Charleston Muscle Relaxers
These muscle relaxers are a purified form of Botulism Toxin A (BTA) derived from Clostridium Botulinum. Like many substances, when used in small, controlled doses, they provide safe, effective relief for a number of conditions. When BTA is injected into a muscle, it acts as a muscle relaxant and thus indirectly as a wrinkle reducing agent. These medications are commonly injected into the glabellar folds (the area between the eyebrow and where the “angry 11’s” can appear), forehead furrows, crow’s feet and vertical lip lines. They are wonderful for helping you achieve a natural looking younger appearance. Most results take one or two weeks for full effect and last approximately 3-6 months.
Dr. Funcik’s Philosophy and Approach to Muscle Relaxers
Dr. Funcik has personally administered more than $2 million of Botox®, over the course of more than a decade. After Botox® first gained FDA approval in 2002, Dr. Funcik became its top provider in North Carolina, South Carolina, Georgia, and northern Florida, and he has trained more than 100 physicians in its use, from places as far away as Korea.
Dr. Funcik can often be heard saying, “There are as many ways to administer Botox® as there are chili recipes.” While his Botox® “recipe” has evolved greatly over years of experience, his goal remains constant: to help patients attain an outcome that looks natural, while also maximizing their improvement and minimizing their investment of time and money.
The rise in popularity of Botox® among less-experienced providers has given rise to many myths. Some providers claim that it lifts the brow and that by treating certain mysterious, hidden spots, they can use it to magically shape the brow. Many also claim that the more units of Botox® they administer, the longer its effects will last. Still more will argue that ordering Botox® from “Canada” is just as safe as getting it from legitimate suppliers, and that the best way to get a good value on Botox® is to pay the minimum price per unit. And many will also claim that it should be injected directly into lines, or that consistent results occur by using certain landmarks on the brow in relation to the eyebrows. Not one of these myths is true!
Botox® does not “lift” anything. It relaxes muscles. This means that if you were to dunk your face in a bucket of Botox®, your entire face would sag—and if you dunked your body in a bathtub of Botox®, you wouldn’t be able to get out of the tub! The main reason for some of the mystery and confusion concerning Botox® techniques is that most patients (and a surprising number of Botox® providers) do not know the exact anatomy, or even the names, of the muscles in the face. These muscles are not studied in school, they do not appear on the posters of muscles we see in gyms, and unless one knows what to look for, they do not reveal themself on the surface of the skin.
When we think of muscles, we typically think of the muscles of the body that connect one bone to another to pull our skeleton and provide movement. Instead of connecting bone to bone, the muscles of the face connect bone to skin, so they move our facial skin and allow expression.
Lines form on the face in the direction exactly opposite that in which the connecting muscle exerts its pull; therefore, relaxing the muscle relaxes the lines. Injecting Botox® directly into lines is a haphazard (and unfortunately, common) approach. It is not difficult to identify the exact muscle size and location on each patient, once certain observation skills are developed—It does, however, require time and effort to master.
Do you remember the adage that it takes more muscles to frown than to smile? In a sense, it is true, especially as it relates to Botox®, because while there are 4 muscles that depress the brow, only 1 muscle lifts it. That single brow-lifter is responsible for creating horizontal lines. If the lifting muscle is injected, the horizontal lines will be diminished, but you also will be less able to lift your brow.
To avoid an outcome that appears silly, uneven, or unnatural, the treatment of horizontal forehead lines requires skill and strategy. We often see patients who, in the past, have had a bad experience with a heavy or uneven brow. This invariably results when providers treat the lifting muscle too aggressively and fail to effectively relax the depressor muscles. The relatively commonplace nature of this issue becomes especially problematic when one considers that until 2013, the depressor muscle was the only muscle FDA-approved for cosmetic treatment with Botox®, and even now, treating the brow lifter with Botox® is considered an “off-label” use.
Muscles always have some tone or contraction, even while you sleep. For example, I can hold up a patient’s hand and then ask the patient to relax his or her arm. Even if the patient makes an honest attempt to relax the muscles of the arm, when I let go of the patient’s hand, the arm will invariably stay put.
This same concept applies to the muscles that lift and drop the brow. Because the brow-depressor muscles always have some tone, they often cause vertical lines to form between the brows. This is true when you are sleeping, and it occurs to an even greater extent when you are frustrated with traffic, your spouse, or your computer.
We all frown more than we think we do, but even if you do not frown a great deal, your depressor muscle complex is still constantly aiding gravity and pushing your brow lower.
And because no one looks better with a lower brow, the single, most beneficial and natural-appearing benefit you can derive from Botox® is to precisely relax the depressor muscles. By relaxing that muscle alone, your horizontal lines will dissipate over time, and no one will ever really know whether or not you have had Botox®. In addition, you will never have an uneven or heavy brow, and you will spend less on Botox®, because you will only be treating one area.
We do treat the lifting muscle on occasions when it is important to the patient. In deciding whether or not to treat the lifting muscle, it is important to consider and accept the reality that even a single drop of Botox® in the brow-lifter will make you less able to lift your brow. A sensible compromise is to only treat the lifting muscle every other time you treat the depressor, and about 2 weeks after the depressor is relaxed. This schedule preserves as much natural brow motion as possible, with less time spent feeling a little heavy in the brow—and it saves you money.
This is the approach that has now largely (but not completely) caught on in Hollywood, marking the end of a mercifully brief era of frozen-faced movie stars. In time, we will see more and more actors with vertically mobile foreheads, reminding us that, despite what air-brushed photos on magazine covers seem to imply, not every line of expression is a cancer cell or cockroach that must be exterminated. Children look cute and young even with some lines of expression. The same goes for adults.
Botox® treatments generally last about 4 months, but this estimate is rather inconsistent and varies from patient to patient and batch to batch. And while administering more Botox® units increases the degree of relaxation, it does not extend the half-life, because the half-life of Botox® is not dose-dependent. (Think of uranium and carbon: Whether you have a gram or a mountain of the element, it will still lose its radioactivity at the same rate.) But this is counter-intuitive. So when Botox® does not last as long as patients expect, they commonly suspect they were under-dosed. But under-dosing results in inadequate relaxation but does not actually shorten the duration of the effect.
In the US, Botox® can be purchased legally only by licensed physicians and from authorized suppliers. Still, it is not uncommon among some bargain basement providers to purchase Botox® illegally (either knowingly or ignorantly) from “Canadian” websites. In reality, some of this “Canadian” product is actually made by the Russian Mafia in the Middle East, and the bank account is in Grand Cayman! The FDA is too understaffed to control this problem. Beware of knockoffs.
We offer each patient their choice of Botox® or Dysport®. All are fine products. They are all similar in the same way that Coke®, Pepsi®, and RC Cola® are similar. In our office, we have a fairly unanimous bias towards Dysport®, and that is the primary agent we recommend and use, with Botox® coming in at a very close second. Both are wonderful, and you can be assured that Dr. Funcik will work with you to determine the product that’s best for you. If you have a preference for one agent, let us know and we will always abide by your preference. Otherwise we will recommend and administer Dysport®.