Where and how to use botulinum toxin on the face and neck – Indications and techniques

Botulinum toxin (BT) is a proteinaceous substance that is derived from the bacterium Clostridium botulinum. It was initially used for the treatment of strabismus by Dr. Alan Scott in the late 1970s after which, it was regularly being used for the cosmetic correction of benign essential blepharospasm by the Carruthers couple. Jean Carruthers while treating one such patient noticed an improvement in the glabellar furrows with an effect on the brow of the patient as well. By the late 1980s through the 1990s, BT was used rampantly as an off-label indication to treat glabellar frown lines. In 2002, the US Food and Drug Administration approved the use of BT type A for the treatment of glabellar furrows. This changed the global scene of facial rejuvenation, heralding a new era. Ever since then, BT has proved to be effective and safe for the treatment of dynamic facial rhytides and is currently being used for various indications. These indications and techniques have evolved with a better understanding of the face and neck musculature and their interactions and actions as well as efficacy of the BT formulations. The authors present an overview of the various cosmetic indications of BT for the face and neck along with the approach to injection techniques for various muscle groups involved.

A ROLE OF AYURVEDIC MANAEGEMENT IN BLEPHAROSPASM w.s.r. NIMESHA - A CASE STUDY

Ayurveda can provide effective and harmless relief for certain diseases which sometimes can’t be cured with modern medicine. Nimesha is a condition, pertaining to Shalakya Tantra in which eye lids starts blinking involun- tary due to influence of Vata Dosha. In this condition patients can’t be able to focus things properly and having lots of discomfort. It can be correlated to blepharospasm i.e., an abnormal contraction of eye lid muscles, which is also refers to benign essential blepharospasm. It is thought to be rare, affecting about 16–133 cases per million. There is no cure for blepharospasm in modern practice. Generally, doctors inject botox injection into eyelid mus- cles which need to get injected in every 4-6 month, rather than permanent benefits it has lots of side effects like diplopia ectropion etc. Ayurveda can be useful in the treatment of blepharospasm and its complication that it is a Vataj Vyadhi all Vatashamak therapies could be effective for its treatment. A 61 years old male patient known case of bilateral blepharospasm was visited in OPD of Government Autonomous Dhanwantari Ayurveda Hospi- tal, Ujjain. He had complained of excessive blinking with tired eye muscles, heaviness around eyes, headache, anxiety and irritation etc. for 3 years. He was on regular allopathic medicine along with botox injection around each eye which is repeated in every 6 months, but after few shots of treatment pt. didn’t receive any benefits.Therefore, he came to us and after Ayurvedic treatment patient showed marked improvement in symptomatology, with limited abnormal eye lid movement and with negligible side effects. Here was 70% relief after Ayurvedic treatment. Keyword: Ayurveda, Nimesha, Blepharospasm, Botox