Chicago — The popularity of botulinum toxin type A injections for correcting wrinkles of the upper face has increased dramatically over the past few years. The extent of its popularity as a cosmetic procedure is obvious when this statistic is considered: The number of botulinum toxin type A procedures rose 157 percent from 2002 to 2003; the next highest increase was chemical peels, which rose a relatively sparse 48 percent over that same period.
It may be that procedures involving the use of botulinum toxin will become more ubiquitous in the not-so-distant future as more applications are discovered.
That was part of the message delivered by Thomas E. Rohrer, M.D., in his presentation, "Botulinum Toxin: Overview and Update," at Academy '05, here.
"Use of it, however, has become more refined as we've come to understand it more. And new uses for it - going beyond the cosmetic - have emerged."
Within the realm of cosmetic procedures, there are a couple of trends involving the use of botulinum toxin. One, ironically enough, is that some cosmetic surgeons are using less of it per procedure.
"Cosmetic surgeons are learning that using a little less botulinum toxin makes for a more natural look, as opposed to that tight, unnatural look," Dr. Rohrer says. "Other trends in the cosmetic arena are that botulinum toxin isn't just for the lower face any more and that it's increasingly being used in combination with other therapies."
Specifically, he says, the use of botulinum toxin injections under the eyes, on the nose and around the mouth is fairly new.
"It's increasingly being used to help correct 'bunny lines' over the nasalis muscle and to correct nasal flare," Dr. Rohrer says. "And in addition to its traditional use to make lips more full, botulinum toxin is being used more on the lateral mouth - to correct 'marionette lines' - and to help enhance the chin."
Combining fillers, procedures
Dr. Rohrer says botulinum toxin is being used successfully in combination with fillers such as Restylane (Q-Med Laboratories) in these areas.
"Botulinum toxin works well alone in lip applications, but it's best used in combination with fillers," he says. "Botulinum toxin helps maintain the desired position of the filler and helps increase its longevity."
Dr. Rohrer says botulinum toxin also is being used in combination with both ablative and non-ablative laser procedures.
"The botulinum toxin prevents disturbance of newly deposited collagen and allows new collagen to form more linear sheets," Dr. Rohrer tells Dermatology Times.
Perhaps most exciting is the increasing use of botulinum toxin in medical - as opposed to cosmetic - applications.
"Botulinum toxin provides effective pain relief for many conditions, including focal dystonia, chronic cervicothoracic pain, myofacial pain syndromes and postherpetic neuralgia," Dr. Rohrer says. "Botulinum toxin has a direct analgesic effect because it inhibits the release of neuropeptides that lead to inflammation and pain. Actually, botulinum toxin works for pain longer than it works for many cosmetic procedures."
Dr. Rohrer adds that work is being done on the molecular structure of botulinum toxin so that it will "prefer" seeking out nerves rather than muscle, which is how it is currently structured molecularly. This would enhance its ability to combat pain.