Today, doctors use botulinum toxins to help patients look the best for their age rather than attempt to make them look half their age.

Botulinum toxin type A treatments such as Botox, Dysport, and – new to Singapore since July 2014, Xeomin – account for more treatments worldwide than the next four most popular of the non-surgical aesthetic treatments combined; almost 10 million in 2013. While the number of plastic surgeries has declined overall in the past couple of years the global market for botulinum toxins grew by more than eight percent to over billion Singapore dollars.*

So what exactly are these millions of men and women around the world having injected into their faces and why?

Dr Colin Song, Cape ClinicToxin injections contain a protein extracted from the bacterium clostridium botulinum, usually referred to as botulinum toxin type A. Dr Colin Song of the Cape Clinic, a plastic surgeon with more than 25 years’ experience explains how they work.

“Botulinum toxin type A blocks or reduces the release of a neurotransmitter called acetylcholine, which is required for muscles to contract. Without acetylcholine, the injected muscle’s ability to contract is reduced or entirely prevented. That stops the bunching of the attached overlying skin which causes the wrinkles.”

Dr Joyce Lim, Joyce Lim Skin & Laser Clinic

Dr Joyce Lim, Joyce Lim Skin & Laser Clinic

Dr Joyce Lim of the Joyce Lim Skin & Laser Clinic explains that toxins don’t work on all wrinkles, “There are two types of wrinkles, dynamic and static. Dynamic wrinkles occur when the muscles that are attached to the overlying skin contract, causing the skin to bunch together, for example, the horizontal lines known as glabellar lines on the forehead when one furrows the brow. Toxins are effective for dynamic wrinkles like these. Static wrinkles are caused by smoking, environmental pollution, sun damage and ageing which cause the skin to lose moisture, collagen and elastin, the skin’s supportive connective tissue. Without them the skin is less able to resist the effects of gravity and starts to sag and wrinkle. Static wrinkles are there all the time regardless of whether the muscles are contracted or relaxed so botulinum toxins are not effective against them.”

Toxins are used to treat dynamic wrinkles in several key areas of the face and neck says Dr. Priya Sen from the Dr Priya Sen Skin & Laser Centre, “Botulinum toxin injections have been found to be effective on other areas where wrinkles form because of muscle contraction. The treatable areas include the bridge of the nose, periorbital lines crow‘s feet at the corners of the eyes and nasolabial folds around the mouth.”

Dr Priya Sen, Dr Priya Sen Skin & Laser Centre

Dr Priya Sen, Dr Priya Sen Skin & Laser Centre

So many injections might sound daunting for those who remember the frozen look often associated with the early days of toxin treatments when tales of New York jet setters and Hollywood housewives throwing ‘Botox parties’ filled the fashion and gossip magazines. However, techniques and tastes have come a long way in the last decade. The emphasis has changed from trying to turn back the clock 25 years to more realistic aims. Now doctors work to achieve subtle and natural-looking effects; helping people look the best they can for their age rather than attempting to make them look half their age.

Dr Ang Chee Beng a consultant dermatologist who has been in private practice for almost 20 years explains the changes he has seen.

“The results achievable with toxins, using more dilute forms like Dysport, have come a long way since the first botulinum toxin was introduced. Even the way doctors administer toxins has changed. In the beginning, the toxin was administered via just a few injection sites with fairly large doses per site almost totally paralysing the muscles. Today we have learnt how to achieve more subtle effects by using the same amount of toxin but administered over many more injection sites with the objective of reducing the range of muscle movement rather than totally paralysing it.”

Dr Ang Chee Beng, Ang, Skin & Hair Clinic

Dr Ang Chee Beng, Ang, Skin & Hair Clinic

Dr Ang also explained how toxins like Dysport have moved beyond just freezing muscles to smoothing out wrinkles and are now used for subtle reshaping and balancing of the face.

“Our facial muscles regularly play tug-of-war with each other to move parts of the face in different directions. Take the forehead and eyes for example, the opposing muscles are the squinting muscles at the outer corner of the eyebrow which pull down and the forehead muscles which pull the eyebrow up. Using a little toxin to reduce the downward pull of the squinting muscles, we allow the brow muscles to lift the eyebrow and open up the eye for a more youthful look.”

Perhaps not surprisingly, considering the country’s love affair with aesthetics and plastic surgery, Koreans have often led the way in discovering new uses for toxins, such as the Dysport Dermalift, an innovative nonsurgical skin tightening procedure using the Dysport form botulinum toxin. It was developed by a Korean plastic surgeon, Dr Lee Youn Seob, who had many actors and actresses as patients. While keen to prevent wrinkles they were worried that the standard intramuscular toxin injections affected their ability to express the full range of emotions with subtle facial expression, a vitally important ability in their profession.

Dr Lam Bee Lan, Ageless Medical Centre

Dr Lam Bee Lan, Ageless Medical Centre

Dr Lam Bee Lan from the Ageless Medical Centre explains, “Dr Lee Youn Seob developed a technique using diluted Dysport injected intradermally (under the skin). By injecting it directly into the dermal layer of the skin and not the deeper muscles which control facial expressions, he discovered he was able to achieve a subtle face lift effect. He refined the technique further by giving more intradermal injections close to the jaw-line to cancel out some of the downward pull of the platysmus muscle, giving a lifting effect to the cheeks and jowls.”

Doctors quickly came to realise that this intradermal treatment had the additional effect of reducing pore size and sebum production in those with oily skin, improving skin quality and reducing acne outbreaks.

If you are considering any kind of toxin treatment be sure to select a doctor with lots of experience and discuss with them the effects you hope to achieve. They should then be able suggest which treatments would suit you and what results you can expect.

*Figures compiled from the 2013 reports of the American Society for Aesthetic Plastic Surgery and the 2014 IMCAS (International Master Course on Aging Skin) Annual Congress


Featured photos by Dreamstime.

Doctor photos are their own.