Botox and Sunglasses Combat Squinting

June 30, 2015

With the start of the summer season, most Floridians are planning to be outside significantly more than they were in the winter and spring. What comes along with the sunshine of the beach, barbecues and afternoons at the ball field? Squinting.

So what. Why is squinting a big issue?

Squinting is a physiologic reflex to bright environments that decreases the size of the opening of the eyelid in order to allow less light to reach the eye. Let’s examine exactly what happens during a squint. Three important facial muscle groups contract. This creates radial wrinkling of the skin and soft tissue around the eye. People will commonly call these by the nickname “crow’s feet,” or “smile lines.” The space between the eyes is narrowed creating both vertical wrinkles many call “11 lines” or “frown lines” as well as one or more horizontal lines at the top of the nose. Besides the extra wrinkles it creates, the act of squinting also lowers the position of the eyebrow.

So what does all this mean?

Over time, the pattern of repeated squinting can result in an increased number and increased depth of wrinkles between the eyes and to the sides of the eyes. This is simply the effect of creasing the skin over and over, similar to what one sees when they fold a sheet of paper in the same place many times. Squinting also encourages a lower brow position.

Of course, the sun can’t take all the blame. As we age, the skin gets progressively thinner, and changes in vision, such as need for reading glasses, can be responsible for many of the squints performed throughout the day even if one is not out in the sun.

Unfortunately, squinting from the sun is a double whammy, as it has been scientifically proven that harmful UV rays independently cause the skin to become even thinner and less elastic, in addition to increasing the risk of skin cancer.Folding skin that is thinner with less ability to stretch will result in deeper, more etched in creases over time. By now, everyone knows that sunscreen will help protect against thinning of the skin, but it doesn’t keep us from squinting. Even after applying sun protection, younger patients may notice that they get specific patterns of tan lines where they have been over using the muscles around the eyes while out in the sun.

So, does Botox® help with squinting?

Yes. Botox® helps to decrease squinting. Botox® treatments by your doctor involve placing small amounts of medicine into specific areas of these key muscles to strategically weaken the contraction in a favorable manner. This requires precision and skill to positively affect both the aesthetics and the function of the muscles around the eye. The benefit is that it significantly reverses these signs of aging. Numerous studies have proven Botox® can decrease the depth and number of wrinkles around the eyes, as well as can slightly raise the position of the brow. It can slightly open or widen the space between the eyes to give a more youthful or rested appearance.

Does that mean that if I get Botox® I shouldn’t wear sunglasses?

No way. Sunglasses are important too, as they protect the actual globe from harmful UV rays. This can potentially lower the chance of developing cataracts, macular degeneration and other eye diseases whose risk specifically increases with increased exposure.

If you have tried Botox® in the past, but didn’t like it, or didn’t see a difference, ask about other FDA approved neuromodulator medications that may work better for you, called Xeomin® and Dysport®.

Dr. Scott Asher, Tallahassee Democrat
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Botox Injections As Wrinkle Treatment: Heat Maps Show Efficacy Of Toxin Via 3D Imaging Technique

June 3, 2015

The desire to remain forever young leads people to splurge on the latest serums, creams, lotions, and cosmetic procedures that hold the hope of eliminating the visible signs of aging. These products claim to outsmart aging by targeting wrinkles, age spots, and uneven skin tone, but do they really work? In a recent study published in the journal Plastic and Reconstructive Surgery, heat maps revealed Botox has both significant cosmetic and psychological effects on patients.

In the U.S., women continue to be the driving force for facial plastic surgery, making up 82 percent of all surgical and non-surgical procedures, according to the 2014 AAFPRS Statistics on Trends in Facial Plastic Surgery Report. Botox injections are among the most common non-surgical procedures along with hyaluronic acid fillers, non-ablative skin resurfacing and peels, and microdermabrasion treatments. The procedure is mostly performed on women between the ages of 35 and 55.

The effectiveness of Botox lies in its highly purified toxin bacterium Clostridium botulinum. It can temporarily erase or reduce horizontal forehead lines, vertical frown lines, and crow’s feet. The injection works by slowing muscles that contract hundreds of times a day and smoothing out lines. The results vary from patient to patient, but they typically last three and a half to four months.

To evaluate the efficacy of Botox, a team of researchers at the Perelman School of Medicine at the University of Pennsylvania were able to create a color-coded heat map via the 3D speckle tracking photogrammetry. This technique helps researchers measure dynamic facial wrinkles and their subsequent reduction following injection. In the study, a total of 14 participants were observed before and two weeks after a Botox application of 20 units of filler in the area between the brows.

The researchers randomly applied white foundation and black speckle makeup. In the pre-treatment heat map, light blue represented wrinkles. Two weeks after treatment, the light blue was largely replaced with light green and yellow. These new colors are representative of the decreased skin compression or wrinkling. Alongside the color changes, the system allowed the precise measurement of wrinkle reduction to signal improvement.

For example, horizontal wrinkling in the treated area decreased from 9.11 percent to 2.60 percent and from 4.83 percent to 0.83 percent in the forehead following injection. The vertical stretch in the forehead decreased from 6.73 percent to 1.67 percent. The average vertical stretch of the area during brow furrowing dropped from 2.51 percent to 1.15 percent.

The heat maps show the effectiveness of Botox in reducing wrinkles, which is extremely useful for improving cosmetic and reconstructive surgery. “As new therapies and expanded applications become available for antiaging and the treatment of neuromuscular disorders, this method may make it possible to quantify clinical efficacy and establish precise therapeutic regimens,” said senior author Ivona Percec, director of basic science research and associate director of cosmetic surgery in the division of plastic surgery at the Perelman School of Medicine at the University of Pennsylvania, in the news release.

Future studies will still need to explore the use of digital image correlation in larger groups. This will help physicians objectively analyze wrinkle reduction and other components of Botox, such as optimal dosage to obtain the best aesthetic benefit. Currently, static photographs and subjective visual assessments are used to measure wrinkle reduction, which are prone to errors.

This innovative technique will help assess the clinical efficacy and help solidify accurate therapeutic regimens as new therapies and applications for antiaging treatments and neuromuscular disorders become available.

Lizette Borelli, Medical Daily
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Botox May Have Long-Lasting, Anti-Aging Effects

May 21, 2015

Botox, an injection that paralyzes facial muscles to reduce the appearance of wrinkles, has a reputation for being the remedy of choice for vain starlets because it’s superficial and fleeting.

But a recent study suggests it may not be quite as superficial or as temporary.

The drug increases skin elasticity for the three to four months that it stays active, according to a Canadian study published in JAMA Facial Plastic Surgery by dermatologist Dr. James Bonaparte of the University of Ottawa and Dr. David Ellis of the University of Toronto.

“The initial theory for Botox was you paralyze the muscle, you then can’t make the wrinkle anymore because you can’t move. This is suggesting that there’s maybe more going on than just that, that you’re actually remodeling the skin to get rid of the wrinkle,” Bonaparte said.

Dermatologists had observed that even deep wrinkles that weren’t erased by Botox became less severe while it was active. Bonaparte has endeavored to measure the effect scientifically.

In the current study, he and Ellis used a Cutometer, a device that sucks the skin and measures how much it rebounds to its previous position. As we age, our skin becomes less elastic, recoiling about 30 percent less at age 70 than it does at age 20.

Flaccid skin makes us look older. It also makes the skin more prone to wrinkle.

The researchers found that when the effects of Botox were at their most powerful, the drug could increase elasticity by 30 percent. The effect peaked at two months and then waned before dropping off at four months.

The researchers tracked 43 women who were using Botox for the first time.

Could Botox Prevent Wrinkles from Forming?
Bonaparte’s earlier work on the same topic was met with criticism. Critics argued that what seemed to be elasticity could simply be swelling as a result of the injury from injection. As the skin heals from injury it draws in more water and becomes more elastic for a week or two.

The current study ruled that out by showing that injury resulted in a different pattern of resistance to the suction.

“Botox might be doing two things, one to the muscle one to the skin,” Bonaparte said.

If indeed Botox makes the skin more elastic, it may also help prevent the formation of wrinkles. That could expand the market for cosmetic injections significantly. More than 6.6 million Americans underwent treatment with Botox or a similar drug last year, according to the American Society of Plastic Surgeons.

Bonaparte, who also works in private practice, performs Botox injections for a fee. His study was funded by Allergan, the pharmaceutical company that makes Botox. All of the research to date on the potential anti-aging effects of Botox has been funded by Allergan, Bonaparte said.

Two other products, Dysport and Xeomin, can also legally be used to mute the furrow between eyebrows. Like Botox, they are derived from the naturally occurring botulinum toxin. Only Botox has the approval of the Food and Drug Administration for use on crow’s feet, but the others are often used off-label.

“There’s not reason to believe the other drugs wouldn’t have the same effect,” Bonaparte said.

To nail down exactly how the botulinum toxins ramp up elasticity, the next step will be to remove small bits of skin from participants before and after the procedures.

Cameron Scott, Healthline News
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