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Dr Smith Arayaskul

Everything You Need To Know About Botulinum Toxin

Dr Smith Arayaskul is a dermatologist at Smith Prive’ Aesthetique Clinic with 17 years of experience. We spoke to him about the common questions patients have about botulinum toxin treatments, so read on to find out more!

What is your favourite aesthetic treatment, and why?

My favourite aesthetic treatments are micro-focused ultrasound with visualisation, hyaluronic acid fillers and the pure^ botulinum toxin. I like how they can be used in combination as part of a customised treatment plan based on my patient’s skin type.

Since you’ve mentioned botulinum toxin, how does it work?

Botulinum toxin is commonly used to address dynamic wrinkles in specific facial areas such as horizontal forehead lines, crow’s feet, and frown lines. Recent scientific publications also suggest that botulinum toxin can be used to lift the lower face, as well as injected intradermally to reduce facial redness, oily skin, and pore size for overall skin quality improvement. However, these applications are currently still considered off-label.

Is there a difference between a regular and pure^ botulinum toxin?

Yes, there is a significant difference between the formulations of commercially available botulinum toxin products! Most commercially available botulinum toxin products contain impurities* such as complexing proteins that are not only unnecessary for the treatment effect, but also increase the risk of neutralising antibody formation leading to the development of toxin resistance. This might eventually result in future treatments being less effective than before, or complete loss of response.

The risk of this happening is minimised with the pure^ botulinum toxin with zero impurities*, which has become my product of choice for all botulinum toxin treatments now.

What are the most common treatment areas that are requested by your patients when it comes to botulinum toxin?

In my practice, I emphasise on coming up with hyper-personalised treatment plans. When patients ask for botulinum toxin treatment in different parts of their face, I will make a thorough assessment and tailor a treatment plan for each individual. The most common areas include the glabellar frown lines, forehead lines and crow’s feet.

When is the right time to undergo a botulinum toxin treatment?

I have to say that the right time is when you have sufficient knowledge about the treatment and how it aligns with your beauty needs.

“Do you know exactly what you want?”, “Do you know when you want the procedure to be carried out?”, “Do you have all the right information about the treatment of choice and the area you want to be treated?”, “Have your doctor suggested any alternatives?”, “Do you understand the potential side effects of the treatment?”

I recommend that you speak to an experienced doctor. When you have answers to all these questions and feel confident about proceeding with the treatment, then you know that it is the “right time” for you to do so.

What is the treatment process like?

A standard treatment process in my practice would start with consultation. I want to have a detailed discussion with my patient to understand the issues we are looking to address and what the treatment plan would be .

After that, we will move on to the preparation process which includes facial cleansing and examining other skin issues without their make-up on. Prior to their treatment, I would use a topical anaesthetic cream for better patient comfort during the procedure, instead of applying cold packs directly on the skin to reduce infection risks.

After the treatment, we will place the patient in a recovery waiting room for a final round of cleaning and application of anti-bruising cream.

How soon can one start seeing results after treatment?

My patients typically start seeing results within 2 – 3 days, and it can take up to 2 weeks for the full effect depending on the treatment indication.

As part of the post-treatment routine, I always advise my patients to avoid any form of touching, rubbing or applying pressure on or around the treatment area within the first 24 hours. I would also recommend avoiding any forms of aggressive exercise or alcohol consumption on the first day.

How long does the effect of botulinum toxin last, and how often do patients need to come back for a touch-up?

It depends on the indication and area of treatment. The treatment effects generally last for 4 – 6 months in most patients, but may vary between individuals. Another important factor that might affect the duration of effect is the development of neutralising antibodies against the active component of botulinum toxin. As such, I always choose the pure^ toxin with zero impurities* to minimise my patients’ risk of developing toxin resistance, so that they get optimal results with each and every one of their toxin treatments.

What would your advice be to people who are afraid of the treatment out of fear of looking unnatural?

Looking unnatural, otherwise also known as the “frozen face effect” usually happens when the dosage of botulinum toxin injected is too high, or when the mapping of facial muscles is not done correctly – causing unnatural muscle movement.

I avoid this from happening by proper facial assessment and mapping of the treatment area to ensure that only the target muscles are injected, as well as using an appropriate dose based on the size and strength of the target muscle. Sometimes, it’s also about communicating with my patients that they have to strike a balance between the desire for longer lasting treatment effects with the importance of achieving natural looking results.

How do you assure your patients that botulinum toxin treatments are safe?

I believe in giving my patients as much information as possible, be it informing them about the medication I use, the dosage involved, the expiry dates to even encouraging them to take photos of the manufacturing lot number.

As part of my practice, I also provide all the necessary information both online and also via a physical leaflet of the entire procedure, the protocols, and also potential adverse effects. We also have an online helpline that patients can reach out to any time of the day if they require assistance.

After all, I want my patients to be able to make educated and informed decisions before proceeding with any treatment involving their body and well-being.

Do not be afraid to ask your doctor the right questions!

Do you have any advice for those who are looking to take their first steps on their aesthetic journey?

You should prioritise knowing and understanding your own skin, what concerns you have and what your beauty goals are. Only then, can a good and customised treatment plan be put into place.

Still have unanswered questions? Book an appointment with an experienced aesthetic doctor today to learn more about the pure^ botulinum toxin with zero impurities*.

^Pure: Absence of impurities*
*Impurities: Presence of complexing proteins, inactive neurotoxin, flagellin & bacterial DNA contaminants.1
1 Park JY, et al. Neurotoxin impurities: A Review of threats to Efficacy. Plast Reconstr Surg Glob Open. 2020;8(1):e2627

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