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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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How Well Do You Know Botox

Who would have thought that modern medical scientists could tame a substance once called “The most poisonous poison on earth” and harness its power to use for goodness? The miracle of controlling Botox, also called Dysport in the United Kingdom and Ireland has resulted in the successful treatment of voice tremors, urinary incontinence, prostatic disease and even depression. The cosmetic applications extend even further, Botox can help control underarm perspiration, reduce the appearance of wrinkles, lift the eyelids and make lips look fuller. So, what was once seen as a terrible poison is now a miracle drug.

Some people are concerned that Botox injections will give them a glazed, expressionless face, but at the hands of a skilled and realistic practitioner, that’s not likely to happen. Certified and expert physicians who use Botox for cosmetic purposes understand how the cells in the face toned to age and relax over time, and use Botox to work with the body’s natural weak spots, providing a firmer resistance. Properly applied, a patient won’t look fake, plastic or expressionless at all.

Another common misconception about Botox is that it’s toxic. True, it’s derived from a toxic substance, but before being approved for cosmetic purposes, it goes through a rigorous safety process that ensures it’s diluted and that the final injection isn’t strong enough to hurt anyone. In fact, most drugs are derived from toxins. In small amounts, they’re used effectively to treat diseases and disorders. In large amounts, though, they’re dangerous.

Belladonna is an example of this. A relative of the potato plant, Belladonna has been used over the centuries as an aphrodisiac, a poison and as a cosmetic eye drop. Today, ophthalmologist use a formula derived from Belladonna to dilate the patient’s upils for an optometric examination. Once dilated, the doctor can see the retina clearly. So any substance that can be called toxic, can also be diluted in order to work with the body instead of against it. “Everything in moderation,” so the saying goes.

The best thing a client can do, when considering whether or not to use Botox or Dysport, is to discuss the matter with a physician who’s informed and trained in using Botox effectively. When there are so many misconceptions and misconstrued information floating around, it’s no wonder that some of the people who would benefit the most from Botox injections may be afraid to pursue the matter.

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