Facial rejuvenation can come from diluted botulinum toxin injections

The latest American Society of Plastic Surgeons (ASPS) statistics report more than a sixfold increase in botulinum toxin injection procedures since the end of the 20th century. Almost any cosmetic surgeon will say the increased demand has come from patients who opt for a more natural-looking rejuvenation, as opposed to the "frozen" look that traditionally prepared botulinum toxins can give.

Taking these desires seriously, Singapore-based plastic surgeon Woffles Wu, M.D., has pioneered an injection technique, called Microbotox, that rejuvenates the face and skin with botulinum toxin, but without any resulting rigid muscle paralysis.

A female patient with oily skin, glabellar frown lines and popply chin shown before (left) and after 24 units of Microbotox per side and traditional onabotulinumtoxinA (two to six units, middle). Note areas of Microbotox in green (right) and traditional onabotulinumtoxinA in black dots. (Photos credit: Woffles Wu, M.D.)

Experts say Dysport (abobotulinumtoxinA, Medicis) also can be used.

Technique Tricks

Another of his goals was to eliminate lateral brow frown lines without causing depression of the eyebrows, he says.

Dr. Wu has found that patients also want Microbotox to the forehead area, crow's feet, infraorbital and cheek areas and bunny lines.

"Many patients who used to receive traditional onabotulinumtoxinA in these areas now request Microbotox instead, as they feel they look more natural and have less stiffness," he says.

Microbotox has multiple uses and has expanded the scope and range of effects of botulinum toxin beyond just muscle manipulation. "The most important areas for Microbotox use are the forehead and the under-eye region," Dr. Wu says.

In the past, injections of traditional Botox to the forehead resulted in either an undesired "Diablo" brow or a totally frozen forehead and uncomfortable depressed brow. "With Microbotox, the forehead lines are eradicated yet the patient can still move his eyebrows and elevate them," Dr. Wu says.

In the lower lid, one of the main problems with administering traditional Botox to eliminate under-eye wrinkles and fine lines was that this created an unwanted over-relaxation of the orbicularis oculi, leading to the eye bags becoming more prominent, or worse, creating "hound dog" malar bagging, Dr. Wu says.

"With Microbotox, these lines can be significantly reduced without compromising orbicularis oculi activity," he says.

In the neck and lower face, "Microbotox is injected into the skin overlying the distribution of the platysma. This results in a smoothening of platysmal bands, horizontal neck creases and creates a lifting effect of the jawline," Dr. Wu says. A similar smoothening effect can be seen in the décolletage, where patients often have multiple wrinkles and crepey skin.

"I also like intradermal for the neck crepiness and for enlarged pores and rhinophyma of the nose," says Steven Dayan, M.D., a Chicago plastic surgeon who says he's been using the technique for three or four years. "I especially find it great for rosacea. I find the results comparable if not superior to IPL (intense pulsed light)."