Early researchers knew that certain wrinkles of the face are produced by repetitive motion of the skin caused by contraction of facial muscles. The contraction of the skin causes destruction of skin structures I call tissue matrix. The repetitive destruction of the tissue matrix eventually causes texture changes, followed by fine lines, and eventually wrinkles that continue to worsen with age. Young people don’t have these wrinkles because young skin produces enough collagen and other constituents of the tissue matrix. When tissue matrix is broken down by muscle movement it is immediately replaced. At some point, generally between 28-32 years old, the skin production of tissue matrix decreases to the point that the lines of age begin to show. These wrinkles vary according to genetics, sun exposure, smoking, and other factors, but everyone is eventually going to show how their muscles move by the wrinkles on their face.
Botox Cosmetic is able to decrease muscle movement by interrupting the nerves ability to communicate with the muscle. Normal nerve function uses a chemical called Acetylcholine which is released at the nerve tips and signals the muscle to contract. Since the Botox molecule interrupts this process, the treated area stops moving, thereby decreasing the destruction of tissue matrix. When the tissue matrix is not being destroyed wrinkles are not made. Even though we make less tissue matrix as we age, the Botox allows tissue matrix to build up, since it is not being broken down. In this way, even wrinkles that have been present for years can soften and eventually disappear.
To cause wrinkles to continue to improve requires repeated Botox treatments. Because the effect Botox has on the nerve ending is temporary the body begins to reverse it immediately after it occurs. Healthy individuals will have reversed the nerve block in 3 months so the skin is now being damaged again by muscle movement. Repeating the treatment will preserve the favorable effects and cause the skin to continue to improve.
Some people are concerned that paralyzing these muscles will give them a “frozen” or “fake” appearance. It is important to understand the Botox molecule can be restricted to a precise area. In the hands of an injector well trained in the anatomy of the facial muscles and the dosing of Botox, it is easy to preserve a natural look and still control the wrinkles that make us look older.
Next, I will review the safety of Botox Cosmetic.
Mack Stewart, M.D.