Anti-wrinkle Treatment with botulinum toxin

Botulinum toxin A is a prescription medication made from a naturally occurring bacterial protein. When injected into a muscle it blocks the nerve impulses, preventing that muscle from contracting in the usual way. Other nerve functions, such as the sense of feeling or touch through the skin, are not affected. Botulinum toxin A has long been used in the treatment of muscular cramp in the area around the eyes and forehead (such as an eyelid spasm). In Switzerland, permission to use it for the treatment of wrinkles has been restricted to the correction of frown lines on the forehead. Efforts are being made to acquire permission for other uses. The injection of very small quantities of botulinum toxin A inhibits the relevant facial muscle.

Deep mimetic wrinkles can be corrected by means of an operation, by the injection of fillers or medication such as botulinum toxin A, or through a combination of procedures. Finding the most suitable solution depends upon the location and depth of the wrinkles.

The injections are administered using a very fine needle, ensuring that the treatment is relatively painless. On rare occasions the injection may initially cause a slight burning sensation.

An improvement in glabellar wrinkles can generally be noticed within one week of treatment, with the peak effect usually visible within 4 weeks. The results last for 3 to 4 months. The safety and effectiveness of treatment on a more regular basis have not yet been investigated. It is therefore not recommended to have frequent treatment. Should the treating doctor deem it appropriate, repeat treatments can be administered if the effects of the previous injection have subsided. Repeat injections should not be administered more frequently than every 3 months.

Please let us know

• if you are pregnant or breastfeeding (treatment cannot be performed during pregnancy or if you are breastfeeding), if you occasionally suffer from fever blisters/cold sores (injection into a particular area could trigger a new outbreak)
• if you have taken any blood-thinning medication in the 7 days prior to treatment (due to an increased risk of haematoma (effusions of blood) after the treatment)
• if you are aware that you have any nervous or muscular disorders (in a few cases treatment with botulinum toxin A is not possible)
• if you are taking aminoglycoside antibiotics (e.g. gentamicin, neomicin; treatment can only be carried out after the course of antibiotics has been completed)

Based on the results of controlled clinical trials, 24% of patients can expect to experience undesirable effects as a result of treatment. Side effects may be associated with the treatment, the injection technique, or a combination of both.

Side effects generally manifest themselves within a few days of the injection and are usually only temporary. Localised muscle weakness is a known pharmacological effect of botulinum toxin. Blepharoptosis (drooping eyelid) is connected with the pharmacological effect of the medication and can be caused by the injection technique.

The following undesirable reactions have been observed after treatment with Vistabel

Reaction at the injection site

Frequent (1%–10%): localised pain/burning/stinging, oedemata and/or haematoma

Nervous system

Very frequent (>10%): headaches (13.3%)
Frequent (1%–10%): facial pain, localised muscle weakness
Occasional (0.1%–1%): dizziness, nausea, oral dryness, feeling of tension in the skin, paresthesia, twitching.

Eyes

Frequent (1%–10%): blepharoptosis
Occasional (0.1%–1%): eye pain, oedemata (face, eyelids, periorbita), eyelid inflammation (blepharitis), visual disturbances, sensitivity to light

Skin

Frequent (1%–10%): skin redness
Occasional (0.1%–1%): dry skin, itching

Immune system

Occasional (0.1%–1%): flu-like symptoms, general weakness, fever, infection

Psychological

Occasional (0.1%–1%): anxiety
Gastrointestinal disorders
Occasional (0.1%–1%): sickness

Contraindications

Known hypersensitivity to the active ingredients, or any of the components used in the formulation. General disturbances in muscular activity (e.g. myasthenia gravis or Lambert–Eaton myasthenic syndrome). Presence of infection at the planned injection site(s).

For additional information (in French and German) www.compendium.ch