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There has been an explosion in the use of Botulinum toxin to treat facial wrinkles over the last decade.
Not all facial wrinkles can be treated successfully with Botulinum toxin. Facial wrinkles can be caused by many reasons. Most of them associated with ageing but skin damage due to sunlight, cigarette smoke, dehydration, sagging of the muscles and other factors are all important.
Some facial wrinkles are caused by an over-activity of the muscles in the face. Muscles in the face are essential to give us our facial expression. We communicate using smiles, frowns, winks as well as a huge number of other facial expressions. As many actors, actresses and normal people know, these methods of non verbal communication are essential for humans to communicate with one another.
As we get older, sometimes the muscles in the face cause wrinkles in the skin. In young, healthy people with well hydrated skin, the skin always bounces back to its normal shape when the muscles relax. As we get older, the skin loses some of its elasticity and some of its hydration and quite often gets thinner as well. All of these factors allow the muscles to cause permanent wrinkles of the skin.
Paralysing the facial muscles by using Botulinum toxin can, in specific circumstances, allow the muscles to weaken and therefore not pull on the skin so hard. This can often allow the wrinkle to smooth out and sometimes disappear.
Cosmetically this can produce a very pleasing result. However if the muscle is completely paralysed, it can mean that area of the face does not move at all and can destroy some of the non-verbal communication.
This is often used for the lines on the forehead. In the UK there has now been a licence granted for the use of Botulinum toxin for "glabellar" lines - these are the vertical lines (usually one or two) at the top of the nose between the eyebrows that appear when someone frowns. These can be very effectively treated by Botulinum toxin in a large number of patients. However if a large amount of Botulinum toxin is used, although this area can be smoothed or even flattened, it can mean that the ability to frown is impaired.
There have been stories that parents who have this treatment and get cross with their children can confuse their children as the non-verbal communication of the frown, i.e. the wrinkled forehead, is not present despite the parent telling the child off with their voice in stern tones. This can lead to some confusion. There are many other instances why non-verbal communication is impaired after such treatments.
Hence a balance must always be struck between the improvement in the cosmetic look of the face versus the reduction in the facial expressions and non-verbal communication produced as a consequence.
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