The method of choice for wrinkle correction is botulinum therapy. It allows you to get a long-term effect of relieving hypertension and reducing the severity of wrinkles in the problem area in one procedure. However, with pronounced dermal creases, it will not be possible to completely remove them with the help of neuroprotein. The cosmetologist understands this, but the patient does not always, therefore, as a result of inflated expectations, disappointment with the result may occur. Combined therapy will help correct such creases: botulinum therapy and bioreparation, which allows you to solve the problem comprehensively and in the shortest possible time.
The first stage is botulinum therapy with Botulax 100 units / Botulax 100 U (Hugel Inc., Republic of Korea) to reduce hypertonicity of the facial muscles of the upper third of the face. This is a highly purified botulinum neuroprotein type A (over 99%), produced in compliance with international GMP standards.
The procedure of choice for improving skin quality, reducing the severity of wrinkles and sagging skin is bioreparation using HYALREPAIR®-02 Bioreparant (Lab. TOSKANI, Russia). It is based on the patented solid-phase modification HYALREPAIR® technology, which consists of adding vitamin C and essential amino acids (proline, lysine, glycine) to hyaluronic acid without the use of cross-linking molecules. This allows you to prolong the effect of the drug, making hyaluronic acid resistant to destruction by hyaluronidases. The effect of the drug summarizes the effect of hyaluronic acid and attached components, which are gradually released into the dermis. This makes it possible to prolong the effect of all components and carry out procedures once every three weeks, which is very convenient for very busy patients.
This master class describes the dosages of drugs, the scheme and features of performing such a procedure.
Procedure:
complex correction of dermal wrinkles of the upper third of the face.
Target:
smoothing wrinkles, lifting skin, preventing structural aging of the face, straightening the oval of the face.
Indications:
- dermal wrinkles of the upper third of the face (forehead, between the eyebrows, outer corners of the eyes);
- sagging facial skin.
Preparations:
"Botulax" 100 units / Botulax 100 U (Hugel Inc., Republic of Korea); HYALREPAIR®-02 Bioreparant (Lab. TOSKANI, Russia); Post Procedure Cream / Restoring cream with peptides (Mesaltera by Dr. Mikhailova, Lab. TOSKANI, Russia).
Equipment used:
insulin syringes with a volume of 1.0 ml (U-40); 3.0 ml syringe; needles 0.3 x 13.0 mm (30G); 0.26 x 12.0 mm (31G).
Duration of the procedure:
30 min.
Recommended course:
HYALREPAIR®-02 Bioreparant - three procedures with an interval of three weeks. If necessary, additional correction with Botu-Lax can be combined with a second bioreparation procedure.
Problem area: forehead and eyebrows
We raise our eyebrows in surprise or indignation, frown in thought or anger. Normal human emotions, the face itself says what a person feels at one time or another, often even if he does not want it.
From here it becomes clear that there is facial expression that we can control - voluntary, and there is one that cannot be controlled - involuntary. The second one is where most of the wrinkles appear.
Active movements of the facial muscles in some people almost never stop; even sleeping, reading or normal routine work can be accompanied by frowning, raising the eyebrows or wrinkling the nose. And from such constant contractions, wrinkles appear on the skin. At first they are dynamic, that is, they pass when facial expressions are calm, but with age they become static, no longer disappearing completely.
And it seems that on the one hand, wrinkles are traces of emotions from various events in our lives, and on the other hand, there are creases that do not add color at all, but on the contrary give the appearance of severity, anger and sadness. Such marks are definitely not what a woman’s face needs in order to look fresh, young and positive.
When a girl comes to me with a problem with facial wrinkles, we always discuss what she expects from my work. In most cases, patients want their face to remain natural, mobile, but without wrinkles. Injections of Botox, Dysport and Xeomin can achieve this effect. You can block facial expressions completely where it is necessary, for example, at the area between the eyebrows, or you can partially block them - this often applies to the forehead.
Description of the procedure
To restore youth with the help of Botox injections to the forehead, you will only need half an hour of stay with a dermatocosmetologist at the Swiss cosmetology center Versua Clinic (the price of the injections will pleasantly surprise you). The procedure itself lasts even less and is absolutely painless. To make you feel as comfortable as possible, we use light local anesthesia.
Before visiting the clinic, keep in mind that our specialist, before carrying out manipulations, will carefully examine you and find out possible contraindications to this method of combating age-related changes.
One wrinkle between the eyebrows
The area between the eyebrows is one of the most problematic on the face. If somewhere wrinkles can even decorate, then the space between the eyebrows is the opposite. He gives the impression of an angry, closed, sad, thoughtful person. All this definitely does not encourage the people around you to communicate.
The eyebrow wrinkle appears from the work of the muscles that frown the eyebrow. In Latin they are called corrugators (musculus corrugaror). They form vertical wrinkles, there may be one or two. And one more muscle, the so-called proud muscle, procerus (musculus procerus, lat.). It forms a horizontal crease on the bridge of the nose; it is rarely single, more often it is several parallel lines, smoothly turning into “rabbit” wrinkles (on the nose). When eyebrow wrinkles quickly disappear after frowning, there is nothing to worry about. You just need to observe and preferably try to control your facial expressions.
It often happens that it is impossible to control, it is not for nothing that such facial expressions are called involuntary. In this case, at the first sign that a wrinkle does not want to go away from an already calm face, it is worth doing prophylaxis. This can be self-massage for the first time, but the most effective is botulinum toxin injections (Botox, Dysport, etc.)
Regardless of whether there is one wrinkle between the eyebrows or two, the cosmetologist works with this area according to the same scheme; only the dose of the drug and the procedure technique may differ.
The wrinkles between the eyebrows that patients treat are often not just static (creased), but also extend deeper than the skin level. It is not easy to work with such wrinkles, because it is not possible to guarantee that they will completely disappear after the procedure. In addition to the fact that correction is expected not only with Botox, but combined - Botox + filler, the correction zone also has its own nuances and only very experienced doctors should work with it. In view of all of the above, it becomes clear that it is definitely not worth delaying the moment of contacting a cosmetologist with this problem.
When patients come for prophylaxis for mild wrinkles, the result is almost 100%. Moreover, after Botox injections, a person feels a block in this area, cannot frown, and this feeling remains even when the effect of the drug disappears completely. That is, for 2-3 months, or even more, self-control appears and in the future wrinkles between the eyebrows appear more slowly, and all this time the face looks positive and friendly.
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conclusions
The ART technique of Botox injections is, in our opinion, the first technique that describes a comprehensive strategy for the treatment of migraine and targets Botox injections around the nerve and different areas of the nerve rather than on loosely distributed muscle groups [6,31]. The ART injection technique is less targeted than that described in the PREEMPT trial [6], but is more comprehensive than the targeted approach originally described by Guyon for screening purposes. The ART injection paradigm is not a screening tool, and both the surgeon and the patient should understand that the purpose of this method is the comprehensive treatment of migraine with Botox.
By injecting closer to the nerves to target known anatomical sites of nerve irritation and focus on regional areas of pain, Botox injection can provide migraine patients with significant pain relief, reduced complications from over-injections, potentially less tolerance to Botox, overall increased patient satisfaction with treatment, and reduced exhaustion due to complications and potentially poorer response from diffuse injections. This injection method may be effective even for episodic migraine, which is currently considered to be less responsive to the techniques described in the PREEMPT paradigm. Future prospective studies comparing this method with the PREEMPT method will definitively determine whether the senior authors' paradigm is validated for long-term use. Our current retrospective data, which are currently being considered for publication, can serve as experimental guidance for any future large prospective studies.
Before and After - forehead and eyebrows
Cosmetological correction 1
Patients come for botulinum toxin correction with varying degrees of wrinkle severity. For some, wrinkles are just beginning to form, for others they are already very noticeable. Wrinkles that do not disappear even after a long period of rest are called static.
They take many years to form due to very active facial expressions. In this case, you can see a significant crease between the eyebrows and wrinkles on the forehead. In this case, muscle relaxation alone will not be enough, because facial expressions will disappear, but the gap and wrinkle will remain in place.
We performed a combined correction - botulinum toxin + filler based on hyaluronic acid with an interval between procedures of 2 weeks.
The procedure was carried out under local anesthesia with cream and took no more than 30 minutes each. The filling effect will last for at least 1.5 years, and botulinum toxin will need to be repeated every 6 months.
Cosmetologist's work:
- correction
- botulinum toxin + filler
- once every 6 months
- procedure 30 minutes
- Result at least 1.5 years
How Botox injections work
Preparations that are used to smooth out wrinkles are made based on botulinum toxin type A. This substance blocks the transmission of impulses from a nerve ending to a specific muscle. As a result, wrinkles are smoothed out and the face looks 5–10 years younger.
Botox begins to act immediately after injection, with the maximum effect of the procedure becoming noticeable within 4–7 days. Chemical denervation does not affect the general well-being of the patient. The drug only affects the ability of muscle tissue to contract in a specific location. Previously, Botox was used exclusively to smooth out wrinkles on the forehead and in the corners of the eyes. Today it is used to eliminate any expression lines.
It is important to know. Over time, botulinum toxin is completely eliminated from the body, and wrinkles return. To maintain the desired effect, Botox injections must be done every 3-6 months.
Before and After - forehead and eyebrows
Cosmetological correction 2
Injections of Botox and Dysport into the forehead area are almost the only way to avoid wrinkles in this area. In addition to self-control, of course. Many people have very rich facial expressions in this zone. Showing your emotions - outrage, surprise or joy - is normal. It’s a shame when telltale age-addling lines begin to form in places where the skin was once perfectly smooth.
In this case, wrinkles were corrected with Botox and we assessed the result after 2 weeks. It can be seen that the eyebrows remained mobile and at the same time wrinkles on the forehead stopped forming. The area between the eyebrows is also quite active, and without blocking it, correction of the forehead is impossible, so the forehead and between the eyebrows were treated with the drug in combination.
The procedure is comfortable even without local anesthesia and takes 2-3 minutes. After the procedure, active facial expressions are required for 30 minutes and a vertical body position for 4 hours. The effect lasts 3-4 months, the procedure is repeated after 6 months on average.
Cosmetologist's work:
- wrinkle correction
- comfortable procedure
- vertical 4 o'clock
- procedure 30 minutes
- Effect 3-4 months
- repeat after 6 months.
Appearance of injection victims
Before making any injection, you need to choose a competent, highly qualified specialist. This will help avoid negative consequences and complications. An illiterate approach by a cosmetologist can turn a patient into a victim of Botox .
Excessive use of botulinum toxin procedures can disfigure your appearance. The face of a Botox victim looks like a wax mask. It is difficult for such a person to express his emotions using facial expressions, since the face is practically unable to move. The face looks swollen and unnatural. The oval of the face changes its structure and shape.
Before and After - forehead and eyebrows
Cosmetological correction 3
The facial muscles, despite their small size, can be quite powerful and create not just wrinkles, but also a certain relief on the face.
This usually suits men, but women, on the contrary, are favored by a smooth, sloping forehead and restrained facial expressions. Botulinum toxin preparations allow you to achieve this quite quickly, literally 3-10 days, and you can enjoy the result. Facial expressions where necessary are preserved, but muscle volume and facial wrinkles have receded.
The procedure is comfortable and takes 2-3 minutes. There are recommendations that should be taken into account - vertical position of the body for 4 hours after the procedure and 30 minutes of active facial movements. The result is assessed on 10-14 days. The effect lasts for 3-4 months, the procedure is repeated after 6 months on average.
Cosmetologist's work:
- result after 2 weeks.
- procedure 2-3 min
- vertical 4 o'clock
- facial expression activity
- Effect 3-4 months
- repeat after 6 months.
Expression wrinkles - 4. Wrinkles on the forehead
Creases that take years to form are difficult to remove. It is known that botulinum toxin is not a treatment for wrinkles, but their prevention, and when a static wrinkle already exists, it will not go away immediately after the procedure, but will smooth out gradually, over the course of weeks, and perhaps disappear only after repeated correction.
In this case, the skin turned out to be of excellent quality, tone and level of moisture. As soon as I blocked my facial expressions, the creases quickly smoothed out almost completely.
The Botox injection procedure lasts 30 minutes along with a consultation, the effect occurs from the 3rd to the 10th day. In this case, we assessed it after 2 weeks. I recommend repeating the procedure once every 4-8 months.
PROCEDURE PROTOCOL STAGE I. BOTULIN THERAPY
A drug:
"Botulax" 100 units / Botulax 100 U (Hugel Inc., Republic of Korea).
Equipment used:
insulin syringes with a volume of 1.0 ml (U-40), syringe 3.0 ml.
Techniques:
intramuscular, intradermal injections.
Neuroprotein restoration:
“Botulax” is reconstituted with a 0.9% NaCl solution in the amount of 2.5 ml per bottle of 100 IU of neuroprotein type A. In this case, in syringes with a volume of 1.0 ml for 40 IU of insulin (with red caps), one division will correspond to one “ mouse" unit of the drug.
Markup:
Before marking, we ask the patient to actively work with her facial muscles (frown, be surprised, squint her eyes) in order to determine the anatomical features of the muscles.
The injection points are applied with a pencil or marker for marking.
Corrugator muscle
(m. corrugator supercilli): we ask the patient to frown (bring the eyebrows as close as possible to the midline).
We mark one medial point on the abdomen on each side, 1 cm above the eyebrows, lateral points for injection into the tail of the muscle, slightly inward and above the place where the muscle fibers are woven into the skin. Total: 4 points (Fig. 1)
.
Depressor brow muscle
(m. depressor supercilli): the injection point is located 0.5 cm inward from the medial canthus of the eye and 0.7 cm above it
(Fig. 2)
.
Muscle of the proud
(m. procerus): The main point is located at the intersection of the lines connecting the medial borders of the eyebrows with the opposite medial canthus of the eye.
Taking into account the anatomical features of the structure of the proud muscle (long abdomen), the second injection point is marked (1 cm above the main point) (Fig. 2)
.
Frontal belly of the occipitofrontalis muscle
(venter frontalis m. occipitofrontalis): We ask the patient to raise her eyebrows up (surprise).
The injection points are located 2 cm above the level of the eyebrows, 4 points on the same horizontal line, at a distance of 2 cm from each other (Fig. 3)
.
Orbicularis oculi muscle
(m. orbicularis oculi): 3 injection points are located 1 cm lateral to the outer bony edge of the orbit, the first is in line with the outer canthus of the eye, the second is under the tail of the eyebrow, the third is 1 cm below the first
(Fig. 4)
.
Transverse part of the nasal muscle
(pars transversa m. nasalis): 2 injection points are located laterally along the lateral surfaces of the nose in the area of its upper third (in the projection of the maximum severity of wrinkles when the patient demonstrates a grimace of disgust: “phi”) (Fig. 5).
Levator labii and ala nasi muscle
(m. levator labii superioris alaeque nasi): 2 points on each side in the transitional fold between the nose and cheek just above and lateral to the wing of the nose
(Fig. 6)
.
Administration of the drug:
Based on the severity of facial activity and the anatomical structure of each muscle, the total dosage per procedure is 54 IU
(Fig. 7)
.
Frontal belly of the occipitofrontal muscle:
the needle is inserted intramuscularly, the needle is directed upward at an angle of 45o.
Dosage per injection point: 3 UNITS Total dosage - 12 UNITS "Botulax" (Fig
.
Corrugator muscle:
at the medial points, the needle is inserted deep into the muscle belly, parallel to the eyebrow (the muscle belly is grasped with the fingers of the free hand).
Dosage - on the right - 1 point 4 units, on the left - 1 point 5 units (Fig. 9)
.
To the lateral points - superficially, subcutaneously, the needle is positioned parallel to the eyebrow, horizontally and slightly downwards (Fig. 10)
.
Proud Muscle:
first point (main) - the needle is inserted at a right angle, deeply, dosage 4 units (the belly of the muscle is grasped with the fingers of the free hand)
(Fig. 11)
.
Second point (optional). The needle is inserted upward, to a depth of 2–3 mm, dosage 1 unit (Fig. 12)
.
Depressor brow muscle:
to a depth of 1 mm, superficially, almost using the “papules” technique.
1 unit is injected on each side (Fig. 13)
.
Orbicularis oculi muscle:
the needle is located in the direction from the orbit, the insertion depth is subcutaneous.
Dosage: 3 units for the central point, 2 units for the upper and lower points (1–3) (Fig. 14)
.
Transverse part of the nasal muscle: depth - subcutaneously, 2 units per point (Fig. 15)
.
Muscle that lifts the upper lip and ala nasi:
the needle is inserted upward, parallel to the nose, subcutaneously.
Dosage per 1 point - 3 units (Fig. 16)
.
