Nunca é cedo demais para começar a combater rugas?

Publicado em: 18 de setembro de 2013

Para preservar a pele jovem , considere sim o uso precoce de intervenções dermatológicas de  combate às rugas – e quanto mais cedo , melhor , segundo dois dermatologistas cosméticos americanos, argumentando sobre artigo publicado online na JAMA Dermatologia .

Padrões de linhas faciais  que surgem com o sorriso, durante o início da idade adulta,  predizem quais e onde serão as linhas e rugas permanentes que serão visíveis na expressão facial anos mais tarde. O mesmo é verdade para as linhas do sono, aquelas que aparecem logo cedo ao acordar, marcando linhas causadas pela forma de dormir e apoiar a cabeça.

Dada a progressão inevitável das rugas facias causadas pelas expressões do dias a dia , nunca é “muito cedo ” para considerar neuromoduladores (toxina botulínica), preenchedores, luz pulsada ou tratamento a laser , de acordo com H. K. Hamilton , MD, e Kenneth A. A., MD, de SkinCare Doctors, em Chestnut Hill , Missa

” Se a ação dos músculos de expressão da mímica facial é diminuída e controlada, as rugas faciais que representam envelhecimento, cansaço ou raiva simplesmente não se formarão”, disseram os autores.

” Iniciar o tratamento regular com um neuromodulador (toxina botulínica)  e eventuais preenchedores entre os 20 e 35 anos seguramente trará um efeito dramático sobre a aparência da face quando chegar a idade de 40-50 anos. Nesta idade, portanto, haverão poucas, se houverem , linhas de expressão”.

 

Como um exemplonotório , eles citaram um trabalho científico publicado de irmãs gêmeas idênticas de cerca de 38 anos de idade.
Uma das irmãs  gêmea começou injeções regulares de toxina botulínica na testa e glabela aos 25 anos, a outra  recebeu injeções nas mesmas áreas somente duas vezes ao longo de 7 anos.

Comparação lado-a-lado das duas mostrou nítida diferença e melhora substancial na aparência nas linhas de expressão da irmã que fez uso regular de toxina botulínica desde uma idade precoce, como 25 anos.

Algumas das intervenções anti-envelhecimento da dermatologia estética atual tem comprovados efeitos biológicos, além dos efeitos físicos, como por exemplo:

Alguns preenchimentos como ácido hialurônico na face, mesmo após absorvidos tem induzido o crescimento de novo tecido conjuntivo, novas fibras elásticas e colágenas.
Estudos com ácido hialurónico fora do campo da dermatologia cosmética têm mostrado que a substância está envolvida na sinalização das células , migração e na diferenciação das células mesenquimais e proliferação de fibroblastos.
Laser e tratamentos com Luz Intensa Pulsada  induzem alterações no tecido conjuntivo dérmico que persistem por muito tempo após os efeitos rápido da fonte de energia.

“Similar à nossa defesa para o uso precoce de outras estratégias para evitar ou diminuir a evolução das mudanças relacionadas à idade , tais como protetores solares e retinóides tópicos , o início do uso conservador e ponderado de neuromoduladores , enchimentos, e tratamentos não-invasivos baseados em energia, sozinho ou em combinação, vai manter os pacientes que procuram jovem e saudável a sua pele “, Hamilton e Arndt concluiu. “Então não há realmente raramente um momento que é muito cedo . Talvez a melhor pergunta é : ‘Quando é tarde demais ?

“Eu acredito que você pode prevenir rugas com uma neurotoxina injetado regularmente para evitar as linhas , impedindo o movimento, ” Rhoda Narins , MD, da NYU School of Medicine , em Nova York , disse em um e-mail . “Eu acho que a maioria das cargas também induzir a pele a produzir colágeno simplesmente esticando a pele. Houve artigos escritos sobre o último. ”

” As neurotoxinas são usadas em minha prática para pessoas que têm o movimento muscular muito forte, especialmente na área da glabela , com uma forte história familiar de linhas profundas “, acrescentou . “Estes pacientes são muitas vezes em seus 20 anos. ”

David Song, MD, da Universidade de Chicago, disse que o uso precoce do neuromoduladores e cargas não necessariamente impedir que as linhas de formação , mas não resolver o problema imediato de fortes linhas de expressão .

” Temos, agora, vir a perceber que estas linhas faciais de expressão precoce na idade adulta se traduzem em linhas permanentes , mais tarde, mesmo em repouso , ” Song disse por e-mail . “Então, em essência, o tratamento no adulto jovem de linhas hiperdinâmicos de expressão facial tem mais benefícios duradouros para a vida adulta mais tarde. ”

No entanto , Song discorda da premissa de que nunca é cedo demais para começar tratamentos. “É claro que , fazendo isso em um [ adolescente ] pode ser eticamente repugnante “, disse ele .

Narins e Song tanto ver algumas outras desvantagens potenciais para a utilização precoce de agentes injectáveis, nomeadamente os custos associados com o tratamento regular ao longo de um longo período de tempo. Narins também notou a ausência de dados de longo prazo ea possibilidade de que um paciente vai ficar “over -tratado ” após um período de tempo.

” Em alguns pacientes que você pode atrofiar os músculos em grande medida, de modo que você tem perda de volume , e , é claro, cada tratamento tem sua riscos e potenciais complicações “, disse Song . ” Além disso, a única desvantagem real pode estar no bolso. ”

Fonte primária: JAMA Dermatologia
Referência Fonte: Hamilton HK, Arndt KA “When is ‘too early’ too early to start cosmetic procedures?” JAMA Dermatology 2013; DOI: 10.1001/jamadermatol.2013.5399.

 

Long-Term Effects of Botulinum Toxin Type A (Botox) on Facial LinesA Comparison in Identical Twins
William J. Binder, MD
Arch Facial Plast Surg. 2006;8(6):426-431.
INTRODUCTIONHyperfunctional lines such as horizontal forehead lines, glabellar lines, and crow’s feet can develop from the repeated contractions of certain muscles (the frontalis, procerus, corrugator, and orbicularis oculi muscles). By blocking the release of acetylcholine from the presynaptic terminal of the neuromuscular junction, botulinum toxin type A (Botox; Allergan Inc, Irvine, Calif) can inhibit the contraction of these muscles.Botox is approved by the US Food and Drug Administration for the treatment of glabellar lines, and its efficacy in the treatment of these and other hyperfunctional facial rhytides (eg, horizontal forehead lines and crow’s feet) is well documented. 1-10 Its duration of effect when used for the treatment of glabellar lines is generally at least 3 to 6 months and has been reported to be effective up to 11 months. 6, 11 Furthermore, it appears that repeated treatments can result in a progressively longer duration of action.5 (Note: Dosing and results reported in this study are specific to the formulation of Botox manufactured by Allergan Inc. The Allergan Inc formulation is not interchangeable with other botulinum toxin products and cannot be converted by using a dose ratio.)Most published studies evaluate the efficacy and tolerability of Botox for no more than 1 year, and there are few reports evaluating the clinical benefits of repeated treatments over the course of many years. Nevertheless, patient satisfaction is generally high, and it is likely that many patients will continue treatment for several years. 2, 12-15 Although controlled studies of this duration are impractical, the evaluation of facial lines in identical twins who have had different exposures to Botox can offer insight into the long-term benefits of Botox treatment. This report evaluates the presence of hyperfunctional facial lines in identical twin sisters, one of whom had regular Botox treatment in the forehead and glabellar regions over many years and one of whom did not.
METHODSHyperfunctional facial lines were evaluated in identical 38-year-old twin sisters. The first twin (hereafter, the regularly treated twin) had received Botox injections in the forehead region and the glabellar region approximately 2 to 3 times each year over the past 13 years ( Figure 1). She had also received a total of 2 treatments with Botox in the crow’s feet area in the last 2 years ( Figure 1). She was last treated with Botox more than 4 months before the “at rest” photographs of the forehead, glabellar, and crow’s feet were taken and 7 months before the “when smiling” photographs of the crow’s feet were taken. The other twin (hereafter, the minimally treated twin) received only 2 treatments with Botox, both in the forehead and glabellar regions. The first of these was administered 7 years ago, and the second was administered 3 years ago.
Figure 1. Approximate sites of botulinum toxin type A (Botox; Allergan Inc, Irvine, Calif) injections in the forehead, glabellar, and crow’s feet regions.
RESULTSIn this study, neither twin experienced any adverse effects from Botox.
FOREHEAD AND GLABELLAR LINES
Photographic documentation shows that hyperfunctional forehead and glabellar lines are not evident at rest in the regularly treated twin. In contrast, they are visible in the minimally treated twin (Figure 2 and Figure 3).
Figure 2. The minimally treated twin (images on the left) and the regularly treated twin (images on the right). Hyperfunctional lines in the forehead and glabellar regions are visible in the minimally treated twin but not in the regularly treated twin.
Figure 3. Oblique views of the forehead and glabellar lines that are visible in the minimally treated twin (left side images) but not in the regularly treated twin (right side images). The crow’s feet are also shown at rest.
CROW’S FEET
At rest, there were no marked differences between the twins in terms of crow’s feet (Figure 3). This is not unexpected because the regularly treated twin had started receiving Botox injections in the crow’s feet area only 2 years previously.
When the twins smiled, there was a marked difference between their crow’s feet (Figure 4).
Figure 4. Crow’s feet when smiling are more visible in the minimally treated twin (left side images) than in the regularly treated twin (right side images), even though the crow’s feet of the regularly treated twin had been treated with botulinum toxin type A (Botox; Allergan Inc, Irvine, Calif) only twice in the last 2 years.
NASOLABIAL FOLDS
Neither twin received any Botox injections in the lower half of the face, and the nasolabial folds in the regularly treated twin were at least as noticeable at rest as those in the minimally treated twin (Figure 3). This suggests a generally similar degree of aging in untreated areas of the face in both twins, giving credence to the belief that the differences between the twins in the severity of their forehead and glabellar lines are attributable to the difference in the number of Botox treatments that each received over a long period of time (rather than a greater propensity for skin aging in the minimally treated twin).
COMMENTIt is well known that a single injection of Botox into a target muscle can inhibit a patient’s ability to contract that muscle for several months and so reduce the appearance of facial lines that would have been apparent during active muscle contraction. The results presented herein suggest that long-term treatment can also result in additional benefits and prevent the formation of permanentlines—so-called imprinted lines—that slowly manifest over time as part of normal aging as a result of dermal and epidermal tissue breakdown caused by repeated muscle contractions. This comparison of identical twins (one of whom received regular injections of Botox in the forehead and glabellar region for 13 years and one of whom did not) demonstrates that long-term treatment with Botox can prevent the development of these imprinted facial lines.Once these lines develop, they can be rectified only by using other treatment modalities such as fillers or skin resurfacing techniques. As long-term Botox treatment appears able to dramatically slow, if not halt, this aspect of the aging process, it would also appear able to delay, if not avoid, the need for such treatment.It is likely that long-term treatment with Botox is able to prevent the development of imprinted lines not only by inhibiting the patient’s ability to contract the target muscle but also perhaps through behavioral modification. With long-term treatment, the patient may become used to having little, if any, need or ability to contract the target muscle and may eventually “learn” to avoid even trying to contract it. It is also thought that, by relieving the mechanical pressure of chronic muscle contraction in this way, dermal remodeling may be facilitated. 6

In the regularly treated twin, the clinical effect of Botox was consistently sustained for at least 6 months after each injection, and the duration of effect did not diminish with repeated treatments. The dosage also remained stable over the 13 years of treatment. It has been reported in the literature that, compared with a single treatment, repeated injections may enhance response rates, prolong the duration of action, and lower the incidence of adverse events. 5, 10 If greater or more prolonged efficacy is achieved with continued treatment, this may afford the opportunity to treat patients less frequently or with lower doses.

In conclusion, long-term treatment with Botox can prevent the development of imprinted facial lines that are visible at rest. Botox treatment can also reduce the appearance of crow’s feet. Treatment is well tolerated, with no adverse events reported during 13 years of regular treatment in this study.

AUTHOR INFORMATION

Correspondence: William J. Binder, MD, 120 S Spalding Dr, Suite 340, Beverly Hills, CA 90212-1800 (info@doctorbinder.com ).
Accepted for Publication: June 1, 2006.
Financial Disclosure: Dr Binder is a stockholder of and a consultant to Allergan Inc.
Previous Presentations: This study was presented in part at the Rejuvenation of the Aging Face Course–2006, sponsored by the American Academy of Facial Plastic and Reconstructive Surgery; February 19-23, 2006; Boca Raton, Fla; and as a poster at the 64th Annual Meeting of the American Academy of the Dermatology; March 3-7, 2006; San Francisco, Calif.
Acknowledgment: I am grateful to Gill Shears, PhD, for assistance with the writing of this article.
Author Affiliation: Department of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, Calif.

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5. Carruthers JA, Lowe NJ, Menter MA; et al. A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines. J Am Acad Dermatol. 2002;46:840-849.

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10. Carruthers A, Carruthers J, Lowe NJ; et al. One-year, randomised, multicenter, two-period study of the safety and efficacy of repeated treatments with botulinum toxin type A in patients with glabellar lines. J Clin Res. 2004;7:1-20.

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12. Sommer B, Zschocke I, Bergfeld D; et al. Satisfaction of patients after treatment with botulinum toxin for dynamic facial lines.Dermatol Surg. 2003;29:456-460.

13. Foster JA, Barnhorst D, Papay F, Oh PM, Wulc AE. The use of botulinum A toxin to ameliorate facial kinetic frown lines.Ophthalmology. 1996;103:618-622.

14. Kowalski J, Ravelo A, Saulay M; et al. Patient self-perceptions and satisfaction with botulinum toxin type A treatment for moderate to severe crow’s feet: results from a placebo-controlled clinical study. Poster presented at the Annual Meeting of the American Academy of Dermatology; July 20-24, 2005; Chicago, Ill.

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