Boston -- A San Francisco-based plastic surgeon says Botox (Allergan), used prior to browlift surgery, actually leads To an improved permanent outcome in that procedure. He says colleagues are observing changes in sites of previous hyperdynamic lines that suggest more lasting effects among long-term users.
It was while describing how he integrates Botox into his practice at the International Master Course on Aging Skin in Boston that Corey Maas, M.D., described these observations and applications for neurotoxins, including Botox in the United States and Dysport in Europe--a slightly different version soon to be marketed in the United States as Relotox.
"I've found there are several areas where they can add a lot to what we can offer patients surgically," according to Dr. Maas, associate clinical professor at the University of California, San Francisco.
As a supplement
Dr. Maas believes neurotoxins can often accomplish what surgery alone cannot.
"Eyelid surgery and facelifting are great recontouring procedures that provide tremendous aesthetic enhance-ment, but there are some things you just can't do with those procedures," he says.
For example, he notes that even with excellent eyelid or facelifting surgery, crow's feet usually remain in many patients due to the presence of overactive muscles around the corners of the eyes.
"Therefore, as an adjunct to facelifting procedures, we offer the completion of the therapy: Botox to soften those lines."
For the lower face, there are other problems that facelift does not adequately address, he says.
"The corners of the mouth can be elevated a little by using Botox in the muscle in the corner of the mouth in a procedure called 'a corner-of-the-mouth liplift.' It's a nice little non-surgical way of getting that groove between the corner of the mouth and the cheek where the lip looks like it's downturned."
He adds that efforts to achieve this with facelift can backfire by resulting in "a strange appearance sometimes seen in movie stars."
For the lower part of the face and neck, he uses neurotoxins to improve banding and other effects that occur either before or after facelift.
"Typically, we try to treat these surgically, but there are people who can heal those muscles and get that band back, so Botox can be a great adjunct to make sure you're getting good neck contour and not getting playsmal bands."
More than a supplement
Although Dr. Maas says he generally regards neurotoxins as supplemental to surgery, he considers browlift an actual part of the treatment.
"This is because we believe it helps us assure a better outcome from the surgery," he says.
"Prior to surgery we pre-treat patients with Botox to reduce the activity of the muscles that pull the eyebrows down. Therefore, there's nothing to pull the eyebrows back down either during the lifting procedure or during healing. This is an effective way to help to assure that the patient gets a long-term result that is not affected by the downward pull of the brow depressor muscles."
Dr. Maas says he cuts the corrugators during the surgery itself as a permanent way to assure no future activity. However, he admits that some fibers may elude his scalpel, and that the body's own healing may restore some of the severed muscles.
Dr. Maas says that contrary to the belief that Botox is completely temporary, he and some of his colleagues have observed that this may not be entirely true.
"Our impression is that with continued use of the therapy over time, the interval between dosing actually increases. We believe that may occur because many people seem to retrain their muscles so they no longer form those deep forehead furrows. This is true for crow's feet too."
Noting that data is currently being gathered to support these observations, Dr. Maas adds, "Theories exist that the muscle weakens and atrophies to some extent when it's not in use. Another theory is that there's some central nervous system feedback loop that's interrupted."
For more information: Ahn M, Catten M, Maas CS: Temporal browlift using Botulinum toxin. Plastic and Reconstructive Surgery. 2000;105: 1129-1135.
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