Frown lines are the result of gathering or knitting the tissue between the eyebrows into a fold. These unattractive folds and furrows are caused by the repeated action of underlying muscles associated with facial expression. Years of squinting and frowning tend to leave deep wrinkles in the skin between the eyebrows and on the bridge of the nose, across the forehead, and at the corners of the eyes. On many people, frown lines produce an angry or sad look that detracts from a pleasant facial appearance. Dermatologic surgeons can now improve these lines without surgery and without scars by a simple injection of botulinum toxin type A.
Botulinum toxin is a purified toxin and, when given orally in large amounts, it blocks the nerve signals from the brain to the muscle, causing a generalized paralysis called botulism.
However, by injecting very tiny amounts into a specific facial muscle, only the targeted impulse of that muscle will be blocked, causing a local relaxation and weakness. In this way, botulinum toxin acts as a muscle blockade to immobilize the underlying cause of the unwanted lines and prevent "wrinkly" expressions.
Botulinum toxin is injected directly into the target muscle to treat vertical lines between the eyebrows and on the bridge of the nose, the squint lines or crows feet at the corners of the eyes, the forehead horizontal lines, and the platysmal muscle bands often visible on the neck, commonly known as turkey neck. It may also be used for eyebrow positioning. Once the muscle is weakened and relaxed, it cannot contract. Since there is no way to make the undesirable facial expression, the lines gradually smooth out from disuse, and new creases are prevented from forming. Other muscles like those needed to raise the eyebrows are not affected so a natural expression is maintained. Botulinum toxin may not be as effective on the smile lines around the mouth because the muscle action in this area is needed for expression and important functions like eating.
Treatment involves injection of very small amounts of botulinum toxin into the underlying muscles to immobilize them. The actual treatment is well tolerated and takes just a short time with minimal recovery. Botulinum toxin takes effect about 3 to 7 days after treatment. The improvement generally lasts about 3 to 4 months before the effect gradually fades and muscle action returns. It is anticipated that the average patient will require reinjection at various intervals. With repeated treatments, atrophy (thinning) of the muscle may occur which usually produces longer-lasting results.
Excessive sweating can be alleviated with injections of a highly diluted form of botulinum toxin directly into the underarm skin or skin on the palms and soles of the hand or foot. There it paralyzes the sweat glands of the skin which are responsible for excessive perspiration. A single treatment session can provide months of relief, and experts believe that injections can be repeated indefinitely once or twice a year to maintain dryness.
Side effects are minimal and typically relate to the local injection. Soreness or mild bruising, while uncommon, may occur around the injection site. Makeup may be worn after treatment, but care should be taken to avoid pressing or massaging the area for several hours. In rare instances, patients may develop temporary weakness of the neighboring muscles, a temporary droopy brow or eyelid, or a headache.
For more information on skin conditions and treatments, along with a list of ASDS members in your state, please visit the Find a Dermatologic Surgeon section of our Web site.
Botulinum toxin treatment for forehead furrows
Botulinum toxin treatment of glabella (frown lines between the eyebrows)
Botulinum toxin treatment for perioral asymmetry (uneven mouth)