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Correcting Difficulties Smiling After Azzalure

Question :

Dear Cosmetic Courses,

I attended your basic and advanced courses in 2005.

I recently treated a 37 year old lady using Azzalure 3 x 0.1ml (15iu in 0.1ml) bilaterally to her orbicularis occuli. I performed my usual technique, injecting into the sites I usually inject into, and making sure I did not inject too low down on orbicularis occuli.

She came for review 2 weeks later, complaining of a heaviness over her cheeks making smiling difficult, more so on the right side.

Could you advise on any intervention that may alleviate this?

I have heard of practitioners advising stimulating the muscle using an electric tooth brush?

Answer :

It does sound like some of the Azzalure may be affecting your patient’s Zygomaticus Major or Minor.

This would cause the symptoms which you describe and is usually caused by the lowest of your crows feet injections.

We have seen this once before and it was caused by Dysport- there is some evidence that Dysport and Azzalure may disperse more than Botox making side effects like these more likely.

Unfortunately, there may not be much you can now do to alleviate it other than being supportive.

The electrical toothbrush trick may work and is certainly worthwhile trying, to both muscles 3 times a day for 5 minutes.

Good luck with this case and let us know how it goes.

The Cosmetic Courses Team

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Lip Augmentation Through Restylane

Much of the focus in plastic surgery lately has been moving north…to the lips! A simple lip augmentation can give you a dramatic and sensuous look with the fullness of celebrities like Angelina Jolie. This procedure can give you more self-confidence and balance your appearance. Since aging can cause you to lose collagen and volume in your lips, lip augmentation can even make you look younger!

But with something as noticeable as your lips, you should take care to make sure the procedure is done right. It is difficult to cover up a mistake right on the front of your face! If you are considering a lip augmentation procedure, take the time to research the best products on the market.

Restylane is one of the more common products on the lip augmentation market, and its results are quite promising. Unlike other injectable fillers like fat and collagen, this substance is a biodegradable gel that contains no animal products. It is based on hyaluronic acid, a substance found naturally in the body with the purpose of providing fullness and elasticity.

Lip injections with Restylane are fast, easy, and relatively pain-free. You do not even need a skin test, since the product is not animal-based and the risk of an allergic reaction is low. Because Restylane does not contain lidocaine like collagen, you may experience pain upon injection. Using a small needle, the gel is placed in the inside of the lips in little amounts. The volume it adds, though, is impressive. The entire procedure can take from just a few minutes up to half an hour, and you can go home shortly thereafter. The full recovery time is only about two to three days, and there are relatively few side effects besides some tenderness and swelling at the site of the injection.

Since Restylane is one of the latest developments in lip augmentation procedures, costs will vary by physician and location. But Restylane is sure to be a great value for your money, since it can stay effective for six months (much longer than other treatments). Using Restylane can enhance and regenerate your lips to add volume and shape. The product has also been approved by the FDA for the improvement of facial wrinkles, aging lines, and crow’s feet.

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Can Botox’s Smoothing Effect Be Socially Hazardous? Experts Disagree

A study carried out in the US by psychologist David Havas and colleagues from the University of Wisconsin-Madison, Arizona State University and the University of Chicago has had UK newspapers crying out that Botox injections will cause friendships to fail. The study’s conclusions suggest that using Botox procedures to effectively “freeze” the muscles that cause lined foreheads and crow’s feet will make users’ faces respond more slowly to bad news, giving the impression that they are indifferent or lacking in sympathy. Yet according to leading UK health website the study may be flawed and its conclusions should not give consumers cause to worry that Botox will destroy their relationships.

The study consisted of recruiting 41 women from cosmetic surgery clinics to participate in a test that involved reading 60 sentences on a computer screen. The women, who received $50 towards the cost of their procedures as compensation, took two tests–one just before their Botox treatment, and the second two weeks afterwards. Both times they read 20 happy, 20 sad and 20 angry sentences, pressing a key on the keyboard to indicate when they had finished reading each sentence.

Analytical techniques such as regression analysis were used to cancel out the effects the position of the questions in the tests, the emotions they were designed to express, and possible anxiety about the Botox procedures. The overall result of the study was the finding that although the time for reading the happy sentences remained unchanged, participants took approximately 0.2 to 0.3 seconds longer to read the sad and angry sentences after their Botox treatments. Drawing on earlier research on both animals and humans, the study’s conclusion was that Botox’s paralysing effect on facial muscles was hindering emotional processing, particularly if the paralysed muscles were the ones usually used to express the emotion in question.

NHS commenters have pointed to several flaws in the study, including the small size of the sample and the fact that previous studies have not shown for certain that reading time is an indicator of the effectiveness of emotional processing. In addition, no research was done to assess the popularity and/or sociability of the study participants, or to independently assess their facial expressions as they read the questions. It seems likely, therefore, that UK newspapers were jumping to unwarranted conclusions when they deduced that Botox use could ruin friendships.

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Smooth Away Wrinkles While You Shop – A Department Store First

In February 2010 Debenhams, the high street department store shoppers usually associate with fashions and furniture, became the first chain to banish customers wrinkles by selling Botox jabs to its customers. For a flat fee starting at £170, shoppers can spend their lunchtime improving their looks with a Botox procedure that generally takes around 45 minutes, including a total of 10 minutes for the jabs and a consultation with a physician in a private consulting room.

The Mediskin Cosmetic Laser Clinic was first rolled out in the Newcastle store. With the use of Botox for cosmetic enhancement in the UK up 2,500 percent in a three-year period, Debenhams is planning to make the clinics available nationwide in the near future. In addition to Botox, the clinics will offer other popular cosmetic treatments such as dermal fillers, age and sun spot reduction, and removal of thread veins.

Botox works by blocking the signals from the brain that cause muscles to contract and move. Tiny injections into the sites where lines and wrinkles appear effectively freeze the muscles, causing a noticeable smoothing effect within three days. The effect lasts for three to four months for the first treatment, and up to six months for subsequent procedures.

Botox treatment has become wildly popular for eliminating crow’s feet and worry lines on the forehead, and gossip columns are rife with stories of celebrities such as Simon Cowell, Victoria Beckham and pop singer Fergie having Botox injections. It’s no wonder that ordinary British men and women are turning to the needle to get a quick and relatively cheap shot of youthfulness. Although some dermatologists warn against the long-term side effects of Botox, the injections have been used for 20 years to prevent eye squinting and it is clear from Debenhams’ move that consumers have come to regard Botox enhancements as a routine cosmetic procedure.

With the UK market estimated at over 100,000 Botox users a year, the Debenhams initiative may be the first sign of a rush to take advantage of the fastest-growing beauty lift in the cosmetic industry. Debenhams spokeswoman Ruth Attridge stressed the advantages to customers of being able to have the procedure done as part of their regular day, while stressing that the Botox jabs will be “all under the guidance of medical practitioners.”

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Permalip ®:Revolutionary Lip Enhancement

Professional beauty experts contend that the key to a youthful appearance is the lips. If your lips are full and young-looking, other age-related flaws such as crows’ feet and frown lines become less noticeable in your overall appearance.

While such environmental factors as sun exposure adversely affect your facial features, the aging and thinning of your lips as you advance in years depends largely on your genes. You can prevent looking older than you feel by being proactive and correcting the demise of the thickness and plumpness of your lips. Additionally, if you are young but want more volume to achieve that ideal look of “kissability,” there are both temporary and permanent cosmetic fixes to give you the lips you desire.

Temporary Cosmetic Enhancement

Temporary treatments to replace the youthful lip fullness that time begins to take away include such injection programmes as Botox and collagen. While Botox works beneath the skin to immobilize the muscles that govern your facial expressions, thus smoothing those wrinkles that become apparent when you frown or smile, collagen injections actually plump up your lips, filling in the lines just beneath your skin surface. The downside of injection treatments is that their positive effects last only 3-9 months, and then the treatments must be repeated.

A Permanent Solution

Permalip® is a new advance in the field of cosmetic surgery that offers a permanent solution to the problem of aging lips. The ground-breaking procedure utilizes a unique silicone implant to fill and plump your lips for a lifelong, beautiful smile.

The Permalip® implant, developed by U.S. cosmetic surgeons, is composed of a soft, pliable silicone solid. A proven procedure that developers have extensively tested, Permalip® has attained CE Marked approval for use in Europe. This permanent lip enhancement that will keep your appearance youthful without repeated treatments.

Unlike older implant treatments, the Permalip® implant is rupture-proof, will not bond with surrounding tissue, and will not harden or deteriorate throughout years of use.

The Procedure

It takes less than one hour under local anesthetic for your cosmetic surgeon to place your implant. You will retain no visible scarring, and you can feel confident knowing that the procedure is fully reversible and can be adjusted for size upon your request.

You will enjoy full recovery from the procedure within two weeks, and the beautiful results will keep you looking as young as you feel. Permalip® is truly revolutionary.

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Collagen, Hyaluronic Acid and Elastin

When fine lines develop around the forehead, crow’s feet around the eyes and wrinkles around the mouth, it is a sign of aging that is more obvious than a change in hair colour and density or a change in body posture.

Skin, consisting of bonded layers, begins to sag and become lumpy as a person ages. What is basically happening is that the skin loses its elasticity. This is usually a result of a depletion of three proteins common in skin: collagen, elastin, and hyaluronic acid.

Collagen is a fibrous protein found in skin, bone, cartilage, muscles, and tendons. It works to connect body tissue. It makes up 25 percent of the protein in the human body, and it is even found in teeth. Like a glue, it holds the tissues of the body together, including the layers of the skin.

Elastin is a protein that pulls back the skin when it is stretched. In addition to keeping the skin elastic and flexible, it keeps the skin smooth. This is why your mouth returns back to its normal shape after using the muscles of your face when talking.

The third essential protein for a youthful, healthy skin is hyaluronic acid. The more of this protein that is lost, the more aged a person begins to look. Fortunately, apart from cosmetics, it is also possible to take nutritional supplements to restore levels of hyaluronic acid. Moisture is lost because of lower amounts of hyaluronic acid. Diets rich in kelp, seaweed, and fish help maintain hyaluronic acid. People with Mediterranean or Asian diets appear to age slower with “plumper skin” than those people who live in cultures where refined foods filled with additives have become the norm. In cultures with poor diets, an enzyme called hyaluronidase begins to work against hyaluronic acid. Part of the process of restoring hyaluronic acid is to reduce the hyaluronidase enzyme.

Depletion of these three skin proteins is exacerbated by indulging in poor health habits like smoking, drinking alcohol, not drinking enough water, not eating nutritious food, not exercising, and getting an excessive sunburn. While taking care of your health by reversing all these conditions will go a long way to restoring your youthful appearance, you can also get relatively quick results by using lotions that provide the skin with what it needs to maintain its elasticity. Most anti-aging skin care programs work on restoring collagen, elastin, and hyaluronic acid.

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Dermal Fillers Require Professional Services

Quick fix dermal filler products include such widely recognized products as Botox, Juvederm, and Restylane. These substances, when properly injected by an experienced clinician, can eliminate obvious signs of aging such as wrinkles, crows’ feet beside the eyes, and forehead creasing.

How Do They Work?

While Botox works beneath the dermal layer to relax those muscles that when contracting, form expressive lines on the face, Juvederm and Restylane work within the skin layer to immediately fill and voluminize the flesh on the face and then provide nutritive revitalization for the longer term. They are especially effective in smoothing areas around the mouth and nose.

Application

Because all three of these dermal fillers require application via injection into facial tissues, they call for the services of a licensed clinician. Only the experienced expert can judge the correct quantity of filler and the proper areas for application. A professional office venue is the safest, most sterile and quality-controlled environment for treatments of this kind.

Industry Concerns

In recent years, especially since sales of Botox, Juvederm and Restylane no longer require a physician’s prescription, more sources are making these dermal fillers available to the general public. People have the option to buy the products directly or online. Incredibly, people are actually giving themselves a do-it-yourself quick facial fix by self-injecting dermal fill substances.

This practice is raising considerable concern among the medical community. Some clinicians point out that medical supplies from unproven sources can easily be counterfeit or substandard products that may cause unwanted side effects. Others focus on the fact that an untrained individual is hardly qualified to judge quantities and injection sites. Amateur applications of Botox, Restylane, or Juvederm can produce some surprising and sometimes alarming results.

Self-injection of dermal fillers can cause redness and infection, excessive swelling, scarring, bleeding, and migration of fillers to undesirable areas of the face. When you inject fillers around your eyes and forehead, you can create droopy eyelids or areas of swelling that a physician may find hard to reverse.

Conclusions

The majority of individuals self-injecting dermal fillers do so to save professional fees. Yet when you consider the potential health problems and side effects that often require a doctor’s intervention later, these do-it-yourselfers rarely save much, and often manage to make themselves look worse rather than better. An initial investment in professional injection of dermal fillers undeniably produces the best results.

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