The many faces of Botox

"Botox (botulinum toxin A, Allergan Medical) has been a big boon for surgeons in many ways," says Steven H. Dayan, M.D., clinical assistant professor of otolaryngology, University of Illinois, Chicago.

For starters, he says, Botox injections serve as a sort of gateway to draw cosmetic patients to surgeons' offices.

Additionally, he says Botox injections, at times, can replace surgical procedures such as forehead lifts.

"For raising the brows," Dr. Dayan tells Dermatology Times, "I will place 15 to 20 units in the glabellar region, leaving the frontalis muscle unopposed.

"I'll also place six to eight units in the temporal region under the tail of the brow."

Similar techniques can replace upper eyelid blepharoplasties, he adds.

Dr. Dayan reveals that although he likes to perform these procedures surgically, "There are times when people say they're absolutely not going to have surgery. Or someone might not be a good candidate for surgery."

Other places he's used Botox include the area around the nose, Dr. Dayan adds.

"Occasionally," he says, "I will use Botox in combination with surgery. This might provide a better result" than surgery alone by reducing tension on the wounds.

"When I'm doing a forehead lift and I want the forehead to stay in position where I've fixated it, I don't want the frontalis muscle to pull on it" during the six to eight week postoperative period when adhesions form, he explains.

In such cases, Dr. Dayan says he injects Botox to the forehead before operating.

"If I'm going to do a scar revision or make an incision in the face - definitely in the forehead - I'm almost certain to use Botox around the wound to 'splint' the wound," decreasing tension in much the same way that putting a cast on a fracture improves healing, he adds.

Other adjuvants

With deep laser treatments, Dr. Dayan says, "I'll also place Botox in the face. If patients can't make the repeated motions of secondary animation, they'll get a better outcome."

Additionally, he says that although he doesn't perform cleft lip and palate surgeries, there's evidence that Botox injections help in these procedures as well.

Post-op use

Postoperatively, Dr. Dayan says he will use Botox if a patient develops a tight banding of muscle in an area such as the neck. In such cases, he says he places 6 units to 20 units directly into the platysmal band, depending on its thickness.

"I've also seen patients who have a prominent ciliary muscle underneath the lower eyelid. I may inject one to two units right into the belly of the muscle to relax it," he says.

Likewise, he says that if a patient develops a paresis, he may treat the opposite side of the face to create symmetry.

"There are also times when I may use Botox to augment my surgical outcome," Dr. Dayan continues.