On point with off-label Botox
Off-Label Cosmetic Use
Even physicians trained in cosmetic medicine underutilize Botox, Dysport or Xeomin for routine cosmetic concerns, says plastic surgeon Larry H. Lickstein, M.D. Among those uses: to treat the wide lower face; soften facial appearance and improve skin quality; to treat dynamic neck bands; to smooth “cobblestoning” over the chin; to soften fine lip lines; to improve corners of the mouth that have turned down; and to address the gummy smile.
Using botulinum toxin type A to treat a wide lower face is popular in Korea and other parts of the Far East, according to Dr. Lickstein, who practices in Northern Virginia.
“It is now being used regularly on women who have a square-shaped face and broad jawline. Frequently this is attributable to a well-developed masseter muscle, and may be associated with bruxism…,” Dr. Lickstein says.
Washington, DC, facial plastic surgeon Houtan Chaboki, M.D., says he also uses neuromodulators, such as Botox, to soften large jaw muscles and finds the approach has more than cosmetic appeal.
“I perform this procedure for cosmetic purposes, but patients with TMJ, or teeth grinding, have reported benefits. Unlike Botox for wrinkles, results for masseter muscle treatment gradually develop over weeks, but the treatment needs to be repeated less often, usually after several months,” Dr. Chaboki says. “Botox jaw reduction lasts approximately three to six months. Treatments need to be performed at least two to three times a year to maintain results.”
To soften facial appearance and improve skin quality, Dr. Lickstein says he uses the concept of “micro-Botox,” which entails using very dilute doses and injecting intradermally, as opposed to subcutaneously or intramuscularly.
“[The concept] was introduced by Woffles Wu in Singapore in the early 2000s,” Dr. Lickstein says. “The low dose does not paralyze muscles as dramatically, but rather softens their actions by affecting the fibers inserting in the skin. We also know that Botox affects glands in skin (consider its use for sweating), and many patients observe improved skin and even reduced pores.”
Botulinum toxin type A treatment of the dynamic neck bands also seems to be gaining ground among cosmetic surgeons.
Most neck bands are redundant skin or platysmal muscle bands or margins, according to Dr. Lickstein.
“In some individuals, these bands are quite active and will move during speech. In those select patients the bands can be softened and made inactive with Botox,” Dr. Lickstein says.
San Diego, Calif.-based plastic surgeon Paul Chasan, M.D., says Botox treatment for early neck banding is an exciting area in cosmetic surgery.
“Many patients in their early and mid-40s have neck banding but are not ready for a mini facelift. Botox in this area works beautifully,” Dr. Chasan says.
Yet another potential botulinum toxin use: to relax muscles over the chin to treat "cobblestoning,” according to Dr. Lickstein.
“Some individuals will notice a wrinkled, irregular, almost corrugated appearance over their chin when they make certain expressions or speak certain words,” Dr. Lickstein says.
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