Botulinum Toxin

botoxDr. Grassetti explains how to undergo treatment with botulinum toxin for wrinkles in security, assessing costs, aesthetic risks according to brands (Vistabex, Azzalure ..), the price to pay to avoid complications such as lowering eyelid (closed eye), the difference between botox and hyaluronic acid.
Wrinkles are caused by the loss of elasticity of the skin such as age and the long-term effects of muscle contractions during facial expressions. They are also worsened by the Sun and by smoking. There are several methods to counteract these effects. A method blocks the nerve impulses that cause muscle contraction by relaxing certain facial muscles and thus smoothing the skin near the wrinkle relaxing and then acting on the very cause that determines (Botox). Other methods simply fill richiamandovi wrinkle water, obtaining the ‘visual effect of its distension (fillers).
Botulinum toxin is a substance produced by certain bacteria, used in low doses, reduces or eliminates wrinkles, giving the skin of the treated regions a fresher, smoother appearance. In fact, it weakens the corrugator muscles that with their continued contraction determine the ‘onset of wrinkles and furrows.
It should be noted that in Italy is indication to use the product to smooth wrinkles between the eyebrows and the bridge of the nose (the wrinkles of the thinker) and those commonly called “crow’s feet.” Further possible aesthetic effects such as smoothing out wrinkles of the forehead or the corners of the mouth, are “off-label” efettuabili procedures and then only under the direct responsibility shared between Doctor and Patient.


After mapping the injection points according to the clinical situation and the patient’s requests, the doctor performs intramuscular injections with very fine needle. The patient will feel a slight burning of a few seconds, followed by a wheal (swelling) temporary.


In the hours after the treatment, there may be a slight swelling in the treated spots. Bruising may appear lower because of accidental breakage of capillaries. Disappear in a few days and can be masked with makeup.
For at least 2 hours after the treatment you should avoid relax and massage the treated parts, to avoid inopportune product spreads. E ‘it is helpful to actively move the treated muscles to facilitate the’ effect of the toxin!


The treatment effect starts to be visible after 5-10 days. If after 20 days the effect does not appear, given the label of the product used to the Doctor, who will ask you for a refund and replacement of the product.
The effects are reversible and duration from 3 to 6 months, at least the first time.
It should be noted that as a result of ‘infiltration could develop the production of specific antibodies which, although rarely, may limit or even cancel the effect of botulinum toxin administered, resulting in a mild correction or nothing!


Although the product is injected in very specific sites and in certain pre-dose by Dr. Grassetti, sometimes the spread can not be fully controllable being able to determine:
• slight static or dynamic asymmetries species eyebrow level. If necessary it can be corrected by a small follow-up treatment,
• relaxation not want levator muscle of the upper eyelid. Should there be, after two or three days after treatment, it would still be a temporary efect and completely reversible in 10-15 days. A eye drops Apraclonidine (IOPIDINE 5 mg / ml) can be help somministrandone a drop in affected eye before you leave home. It determines the contraction of the muscle of Muller, sincinetico levator muscle of the eyelid and located below this.
• A side effect instead more common is represented instead by a modest frontal headache 2-3 hours after the treatment, the duration of some hours.


It should be avoided in patients with myasthenia gravis, women who are pregnant or breastfeeding, allergic to botulinum toxin and human albumin, subjects treated with aminoglycoside or quinolone antibiotics or with other agents that interfere with neuromuscular transmission (spectinomycin, muscle relaxants tubocurarinici) .
 – Axillary Hyperhidrosis –
This term defines the excessive sweating in the armpit level. This condition that causes embarrassment is actually very easy to treat. There are remedies both medical and surgical. Both are intended to stop the pathophysiological mechanism that causes a localized excessive sweating armpits, without however interrupting the physiological temperature control mechanism of sweating.

Botulinum toxin

Injecting in a completely painless botulinum toxin under the skin of the region to be treated, decreases the stimulation of the sympathetic nervous system (the one active in situations of anxiety, stress, danger, embarrassment, agitation ..) on the sweat glands, which secrete therefore less and more regularly. Dr. Grassetti is co-author of a randomized double-blind study performed in Shanghai and published in the scientific journal of the American Society of Aesthetic Surgery, which shows that the botulinum inhibits not only the production of sweat, but also excess sebum .
The treatment for axillary hyperhidrosis surgery lasts 30 minutes, does not require local anesthesia, it begins to act after a week and should be repeated once or twice a year depending on individual factors.
Contraindications to treatment with botulinum toxin
It should be avoided in patients with myasthenia gravis or who have undergone previous surgery to the armpit, women who are pregnant or breastfeeding, allergic to botulinum toxin and human albumin, subjects treated with aminoglycoside or quinolone antibiotics or with other agents that interfere with neuromuscular transmission (spectinomycin, muscle relaxants tubocurarinici).


There are many more or less invasive methods to block the adrenergic impulses iperstimolano axillary glands to sweat secretion. Most of them are invasive (sympathectomy), or induces against un’ipersudorazione compensatory in other parts of the body like the back, chest and hands.
The most recently used technique is a sort of very superficial liposuction armpits, which mechanically denerva a large part of the sweat glands, resulting in a reduction of 50-70% of the adrenergic sweating or to that which occurs in the agitation or embarrassing moments.
The treatment is performed under local anesthesia with sedation through the microaccessi in the armpit and you can return to normal after 1-2 weeks. During this period must wear a elastocompressiva band to prevent the formation of seromas and swelling; also you have to start 5-6 days after the Physiotherapy and massage to prevent painful scar retractions and “sense of shock” up the arm.
Possible bruising, which resolves completely within 1-2 weeks.


Before undergoing any treatment to cure axillary hyperhidrosis, it is mandatory to exclude all causes that may be secondary to other conditions such as hyperthyroidism, hypoglycemia, obesity, hormonal disorders, antidepressants, pheochromocytoma, spinal cord diseases.