Permanent Botox: How It Works

Can we stress enough how much we love how Botox keeps us crease-free around the eyes and forehead? That's why we had to share this procedure we just heard about, which is gaining popularity in Brazil. For six years, surgeon Fausto Viterbo, MD, has been developing a permanent alternative to Botox injections for the smoothing of crow's-feet: removing the muscle that causes the wrinkles.

A Sao Paolo surgeon and facial paralysis specialist, Dr. Viterbo first used the technique on patients who suffered from facial spasms, but has since 2000 been offering the technique for cosmetic correction. He removes a small part of the orbital muscle that causes wrinkles. Dr. Viterbo said that blinking and facial expressions are generally unaffected, but the wrinkles disappear. The surgery is performed by making small incisions around the eye, either during facelift procedures or on its own; healing time is approximately one to three weeks.

Commonly performed in the US to treat eye spasms, doctors here do not often remove these muscles for cosmetic purposes. Botox remains the preferred option, and does not carry the risks associated with permanent muscle removal.

The removal of the muscles causing facial wrinkles can indeed be considered a "permanent" manner of generating results similar to those of Botox. However, as in the above discussion of fat injections versus Perlane injections, the invasiveness of such a surgery is its main downside. Part of the beauty of Botox is its lack of side effects and minimal invasiveness, and both advantages that are lost when surgery is performed as an alternative.

Physicians have been slow to embrace this technique in the US in part due to the fact that risks include contour depressions. Furthermore, this surgery is permanent, which can be both an advantage, or a disadvantage (if the result is not pleasing to the patient).

Finally, when the relevant facial muscles are removed, they have a tendency to re-weld themselves, meaning that the surgery has no permanent effect at all. In order to be successful, the surgical removal of muscle must be combined with traditional Botox injections, to prevent the movement and re-welding of the muscles.