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Talent & Techniques

Talent & Techniques: Emerging concepts in the use of neurotoxins

Article-Talent & Techniques: Emerging concepts in the use of neurotoxins

micro Botox, neurotoxin, wrinkle reduction, facial rejuvenation

The use of neurotoxins, such as Botox Cosmetic from Allergan (Irvine, Calif.), has been around for decades and focused predominantly on the treatment of lines and wrinkles, as well as facial shaping. In recent years, however, the use of very small amounts of neurotoxin (known as “micro Botox,” “meso Botox” or “baby Botox”) has been used to address more superficial changes within the skin itself and has been shown to improve the skin’s tone and texture, soften fine lines and reduce the appearance of pores.

It is believed that these results are caused by neurotoxin’s effect on the sweat glands, oil glands and the erector pili muscles within our skin, which causes pores to shrink. Due to the effect on oil glands, this treatment can potentially also reduce the occurrence of acne.

As we look for ways to affect global changes in facial aging and fine tune results from our other products and procedures, the use of micro Botox has grown more popular. While effects of these very small amounts of neurotoxin are subtle, when used in combination with other procedures, overall results are noticeable and potentially more enduring.

In my practice, we utilize micro Botox in one of two ways.

When used alone, very small aliquots of neurotoxin are placed using a 32-gauge needle to inject product in the superficial dermis versus the conventional, muscular injections we are familiar with.

Micro Botox can also be placed via topical applications using open channels in the skin created by microneedling. In this case, we generally combine a diluted form of neurotoxin with other ingredients such as hyaluronic acid and platelet-rich plasma.

The patient in Figure 1 is a young, 42-year-old woman who presented to me with generalized facing aging. She was concerned about reversing the age-related changes, but in a way that would keep her looking natural. She ultimately began a medical skincare regimen and underwent treatment with Botox Cosmetic, as well as Juvéderm Voluma XC to her cheeks.

Most recently, I saw her for persistent fine lines and wrinkles to her lower and lateral lids and suggested micro Botox to help improve her overall skin tone. Using a very diluted concentration of Botox Cosmetic, a total of 8 units was placed via multiple aliquots into the superficial dermis of this area.

Ten days later, she returned and was very pleased with the subtle results that she had achieved. She felt that the skin around her eyes was smoother, more clarified, and that the fine wrinkles had softened. To further optimize long-term results, we recommended adding a series of three Microneedling Plus treatments (microneedling plus PRP, micro Botox and hyaluronic acid) spaced four weeks apart.

In addition to optimizing the skin’s appearance, micro Botox can also be used for improving scar outcomes. While there is some disagreement in the literature as to efficacy, I recommend it to all of my patients as a relatively low-cost option to help surgical scars heal optimally.

With this treatment, micro Botox is injected in the superficial dermis on either side of the incision at the time of surgery. Then, in the early healing period, a series of Microneedling Plus treatments is started at around four to six weeks following the procedure.

Micro Botox is an exciting new option for our patients and one that I believe will grow in popularity. I also think that this will become less of a stand-alone treatment and more often used in combination with other products and procedures.

As with many of the procedures we perform, results are often anecdotal and the science behind the actual outcomes is not well understood. My hope is that we become better educated on what micro Botox is achieving at the cellular level, and how we can use this knowledge to improve results and better help our patients.

Meet the Expert

Gregory Buford, M.D., F.A.C.S.
Dr. Buford is a board certified plastic surgeon currently practicing in Denver, Colo. As a graduate of the Baker / Stuzin / Baker Cosmetic Surgery Fellowship in Miami, he is one of the few cosmetic plastic surgeons in the Rocky Mountain region to have completed formal post-graduate training. His practice is limited exclusively to aesthetic medicine with an emphasis on breast enhancement, body contouring and minimally invasive facial rejuvenation.

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