Botulinum toxin use in dermatology

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Botulinum toxin

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Botulinum toxin use in dermatology

  1. 1. Botulinum Toxin Dr. Sanjay Singh AIIMS, Dermatology
  2. 2. Introduction  Product of clostridium botulinum  Bacteria and their spores are ubiquitous  Found in soil and marine segments  Spores detected in vegetables, fruits and sea foods
  3. 3.  Growing bacteria produces neuron toxin, botulinum toxin, the most poisonous substance  Toxin inhibits the release of acetylcholine  Results in flaccid paralysis
  4. 4.  Seven serologically distinct types exist  Type A ( Allergan)  Type B (Myobloc)  All seven types are distinct in their molecular weight  Botax is indicated in wrinkles caused by muscular contraction and not by solar exposure
  5. 5. Indications  Frown lines between the eyebrows ( glabellar lines)  Strabismus and blepharospasm associated with dystonia  Cervical dystonia  Transverse forehead lines
  6. 6.  Lateral canthal wrinkles (crow’s feet)  Medial and lateral brow lifts  Wrinkles on the upper lips  Nasal scrunching and flaring
  7. 7.  Marionette lines  Necklines  Platysmal bands  Mental creases and dimpling of chin  Palmo plantar hyper hidrosis
  8. 8. Relevant anatomy  Vertical rhytides- Corrugator supercilii muscle  Horizontal rhytides- Procerus muscle  Horizontal frown lines – Frontal muscle  Crow’s feet – Orbicularis oculi muscle
  9. 9.  Excessive lip pursing – Orbicularis oris and mentalis muscle  Platysmal bands- Platysma
  10. 10. Dosing of Botox
  11. 11. Contraindications  Wrinkles not caused by muscular contractions  Neuromuscular disorders  Hypersensitivity to any ingredient in formulation  Pregnancy or breast feeding
  12. 12.  Unrealistic expectations  Possible interference with the patients’ work or daily activities due to changed expressions
  13. 13. Workup  EMG  Starch iodine test
  14. 14. Treatment  Preoperative details  Patient counseling  Pre and post photographs  Remove makeup's
  15. 15.  Patient should lie on back propped up position  After injection do not massage the injection site  Avoid exertion on the day of treatment
  16. 16. Complications  Local effects: Drooling, pain, bruising, infection  Weakness of muscles  Ptosis  Delayed eye closure  Headache

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