As a result of movements such as laughing, getting angry, sad, crying, surprised, and squinting, the facial muscles move and wrinkles form on the skin over it. As a result of the repetition of these movements over the years, the wrinkles on the skin become permanent. These wrinkles occur in varying degrees depending on the person's habit of using their facial expressions, the duration of exposure to the sun, skin and muscle structure, age and gender. The substance used in Botox application is a protein secreted by the bacterium clostridium botulinum. This substance temporarily reduces or destroys the function of the muscle in the applied area by blocking the electrical transmission from the nerves to the muscles. When the muscle loses its function and cannot contract, the wrinkles on the skin also decrease or disappear. During the Botox effect, these mimic muscles work weakly or do not work, so the wrinkles on our face are significantly reduced. In this way, wrinkles in the upper part of our face, namely the forehead, the frown area and the crow's feet around the eyes, can be controlled to a large extent.
Botox is not a miracle. It will not make any permanent changes to your face. It also won't make you look like you were 20 years ago. However, it will help you to have a much more positive and energetic image compared to your current state.
After the treatment area is cleaned locally, a local anesthetic cream is applied if our patient also desires and needs it, and it is waited for about 30 minutes. Otherwise, if our patient has had botox application before and he knows that the pain is not too much, there is no need for local cream. Generally, patients may want to apply a cream, but people who have had this job and have previous experience do not need cream application because they know that the pain is very mild with botox injection and it takes a very short time.
Botox is injected into the muscle from several points with very fine-tipped special needles. During the application, there is no major pain complaint that disturbs the patient. The pain is very tolerable, very short and very momentary, does not continue after the procedure is over.
There are a few points to consider after the procedure. One of them is a very slight swelling in the area where botox is applied, if there is such a swelling, only pressure should be applied on it, it should not be spread by rubbing. In addition, there may be minor bruises due to the needle coming into contact with a small vein during the botox procedure, if there is such a situation, it is useful to put some pressure on it and apply ice. In addition, you should not be very active after botox application. It is recommended not to do sports, especially in the first 24 hours. It is not recommended to hold a position with the head tilted forward.
The image that our patient will obtain from botox starts to show itself positively on the 5th day – 7th day. When the 2nd week is over, the best image is reached. For this reason, we evaluate our patient at the end of the 1st or preferably the 2nd week, especially in patients who have done botox for the first time, and if there is a missing dose, we invite the retouching dose to complete it.
Generally, the effect of botox is about 4 months, but there may be personal changes and we hear that the effect of botox lasts for 6-8 months in some patients; but on the contrary, we observe that the effect is much shorter in some patients. It is clear that there are individual differences here.
As for the side effects of Botox; The most important thing to note here is that the idea that Botox is a substance injected into random spots leads to huge mistakes. Today, we observe that many doctors who are not Plastic Surgeons or Dermatologists are curious about this botox process, and even people who are not doctors are interested in such procedures, and therefore unwanted images and bad results are increasing.
Botox is a procedure that should be done by experienced physicians who are in really good hands, who have knowledge of anatomy and who evaluate every wrinkle very well. Otherwise, as a result of botox applied to the wrong spots, you may have an undesirable appearance for 2-3 months and you may have to walk around in that way. An experienced physician who knows which mimic movement and line is created by which muscle is the most indispensable element in achieving the desired result.
WHAT IS BOTOX?
There is a myth that botox is a snake venom. However, this is completely false information. It is a protein-based toxin released by a bacterium called Clostridium botulinum. We use this toxin for controlled muscle paralysis, with companies dosing it in a controlled manner. For years, botox has been used in physical therapy, neurology and even in ophthalmology in the treatment of strabismus, for the relaxation of spastic muscles, that is, the muscles that contract undesirably excessively and involuntarily. It has been among the aesthetic and cosmetic procedures in order to reduce wrinkles on the face for about 15 years.
WHAT IS THE DIFFERENCE BETWEEN BOTOX AND FILLING? DOES BOTOX Cause Swelling?
Botox is a substance that is injected in very small amounts and shows its effect with its chemical effect, and does not have a bulking feature. Therefore, we do not expect any swelling in the areas where botox is applied. We are surprised, especially when we read comments on television and in magazines about someone with swollen eyes and swollen eyes, as if they had Botox; Because normally, a person who has botox leaves the clinic without leaving any trace after botox is done in a way that no one will ever understand. There may be just a small point bruise, which usually does not happen. In other words, after botox application, no one can understand that botox is done, it does not create swelling, it does not create fullness.
Filling materials, on the other hand, create fullness and swelling in the places where they are applied due to an increase in volume. Ready-made fillers are prepared in a sterile manner, fabricated in injectors, and these packages are opened in front of the patient and used for only one patient. The aim is to reduce the collapse and tissue scarcity in the planned area and to give fullness to that area. Among the filling materials, there are also fat injections and tissue cocktail applications in which the patient's own tissue is used, which are very popular today.
WHEN DO WE PREFER BOTOX, WHEN DO WE PREFER FILLING MATERIAL?
Botox is used for the lines formed by the work of the muscles on the face, which are formed by the work of the muscles actively. In other words, the target point of botox is the facial mimic muscles. Filling material should be used for lines that exist even without working the mimic muscles or for the lack of tissue. We can explain this as follows; When a patient looks at you without making any mimic movements, if there are horizontal lines on his forehead, if the frown line is evident even though he does not make any gestures, or if the lines of the crow's feet around the eyes are clear even without making any smile movements, these lines are static lines, that is, the scars formed on the skin as a result of the mimic movements of years. are depressions.
In order to reduce these, it is recommended to inject filler material into these areas. However, if there is no or very little line when our patient does not mimic, but when we make some mimic movements; For example, if the eyebrows are raised for horizontal lines on the forehead, a frown movement for the clarity of the frown line, or a deep smile for the crow's feet area, if there are obvious lines, botox is recommended to reduce them. In short, Botox is used for active lines, that is, for lines formed by active contraction of the muscles, and Filling is used for passive lines, that is, for reducing existing lines even without making any mimic movements.
In some areas, botox and filler support each other. The best example and a very common example for this is our patients whose frown lines are very deep and the patient has a deep frown line even without mimicking. In these patients, we first treat the area with botox in a way to prevent active streaking. After the procedure, that is, 1 week - 2 weeks later, we see that the muscle here does not contract, but even though the muscle does not contract, if the presence of the line disturbs us and the patient, we additionally perform a filling procedure under this line. Thus, the active movement will be limited by botox, and the passive line will be reduced by filling. The use of Botox in this area also extends the life of the filling material because the presence of movement is a disadvantage for the filling materials we use. Filling materials can melt easily in areas where there is a lot of movement, and their life can be longer in areas where there is less movement, that is, their effects can stay longer. For this reason, if filling is to be used on the forehead and horizontal lines, it is recommended to apply botox to the forehead area before this procedure, to apply botox before this procedure if filling is to be used in the frown area, and even if filling is to be done in the crow's feet area, it is recommended to apply botox before these procedures.
Unfortunately, botox use is not very efficient in the lower half of our face. Because there are many muscles with different pulling direction, especially in the nose edge and mouth corner region, and botox injections made to these areas can cause asymmetries around the mouth. Therefore, the use of botox in this area is applied in smaller doses and hesitantly. Filling is generally preferred for laugh lines extending from the edge of the nose to the corner of the mouth.
HOW LONG DO THE FILLING MATERIALS LAST?
This is one of the top questions that many patients ask us. However, the answer to this question is not very clear. First, a filling material cannot have the same effect on every part of our body for the same time. Because of the movement, its lifespan in some regions may be long and in some regions it may be short. The best example of this is that a filling material that we apply to the lip can melt in a short time, within a few months, and lose its effect, but when the same filling material is applied to the frown area after botox, it easily shows its effect for 7-8 months. In other words, it is not possible to predict a lifetime for a filling material that will be valid for every region.
WHY ARE LONG EFFECTIVE FILLER MATERIALS NOT ATTRACTIVE?
Today, when we go to international large meetings and congresses, we meet with the representatives of many companies and many company representatives also talk about their own products. However, our current experience has shown that, considering the patient, it is very important for the procedure to be effective for a long time, but a second factor, the criterion is the safety of the applied material. Today, when the safety and permanence factors are evaluated, the recommended opinion is as follows; safety should be at the forefront, materials that have the risk of allergic reaction should not be preferred, this issue should be explained to the patient in a good way and it should be explained that permanence is important, but in case of any adverse situation, this can be a really important problem for the person. Therefore, a material that is primarily safe should be selected; Secondly, care must be taken to ensure that its duration is sufficiently appropriate.
Unfortunately, today, there are no materials that are completely safe and have a long duration. Materials with a long durability starting from a few years should not be preferred due to the risks of allergic reaction or tissue hardening such as granuloma.
WHAT IS THE DIFFERENCE BETWEEN OIL INJECTION AND FILLER MATERIALS?
WHEN, WHICH SHOULD BE PREFERRED?
Fat injection is actually a very good procedure used as a filling material. It is very attractive because it is the patient's own tissue and does not contain any foreign matter. However, the process of removing such a material from the patient requires an intervention, albeit a small one. For this, in good conditions, in a sterile environment, it is necessary to enter the patient's fat area, usually the abdomen, through a small incision and remove fat from this area under local or general anesthesia. When this is done in an ideal way, it is a procedure that should be done in operating room conditions. If the amount of fat to be taken is not large, it can be taken under local anesthesia, but if the amount of fat to be removed and used is high, general anesthesia is required.
Ready-made filling materials, on the other hand, are a process that can be immediately decided and applied instantly, without the need for special preparation of the patient, in office conditions such as botox. In other words, when the patient comes and says to you that I want these areas to be a little fuller, the patient's desire can be fulfilled instantly by using a few packs of ready-made filling materials. However, since general anesthesia may be required in operating room conditions, especially if the amount is high in fat injection, conditions such as pre-operative examination and preparation, fasting and operating room environment are required.
My guidance in my meeting with my patients is as follows; If our patient's complaint is in a position where the area he is complaining about can be handled with 1-2 packs of ready-to-use filling material, after explaining both the fat injection and the ready-made filling material to our patient, I emphasize the practicality of the ready-made filling material again and direct him to the ready-made filling material. However, his own desire may still be fat injection, and in this case, I am starting the preliminary preparations for the procedure. If the areas that our patient wants to be filled are large, that is, if 4-5 packages or more are required as ready-made filling material, it will not be economical to provide these amounts with ready-made filling material. In this case, I direct my patient to fat injection. Because I can provide even more than the amount I will use by taking oil from him, I make oil injections. Thus, instead of opening 5-6 packages of ready-made filling material and an expensive procedure, I take enough fat from one area of our patient and provide injectable material for my patient, while reducing the fat in that area and providing a secondary gain for my patient.
DIFFERENCES AND SIMILARITY BETWEEN OIL INJECTION AND READY FILLER MATERIALS
Fat is not a foreign substance as it is the patient's own tissue. The ready-made filling material, on the other hand, is a foreign substance injection into our body, although there are now very safe filling materials, and therefore fat is a material that can be used more easily.
With fat injection, a certain amount of cells that can live in our body and are permanent are grafted. In fact, it has been shown in studies that some of these cells have stem cell properties. The fact that adipose tissue is a very good source of stem cells has now been accepted, but stem cell isolation from adipose tissue is a laborious and expensive procedure. Unfortunately, some physicians give false information to their patients due to commercial concerns and reflect their procedure as 'stem cell transplantation'.
It is said that the oil injection is done once and stays for a lifetime. This is absolutely not true. Fat injection, like ready-made filling materials, is a process that needs to be repeated at intervals of 6 months - 1 year, and support doses are required. Although there are intense studies on fat injection today, it is a process that cannot be predicted how much of it will survive and be permanent when it is injected, and it should be accepted that half of it can dissolve in a period of 6 months on average.
In fat injection, the patient should know that additional doses will be required at intervals of around 6 months and more than once. Since some living cells will remain in each session, the frequency of fat injection will gradually decrease, the amount given will gradually decrease, but it is not correct to give a clear number of sessions for this. Personal differences emerge.
In ready-made filling materials, since there are no living cells, there will be melting at variable times after providing fullness, and due to these melting, these materials will have to be used again and again.
The patient can give up the procedure at any time, both in the botox process, in the oil filling process, and in the procedures related to ready-made filling materials. When he gives up, he won't get any worse than before.