applications within 14 days at the latest after the muscles start to resume their function, the effect may last up to 5 months in approximately one third of patients. Since most patients are happy with the effect of botulinum toxin, most of them seek this wrinkle treatment regularly and long-lastingly.
To sum up: “The effect is excellent, but not permanent. There is no point in undergoing only one treatment. Fine wrinkles subside after one or two applications, but before deep wrinkles disappear completely or almost completely, it may require up to 3 to 4 applications at roughly 3 month intervals. You can start and stop having Botox treatments whenever you like.
Are there any side effects?
There are very few side effects involved in this treatment. Whereas allergy to other medications is possible, it is has not been reported with botulinum toxin. Only pregnant women and people suffering from swallowing difficulties (dysphagia) must not be treated with botulinum toxin. Temporary cosmetic complications include brow drooping after treating forehead lines in people with drooping forehead, sagging eyelid or unfocused sight after Botox has “leaked” into the eyelid or oculomotorius muscles when injected into the area between eyebrows. There is however no reason for being worried. For one thing this occurs very rarely and more importantly it is only a temporary phenomenon that subsides spontaneously within 2-3 weeks (that is much sooner than the Botox effect usually lasts). Occasionally a minor bruise may appear after the application caused by piercing some of the tiny blood vessels in the underlying tissue where the doctor applying the medicine was not able to see it. The small bruise gradually fades and you can speed up the process by applying a tea soaked compress and ointment for bruises (e.g. Heparoid etc.).
Immunity against botulinum toxin is described in about 2-3% of patients. In this case there is no effect even after repeated applications. This is called innate immunity agaist botulinum toxin.
There is also acquired immunity against botulinum toxin – to prevent it another dose of botulinum toxin must not be administered sooner than 6 weeks after the last application of botulinum toxin.
Am I a suitable candidate?
Only a consultation can determine this, of course. It depends rather on the type and location of wrinkles. Botulinum toxin is well tolerated by most people. Pregnant women and patients with neurologic diseases however should not be treated. As for age, it is most popular with people over the age of 30. The upper age limit is not given. The minimum age is determined by the completion of adolescence. We have already treated a couple of young women between 22 and 24 years of age who started to develop first temporary mimic wrinkles. But it must be emphasized that many years of uninterrupted botulinum toxin treatment may result in considerable muscle emaciation in the treated areas. Therefore in these cases it is advisable to break the regularity of injections from time to time so as to allow the muscle to regain its strength.
Botulinum toxin for the treatment of excessive local sweating
Excessive sweating (hyperhidrosis) can be socially as well as professionally very uncomfortable and embarrassing and often leads to considerable emotional stress and complications. Some patients who suffer from excessive sweating of the whole body can regularly undergo medicamentous treatment. This is not quite possible for patients who suffer from localized excessive sweating of the armpits, palms and soles. These can be successfully treated with Botox injections.
When botulinum toxin type A is injected into the problem area, the nerve fibres, which stimulate the sweat glands function, are intensely blocked. This leads to almost complete suppression of sweat production in the treated area. As the toxin is injected only into the skin, there is no risk of affecting deeper muscle structures and thus their function. The procedure is similar to the above described wrinkle removal surgery. The botulinum toxin treatment takes effect after 3-7 days and lasts about 6 months. Repeated injections bring similar results. The treatment is normally well tolerated and does not involve any adverse side effects.
If I have flown, or travelled overland, to Ostrava to have this treatment, how soon can I travel back to my home country, and what does it mean for follow up visits?
For this procedure, you will be required to arrive at Cleopatra Clinic in Ostrava, at least ……(hours/days), before your operation, so that you can be prepared in the clinic. You (will/will not be) be required to stay over-night, on the night before your surgery, at the clinic. Immediately after your surgery, you will stay recuperating at Cleopatra Clinic for …....(hours/days). After completing this short Clinic-stay period, you must stay in your (hotel/apartment above Clinic) in Ostrava area for at least…..(hours/days), to comply with post-op check-up & bandage changes. After this period, you are fit to fly or travel overland, back to your home country. Your Cleopatra Clinic surgeon will advise you, at consultation, or during your initial phone call/email to us, about the possibilities of you arranging with a doctor in your home-country to perform final bandage-change/stitches-removal, where relevant. (Also, please do pay attention to your Cleopatra Clinic surgeon’s advice regarding necessary medical preparation documents you’ll need, before you travel to Ostrava, such as EEG, blood-tests, and chest x-ray, where applicable, for this type of operation.)
Can I travel to Ostrava as part of a holiday, and incorporate my first consultation at Cleopatra Clinic, into that holiday?
Of course you can! We have had several satisfied clients already, who dropped by our clinic to register their interest & intent to have an elective operation with us, and who’d actually been on vacation in the West Poland/East Czech Republic area. They had heard that Czechoslovakia is actually the birthplace of many historical advances in plastic surgery; and whose surgeons continue to teach and make advances in this area of medicine, finding new techniques which are then adopted & emulated by other surgeons all over the world.
There are many people who come to this part of the world to enjoy Poland’s Zakopane, Katowice, & Krakow, and Prague in Czech Rep., who made the trip to us, to make enquiries! Ostrava itself is a great little city, with a proud tradition of hardworking people, nestled in the west Silesia region. Many German, British, Danish and other European nationalities enjoy visiting this area, and find it a pleasure to travel on the Ostrava trams! With airlines such as Germanwings, Wizzair, Ryanair, easyJet and others, it is possible and more than convenient to travel here to enjoy the scenery, the local delicious local cuisine…and 500mls mug of delicious local Ostravar beer! Ostrava itself is undergoing a regeneration, and there are several top class new shopping malls you can visit, if so inclined. Also, go onto ‘trivago.com’, and get really great deals on hotels in every price range!
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