The botulinum toxin has been used for many years now for neurologic and oculist use. It has been very helpful for many diseases as the spasmodic stiff neck, strabismus, blepharospasm and thousands of patients underwent the treatment! Since 1987, two Canadian partners, both ophthalmologists, the Carruthers had a genial idea to use this toxin for mimic wrinkles. Thanks to this, in the field of aesthetic medicine they are very famous and very requested for conferences and teachings. Since then, the use of the toxin has been exponential thanks to its best results and the almost total absence of dangerous collateral effects. In Italy, botulinum toxin has been authorized for aesthetic use for few years now and it can be used only for the glabella wrinkles, those between the eyes. For any other indications has an off-label use (there is not the indication on the information leaflet), and so the doctor takes the responsibility to do it and the patient has to be aware of it. Botulinum toxin does not present any particular risks, but it has absolutely to be done by an expert, since he rarely makes mistakes (the toxin is powerful and always works) and, if it is done badly, it can cause problems which are however transitory. Palpebral ptosis, ptosis of the eyebrow and sometimes even the lower lip and also the treatment of the lower third of face could have a ptosis. This is due to exaggerated and dangerous dosages and to injections in wrong position. The best indication for this medicine remains the upper third of face and so the glabella wrinkles, the frontal wrinkles and the wrinkles of the lateral cantus of the eye (crow’s feet wrinkles). In particular, the glabella wrinkles have great results with a great naturally since they take away the “angry look” of a person. If you are often told to look angry when you are not, it could be due to this attitude. But also the forehead well responds to the treatment as for the so-called crow’s feet wrinkles. Lately, in all congresses, more and more reports are about mouth, lower third of face, neck and also décolleté. These remain a difficult zone that only expert doctors should treat; they still give very outstanding satisfactions. In particular, mouth reacts very well and, despite what the media and many colleagues say, in my opinion, this is a zone with zero risk. The technique has to be obviously rigorous with prudential dosages. And for the code bar wrinkles of the upper lip, the one due to an excessive mimic, does not exist anything so efficient: laser, deep peelings, fillers or integrations with fat are not able to eliminate the problem as botulinum toxin. After the injections, the toxin acts for several days, not immediately, and so you need to be patient. It usually takes 7, 10 days, but on the information leaflet of Vistabex, is reported that to have the real and definitive result you have to wait 30 days. We have to remind that nowadays there are not any lasting problems after the treatment with botulinum toxin, and so the medicine is very safe. In the end I want to remind again that the goal is not to be totally paralyzed, but to have some reduced movements in order not to see too many wrinkles (the ability of the doctor consists on finding the compromise!). The result is not everlasting, fortunately and unfortunately: after about 4-6 months, the treatment has to be re-done, if we want to maintain the result. The botulinum toxin is also very useful in the treatment of dysidrosis, alterations of perspiration, with very efficient and natural results. For this indication it can be done on hands, feet and armpits, with more lasting results compared to wrinkles: basically, it can last a year. Indications: Mimic wrinkles due to movement Glabella wrinkles Frontal wrinkles Wrinkles of the lateral cantus of the eye (crow’s feet wrinkles) Code bad wrinkles of the mouth (young smokers) Ptosis of the cheekbone Plasmatic bands of the neck Aging of décolleté Excessive sweating of armpits, feet and hands.

Informed Consent –Botulinum Toxin