There’s a wealth of information out there about cosmetic medicine, but how much of it is really accurate? The internet is flooded with sensational media stories and misguided opinions on the topic of Botox and fillers. In the first of a series of Q&A sessions with Dr Tristan Mehta, we start to distinguish myth from reality.
Q: There has been talk that with repeated Botox treatments of areas such as the masseter muscle for facial slimming the results may become permanent. Is this the case?
A: The mechanism of action of botulinum toxin is to block pre-synaptic release of the neurotransmitter acetyl-choline. It is postulated that over the period of four months, new synapses develop with the motor end-plate of the affected muscle, allowing the muscle to contract again. As a consequence of denervating a muscle, there will be muscle atrophy (wasting or loss of muscle tissue) from lack of usage. This is actually the mode of action for specific treatments such as de-bulking the calves or the masseter muscles. For more information please see our e-learning sample.
Q: Does this mean that in the long run, there may be side effects such as muscle atrophy resulting in sagging jowls over an extended period of time?
A: Sagging jowls have a different pathophysiology altogether.
The ageing process occurs in four tissues – the bone, muscle, fat pads and skin.
As we approach the third decade, we begin to favourably resorb bone from the maxilla and the orbits. As the overlying fat pads lose their bony foundation – alongside ligamentous and soft tissue atrophy – fat pads lose their tightly packed mosaic structure and begin to migrate. Alongside the pull of the platysma muscles, fat pads will ultimately form jowls – this has very little to do with the effect of ongoing botulinum toxin treatments.
Q: Where fillers are concerned, can their volume-enhancing effect stretch the skin with repeated use, leaving it distorted when treatment is discontinued? An example being layering of the lips long term.
A: Injectable treatments, when delivered professionally, will not result in distorted puffy features and with modern hyaluronic acid fillers, any unwanted cosmetic effects can be reversed with an injectable enzyme.
Elastic fibres within the dermis give the skin organ its visco-elastic property. With ageing (and accelerated by photodamage), this elastic property is diminished. Significant reductions in facial volume can lead to saggy skin if skin elasticity is sufficiently reduced with ageing. With the volumes of treatment in typical dermal filler treatments, this would not be a concern.
Q: Studies in mice have also occasionally documented foreign-body type granulomatous reactions, however some literature states that as hyaluronic acid is a natural substance, fillers are less regulated than botox in the UK?
A: Foreign-body granulomatous reactions are well documented even with hyaluronic acid-based fillers. A major hypothesis for this is the biofilm theory – which reinstates the importance of aseptic technique and a clinical environment for the delivery of these treatments. Despite dermal fillers being clearly more dangerous than botulinum toxin, they remain a medical device and can be acquired by a non-medic without prescription. However, there is a push to change this regulation. We’ve summarised the latest regulation in cosmetic medicine on our HEE guidelines page.
Q: Lastly, what are the consequences should filler become lumpy and migrate away from the site of injection and how long after treatment is it possible that this might happen?
A: Hyaluronic acid fillers typically last between six months to a year. If administered incorrectly or if the wrong weight of filler is used for the tissue plane being injected, lumps can occur. These can be removed by injecting hyaluronidase, the reversing enzyme.
You can find more information about the mechanism, and surprising history of botulinum toxin and Botox by reading our Botox bite over on Medium. For information about Harley Academy’s Ofqual-regualted, BCAM endorsed level 7 qualification in aesthetic medicine please see our training courses page.
If you are a medical professionals then you can deepen your knowledge of Botox, fillers, dermatology, and related topics through our postgraduate level 7 course. Take a peek at our e-learning by following this link. Questions in this edition of our cosmetic Q&A posed by Nia from the Mixed Medic.
We have over 100 hours of e-learning available upon enrolling on the level 7 certificate in facial injectables.